Overview
A new pilot study published in the Journal of the American Geriatrics Society explored a multicomponent prehabilitation program for older adults facing major elective surgery. The program combines physical therapy, nutrition optimization, and mindset support in the weeks leading up to surgery. The researchers found that delivering this program in a short three- to four-week window is feasible and holds promise for improving postoperative outcomes.
The Intervention
The prehabilitation model studied was multi-component, integrating three core elements: structured exercise with a physical therapist, targeted nutrition guidance, and psychological or mindset support designed to reduce anxiety and build resilience before surgery. This combination aimed to bolster physical function, strength, and overall well-being before the stress of surgery, potentially reducing recovery time and complications afterward.
Key Findings
Among participants who completed the intervention, the study observed several notable improvements following surgery: walking speed increased by 0.2 meters per second, and the time to complete five chair stands—a standard assessment of lower-body strength in older adults—decreased by 3.4 seconds. Additionally, patient-reported physical function scores rose by about 4.4 points at 90 days post-surgery relative to baseline. These measures suggest meaningful, though modest, gains in physical function and independence for older adults undergoing major procedures.
Feasibility and Practicality
The study’s main takeaway is feasibility: delivering a multicomponent prehabilitation program within a brief pre-surgical window is achievable and acceptable to patients. However, researchers emphasized practical barriers that could hinder real-world adoption. A lack of a coordinated system to facilitate timely access to physical therapists and dietitians before surgery in routine care emerged as a significant obstacle. Streamlining referrals, creating integrated care pathways, and ensuring adequate reimbursement will be key to translating these findings into broader practice.
Why This Matters
Older adults often emerge from major surgery weaker, slower, or less able to perform daily tasks. This study adds to growing evidence that preparing the body and mind before surgery can impact recovery trajectories. Even modest improvements in walking speed, strength, and functional tasks can translate into greater independence and a lower risk of postoperative complications. The authors stress that the observed benefits, while encouraging, need confirmation in larger trials, but the potential value of prehabilitation is clear: better outcomes may be achievable with targeted preoperative preparation.
Expert Insights
“If you are an older adult scheduled for major surgery, this study suggests that to help you recover more fully, you and your medical team may consider exercising with a trainer or physical therapist, optimizing your nutrition, addressing anxiety or mood, and building strength,” commented Dae Hyun Kim, MD, MPH, ScD, associate director and senior scientist with the Marcus Institute for Aging Research. He added that more research is needed, but early evidence points toward meaningful benefits when mind and body are jointly prepared before surgery.
Next Steps in Research
The authors call for larger, controlled studies to compare multicomponent prehabilitation directly against usual care. Such trials would help determine the true effect size of prehabilitation on postoperative outcomes, identify which components drive benefit most, and clarify how to best integrate these programs into standard surgical pathways. Until then, the pilot results offer a hopeful signal that proactive, comprehensive prep can improve recovery for older adults facing major surgery.
