Overview: A Multicomponent Prehabilitation Approach
A recent pilot and feasibility study published in the Journal of the American Geriatrics Society explored whether a prehabilitation program—combining physical therapy, nutrition guidance, and mindset support—could be feasibly delivered in the weeks leading up to major elective surgery for older adults. The goal was not only to prepare the body for surgery but also to support a smoother, quicker recovery in the weeks and months afterward.
The study, titled Multi-Component Prehabilitation Program for Older Adults Undergoing Major Elective Surgery: A Pilot and Feasibility Study, enrolled participants who were slated for major elective procedures and completed the intervention within a short, three- to four-week window before their operation. The team assessed physical performance, functional status, and patient-reported outcomes to gauge potential benefits.
Key Findings: Measurable Gains Before and After Surgery
Among participants who finished the program, several objective and patient-reported improvements emerged:
- Postoperative walking speed increased by 0.2 meters per second, a meaningful gain in mobility that can influence independence and activity levels after discharge.
- Time to complete the five-chair stands test, a standard measure of lower-body strength in older adults, decreased by 3.4 seconds, signaling improved functional performance relevant to daily activities.
- Patient-reported physical function scores rose by about 4.4 points at 90 days post-surgery compared with baseline, indicating a steady trajectory of recovery reported by participants themselves.
These results, while preliminary, point to the potential of a structured, multicomponent approach to bolster resilience before surgery and help patients regain function more quickly afterward.
Why This Matters: Implications for Older Adults
Older adults often face a higher risk of postoperative weakness, slower mobility, and extended recovery periods. The prehabilitation concept aims to improve the body’s readiness for the stress of surgery by optimizing three domains: physical conditioning, nutrition, and mental well-being. As the authors note, even modest improvements in speed, strength, and perceived function can translate into greater independence and fewer complications after surgery.
In the study, the authors emphasized that the gains occurred within a tight three- to four-week preoperative window, underscoring the feasibility of delivering such a program in real-world clinical timelines. Dr. Dae Hyun Kim, associate director and senior scientist at Hebrew SeniorLife, described the findings as encouraging: the intervention was doable in the available time, and participants could complete it with demonstrable benefits.
Feasibility and Barriers to Widespread Adoption
Despite promising results, the researchers cautioned about challenges that could limit broader implementation. Foremost is the need for a coordinated system that ensures timely access to physical therapists, dietitians, and other professionals before surgery. Unlike elective programs in some centers, routine care does not always provide a streamlined pathway to preoperative optimization. This gap can hinder scaling the approach to larger patient populations.
Kim stressed that the study does not claim superiority over usual care, but it does indicate potential added value. He suggested that if healthcare teams can create logistics for rapid enrollment and multidisciplinary collaboration, more older adults could benefit from prehabilitation programs as part of standard surgical care.
Future Directions: What Comes Next?
The study authors advocate for larger, randomized trials to compare multicomponent prehabilitation with usual care, and to better quantify which elements drive the most benefit. They also call for health systems to develop smoother referral pathways, standardized protocols, and reimbursement models that support prehabilitation as a routine preoperative service.
Expert Perspective
“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,” Dr. Kim remarked. “While more research is needed, this early evidence points to the potential value of preparing both body and mind before surgery.”
Bottom Line
The Multi-Component Prehabilitation Program demonstrates that a three- to four-week preoperative regimen combining physical activity, nutrition optimization, and psychological support is feasible and can yield meaningful improvements in mobility, strength, and perceived function. As healthcare systems explore ways to enhance recovery for older adults, such prehabilitation strategies may become a valuable component of perioperative care if access barriers can be addressed in routine practice.
