New Hope for Surgical Recovery in Older Adults
As the population ages, the medical community is increasingly focused on strategies to improve recovery after major elective surgeries. A new pilot study published in the Journal of the American Geriatrics Society explored a multicomponent prehabilitation program designed for older adults. This program combines physical therapy, nutrition optimization, and mindset or psychological support in the weeks leading up to surgery. The researchers aimed to determine whether such a program is feasible to deliver in a tight three-to-four-week window and whether it might improve postoperative outcomes.
What the study did
Officially titled “Multi-Component Prehabilitation Program for Older Adults Undergoing Major Elective Surgery: A Pilot and Feasibility Study,” the research enrolled older adults scheduled for major elective procedures. Participants who completed the intervention showed notable, though preliminary, improvements in several key areas of functional performance after surgery:
- Postoperative walking speed increased by 0.2 meters per second.
- Time to complete five chair stands, a standard test of lower body strength, decreased by 3.4 seconds.
- Patient-reported physical function scores improved by about 4.4 points at 90 days post-surgery compared with baseline.
These changes suggest that even modest gains in walking speed, strength, and self-reported function can translate into better independence and potentially fewer complications during recovery.
Feasibility: Can this be done before surgery?
The study’s primary contribution is its demonstration that a coordinated, multicomponent program can be delivered within the typical preoperative window of three to four weeks. This is important because most older adults face time constraints before planned procedures, making complex prehabilitation seem impractical. The researchers reported that participants who completed the program were able to adhere to the plan, indicating the approach is feasible in real-world clinical settings.
However, the authors cautioned that scaling up would require systematic changes in routine care. In particular, they noted a lack of a coordinated system to connect patients with physical therapists and dietitians promptly before surgery. Without streamlined access to these professionals, the full potential of prehabilitation may not be realized on a broad scale.
Why this matters for older patients
Older adults often face disproportionate challenges after major surgery, not solely due to age but because of diminished physical reserve and nutritional status entering the procedure. This study suggests that a proactive, multicomponent approach—training the body through exercise, optimizing nutrition, and addressing mental health or anxiety—can help patients recover more fully. The observed improvements in walking speed, chair stands, and perceived physical function are meaningful in daily life, potentially enabling greater independence and reducing the risk of postoperative complications.
Expert perspective
Speaking about the implications, co-investigator Dr. Dae Hyun Kim emphasized that prehabilitation could become a valuable option for older adults facing surgery. “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,” Kim stated. He also cautioned that while the early results are encouraging, more extensive research is needed to confirm the benefits and determine which components are most effective.
Next steps for research and care pathways
The study authors acknowledge that larger trials are necessary to compare multicomponent prehabilitation with usual care and to identify which patient groups stand to benefit the most. They also call for health system innovations that enable timely access to preoperative services, integration of nutrition and mental health support, and better coordination among surgeons, primary care providers, and rehabilitation professionals.
In the meantime, clinicians and patients can take away a practical message: preparing the body and mind before major surgery—through supervised exercise, optimized nutrition, and psychological preparation—has the potential to improve postoperative recovery. As the population ages, such proactive approaches may become an important part of standard preoperative care.
Bottom line
The pilot study demonstrates feasibility for a three-to-four-week prehabilitation program in older adults undergoing major elective surgery and provides encouraging signals that modest improvements in physical function may accompany better recovery trajectories. The road to widespread adoption will require improved access and coordination, but the evidence to date suggests that such programs are worth pursuing as part of comprehensive perioperative care.
