# Prehabilitation before cancer surgery

Source: https://onco.cc/technologies/prehabilitation/  
OnCo record `prehabilitation` (Technology). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Prehabilitation is a few weeks of structured exercise, nutrition and psychological preparation between diagnosis and surgery to make patients fitter for the operation and speed recovery.

## Summary

Multimodal prehabilitation (aerobic and resistance exercise, protein supplementation, anxiety reduction, smoking and alcohol cessation, anaemia correction) uses the 4-8 week pre-operative window. Randomised trials in colorectal (PREHAB, JAMA Surg 2023: fewer severe complications), oesophago-gastric, lung (PREPARE) and hepatobiliary surgery show improved functional capacity (6-minute walk) and, in some, fewer complications and shorter stay, though results are heterogeneous and the largest trials are recent. It complements Enhanced Recovery After Surgery (ERAS) pathways and geriatric assessment; NHS England has a national prehabilitation programme with Macmillan.

## Fields

- Kind: Technology
- Status: emerging
- Last checked: 2026-09-08
- Tags: gap-fill; supportive
- Principle: Exploit the pre-operative window to raise physiological reserve so patients start from a higher baseline and return to it faster; interventions are supervised or home-based and targeted to measured deficits.
- Since: 2010
- Strengths: Fewer complications and faster functional recovery in several RCTs; Low cost and low risk; Engages patients at a motivated moment
- Limitations: Neoadjuvant therapy shortens or complicates the window; Evidence heterogeneous; optimal dose unclear; Requires programme infrastructure

## Notes

- Before a Whipple operation: Pancreatic Cancer UK says some hospitals offer prehabilitation focused on diet and physical activity to help you recover faster; Macmillan says stopping smoking lowers the risk of a chest infection and helps the wound heal, and that some hospitals run an enhanced recovery programme.
- Before bowel cancer surgery: Bowel Cancer UK says prehabilitation aims to improve physical and emotional health before treatment and may involve a dietitian, a physiotherapist, an occupational therapist and a counsellor or psychologist, and that the evidence shows it reduces anxiety, improves fitness and can shorten the time in hospital. It may be offered as part of an enhanced recovery programme, which aims to help the bowel start working sooner after the operation.
- Lymphoma: Lymphoma Action publishes material on getting ready for treatment, which in a disease often treated within days of diagnosis means the few things that can be done in that window rather than a programme of weeks: the fertility referral, the dental check, the vaccinations that can be given before immunosuppression starts, and arranging the practical and financial side before the first cycle.

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Prehabilitation
- PREHAB trial (JAMA Surg 2023): https://doi.org/10.1001/jamasurg.2023.0198
- Macmillan prehabilitation guidance: https://www.macmillan.org.uk/healthcare-professionals/news-and-resources/guides/principles-and-guidance-for-prehabilitation
- Pancreatic Cancer UK: who can have surgery for pancreatic cancer?: https://www.pancreaticcancer.org.uk/information-and-support/treatments-for-pancreatic-cancer/surgery-for-pancreatic-cancer/who-can-have-surgery/
- Macmillan: surgery for pancreatic cancer, before and after: https://www.macmillan.org.uk/cancer-information-and-support/treatments-and-drugs/surgery-for-pancreatic-cancer
- Cancer Research UK: prehabilitation: https://www.cancerresearchuk.org/about-cancer/treatment/prehabilitation
- Bowel Cancer UK: prehabilitation, preparing for treatment: https://www.bowelcanceruk.org.uk/about-bowel-cancer/treatment/prehabilitation/
- Macmillan: preparing for bowel cancer treatment: https://www.macmillan.org.uk/cancer-information-and-support/bowel-cancer/preparing-for-bowel-cancer-surgery
- Lymphoma Action: getting ready for treatment (prehabilitation): https://lymphoma-action.org.uk/information-and-support/lymphoma-treatment/getting-ready-treatment-prehabilitation
- Lymphoma Action: exercise and lymphoma: https://lymphoma-action.org.uk/information-and-support/living-and-beyond-lymphoma/exercise-and-lymphoma

## Connected records

- cancers: [Advanced-stage classical Hodgkin lymphoma (stage III to IV)](https://onco.cc/cancers/advanced-stage-classical-hodgkin-lymphoma/), [Breast cancer (all types)](https://onco.cc/cancers/breast-cancer/), [Burkitt lymphoma](https://onco.cc/cancers/burkitt-lymphoma/), [Colorectal cancer](https://onco.cc/cancers/colorectal/), [Cutaneous T-cell lymphoma (mycosis fungoides and Sezary syndrome)](https://onco.cc/cancers/cutaneous-t-cell-lymphoma/), [Diffuse large B-cell lymphoma](https://onco.cc/cancers/dlbcl/), [Early-stage classical Hodgkin lymphoma (stage I to II)](https://onco.cc/cancers/early-stage-classical-hodgkin-lymphoma/), [Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma)](https://onco.cc/cancers/malt-lymphoma/), [Follicular lymphoma](https://onco.cc/cancers/follicular-lymphoma/), [Hodgkin lymphoma](https://onco.cc/cancers/hodgkin-lymphoma/), [Lung cancer (all types)](https://onco.cc/cancers/lung-cancer/), [Mantle cell lymphoma](https://onco.cc/cancers/mantle-cell-lymphoma/), [Marginal zone lymphoma](https://onco.cc/cancers/marginal-zone-lymphoma/), [Nodal marginal zone lymphoma](https://onco.cc/cancers/nodal-marginal-zone-lymphoma/), [Nodal T-follicular helper cell lymphoma, angioimmunoblastic type (angioimmunoblastic T-cell lymphoma)](https://onco.cc/cancers/angioimmunoblastic-t-cell-lymphoma/), [Nodular lymphocyte-predominant Hodgkin lymphoma (nodular lymphocyte-predominant B-cell lymphoma)](https://onco.cc/cancers/nodular-lymphocyte-predominant-hodgkin-lymphoma/), [Non-Hodgkin lymphoma (all types)](https://onco.cc/cancers/non-hodgkin-lymphoma/), [Non-small-cell lung cancer](https://onco.cc/cancers/nsclc/), [Oesophageal cancer](https://onco.cc/cancers/esophageal/), [Pancreatic ductal adenocarcinoma](https://onco.cc/cancers/pancreatic/), [Peripheral T-cell lymphomas (including cutaneous T-cell lymphoma)](https://onco.cc/cancers/peripheral-t-cell-lymphoma/), [Primary CNS lymphoma](https://onco.cc/cancers/primary-cns-lymphoma/), [Primary mediastinal (thymic) large B-cell lymphoma](https://onco.cc/cancers/primary-mediastinal-b-cell-lymphoma/), [Prostate cancer](https://onco.cc/cancers/prostate/), [Relapsed and refractory classical Hodgkin lymphoma](https://onco.cc/cancers/relapsed-refractory-hodgkin-lymphoma/), [Sezary syndrome](https://onco.cc/cancers/sezary-syndrome/), [Splenic marginal zone lymphoma](https://onco.cc/cancers/splenic-marginal-zone-lymphoma/), [Triple-negative breast cancer (TNBC)](https://onco.cc/cancers/tnbc/), [Waldenström macroglobulinaemia](https://onco.cc/cancers/waldenstrom/)
- fronts: [Diet, Exercise & Lifestyle](https://onco.cc/fronts/nutrition-lifestyle/), [Recovery & Rejuvenation](https://onco.cc/fronts/rejuvenation/), [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/), [Surgery & Interventional](https://onco.cc/fronts/surgery/)
- technologies: [Cardiopulmonary exercise testing: the hardest number in recovery](https://onco.cc/technologies/rejuv-measure-cardiopulmonary-exercise-testing/), [Enhanced recovery (ERAS) and perioperative nutrition](https://onco.cc/technologies/eras-perioperative-nutrition/), [Exercise & lifestyle oncology](https://onco.cc/technologies/exercise-oncology/), [Exercise is the best-evidenced thing on this front, and most survivors are not doing it](https://onco.cc/technologies/rejuv-access-exercise-programmes/), [Frailty and late effects in survivors](https://onco.cc/technologies/rejuv-age-frailty-and-late-effects/), [Geriatric assessment](https://onco.cc/technologies/geriatric-assessment/), [Immunonutrition before cancer surgery](https://onco.cc/technologies/immunonutrition-perioperative/), [Muscle and strength after treatment: sarcopenia, cachexia and what rebuilds](https://onco.cc/technologies/muscle-recovery-after-cancer-treatment/), [Nutrition support and cachexia management](https://onco.cc/technologies/oncology-nutrition/), [Referral to rehabilitation: the service most people who need it never see](https://onco.cc/technologies/rejuv-access-rehabilitation-referral/), [Robotic & minimally invasive surgery](https://onco.cc/technologies/robotic-surgery/), [The exercise prescription after cancer: the dose the guidelines state](https://onco.cc/technologies/exercise-prescription-after-cancer/), [Walking, gripping and standing up: the tests that take five minutes](https://onco.cc/technologies/rejuv-measure-functional-tests/), [What a prehabilitation programme actually contains, and how long it needs](https://onco.cc/technologies/rejuv-rehab-prehabilitation-programme/), [What actually works after treatment](https://onco.cc/technologies/rejuv-frontier-what-works/), [What the randomised trials of prehabilitation found, operation by operation](https://onco.cc/technologies/rejuv-rehab-prehabilitation-evidence/)
- key papers: [Effect of Multimodal Prehabilitation on Reducing Postoperative Complications and Enhancing Functional Capacity Following Colorectal Cancer Surgery: The PREHAB Randomized Clinical Trial](https://onco.cc/key-papers/paper-molenaar-jama-surg/)
- terms: [Prehabilitation (the pre-treatment window)](https://onco.cc/terms/prehabilitation-term/), [Surgical morbidity and postoperative complications](https://onco.cc/terms/surgical-morbidity/)
- trials: [PREHAB: multimodal prehabilitation before colorectal cancer surgery](https://onco.cc/trials/prehab-trial/)
- bottlenecks: [Rehabilitation is recommended everywhere and commissioned almost nowhere](https://onco.cc/bottlenecks/rejuv-agenda-rehabilitation-not-commissioned/)
- roadmaps: [Diet, exercise and lifestyle roadmap: causes established → interventions that disappointed → exercise proven as treatment](https://onco.cc/roadmaps/nutrition-lifestyle-roadmap/), [Recovery and rejuvenation roadmap: cure is not enough → survivorship gets a name → the cohorts that measured the cost → exercise proven as treatment → biological ageing measured and sold → repair, if anyone funds it](https://onco.cc/roadmaps/rejuvenation-roadmap/), [Supportive care and survivorship roadmap: making treatment bearable → proving it extends life → caring for tens of millions afterwards](https://onco.cc/roadmaps/survivorship-roadmap/), [Surgery roadmap: radical operations → less surgery → no surgery when a drug has done the work](https://onco.cc/roadmaps/surgery-roadmap/)

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