Exercise- and Nutrition-Based Prehabilitation Programs in Surgery: A Systematic Review and Meta-Analysis

BACKGROUND: Exercise- and nutrition-based prehabilitation programs are promising emerging strategies for enhancing surgical recovery. However, earlier studies have reported mixed findings about their impact on postoperative outcomes. The purpose of this study is to investigate the efficacy of exercise- and nutrition-based prehabilitation on postoperative outcomes, including length of stay (LOS), complications, quality of life (QoL), pain, and mental health. STUDY DESIGN: A systematic review and meta-analysis was conducted, using Medline, Cochrane Central, EMBASE, and Web of Science, following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Studies published between 2004 and 2024 were identified with search terms including "prehabilitation," "exercise," "nutrition," and "surgery." Eligible studies (n = 293) were randomized controlled trials (RCTs) evaluating exercise or nutrition-based prehabilitation programs and reporting LOS and complications as primary outcomes. Secondary outcomes included QoL, pain, and mental health scores. Random-effects meta-analyses estimated pooled effect sizes. RESULTS: Twenty-three RCTs were included (2,182 participants). Exercise or nutrition-based prehabilitation reduced complications (odds ratio 0.52. 95% CI 0.35 to 0.78, p < 0.002, I2 = 47.1%) and LOS (mean difference [MD] -0.44 days, 95% CI -0.78 to -0.11, p = 0.01, I2 = 44.8%) compared with standard treatment. When comparing interventions, nutrition only had a greater reduction in LOS than exercise only (MD -1.09 days, 95% CI -1.72 to -0.47 vs MD -0.20 days, 95% CI -0.51 to 0.09; p = 0.01). Although QoL was not reported in nutrition-only RCTs, exercise alone improved QoL measures (standardized MD 0.94, 95% CI 0.24 to 1.64, p = 0.01, I2 = 93.6%) compared with standard treatment. CONCLUSIONS: Exercise or nutrition-based prehabilitation programs reduce LOS and complications across multiple surgical contexts. Further work is needed to elucidate the effects of different intervention protocols on postoperative outcomes.