Exercise-based prehabilitation programs reduce hospital stay and postoperative complications in surgical patients with cancer: a systematic review and meta-analysis

Objectives To evaluate the effectiveness of exercise-based prehabilitation program on hospital length of stay and postoperative complications in patients with cancer undergoing surgery, and to identify which intervention characteristics are associated with greater reductions in postoperative morbidity. Data source A systematic search was conducted in PubMed and Web of Science from inception to June 2026. Study selection After eligibility assessment, 152 articles were reviewed in full, and 55 randomized controlled trials were included in the meta-analyses. Outcomes measures Hospital length of stay (HLOS) and postoperative complications including overall (i.e., any deviation from the normal postoperative course), major and minor complications, comprehensive complication index, pulmonary complications, pneumonias and readmissions. Results Exercise-based prehabilitation programs significantly reduced HLOS in the overall analysis (d = -0.21, approximately -0.79 days), although heterogeneity was substantial (I 2 =85%). In stratified analyses, HLOS was significantly reduced in gastrointestinal cancers, whereas non-significant reductions were noted in thoracic and genitourinary cancers. Overall postoperative complications were reduced in the overall analysis (RR = 0.82, I 2 =46%), with significant reductions observed in gastrointestinal and thoracic cancers. Postoperative pulmonary complications and pneumonias were also decreased (RR = 0.69 and 0.59; respectively). Moderator analyses indicated that larger effects were observed in studies including a higher proportion of women and older patients, and in supervised multidisciplinary aerobic or concurrent training programs. Conclusion Exercise-based prehabilitation programs are effective in reducing HLOS and postoperative complications in patients undergoing cancer surgery, with larger effects observed in women and older patients. Implementing supervised, multidisciplinary aerobic or concurrent training prehabilitation may serve as promising strategies to maximize postoperative recovery.