Prehabilitation Before Cancer Treatment

Prehabilitation means getting your body and mind ready in the weeks before cancer treatment, most often before surgery. This page explains what a program includes, what the research found, and why the studies disagree.

The strongest single trial of this idea spelled out its program precisely. That makes it a good starting definition. The PREHAB randomized clinical trial was published in JAMA Surgery in 2023. It tested a 4-week in-hospital supervised multimodal prehabilitation program. That program had four parts.

• A high-intensity exercise program, 3 times per week.
• A nutrition plan.
• Support for mood and stress.
• A smoking cessation program, where needed.

That is what "multimodal" means. Not exercise alone. Exercise, plus nutrition, plus psychological support. Plus help quitting smoking where that applies. All of it packed into the weeks before an operation.

PREHAB was an international, multicenter trial. It ran in teaching hospitals that already had enhanced recovery after surgery programs. Adults with non-metastasized colorectal cancer were randomized to prehabilitation or standard care. Both groups received standard care around the time of surgery (perioperative care). Enrollment ran from June 2017 to December 2020. Follow-up finished in December 2021. One caveat sits in the record. The trial was stopped early because of the COVID-19 pandemic.

The main analysis included 251 participants (the intention-to-treat population). Median age was 69, and 55% were male. Tumors were in the colon in 206 of them. And 234 had laparoscopic or robotic-assisted surgery.

The primary complication measure was the Comprehensive Complication Index. The trial counted how many people scored above 20 on it. That is a threshold for severe complications.

• Severe complications were significantly less common with prehabilitation. The figures were 21 of 123 people (17.1%) against 38 of 128 (29.7%). Odds ratio 0.47, 95% confidence interval 0.26 to 0.87, P = .02.
• Medical complications, such as lung problems, were also fewer. The figures were 19 of 123 (15.4%) against 35 of 128 (27.3%). Odds ratio 0.48, 95% confidence interval 0.26 to 0.89, P = .02.
• Walking capacity did not separate. Four weeks after surgery, the 6-minute walking distance did not differ significantly between groups. That comparison was against baseline. The mean difference favoring prehabilitation was 15.6 meters, 95% confidence interval minus 1.4 to 32.6, P = .07.

That third point matters as much as the first two. The trial's own functional measure did not reach significance. Other measures of physical function did tend to favor prehabilitation. The authors concluded the program showed benefit. They pointed to fewer severe and medical complications, and a better recovery.

So the honest summary of PREHAB is narrow and real: fewer severe complications, no clear gain in measured walking distance at 4 weeks.

This is where anyone reading about prehabilitation should slow down. The published syntheses disagree.

A 2025 systematic review and meta-analysis appeared in the Journal of the American Geriatrics Society. It pooled 14 articles covering 2,314 patients who had colorectal cancer surgery. Set against control groups, the programs cut three outcomes significantly.

• Length of hospital stay, by a mean of 2.47 days (95% CI minus 3.56 to minus 1.39).
• Postoperative complication rate, odds ratio 0.74 (95% CI 0.59 to 0.94).
• Time to first passage of flatus, by a mean of 0.43 days (95% CI minus 0.66 to minus 0.20). That is an early marker of bowel function returning.

Its conclusion was clear. This kind of program before colorectal cancer surgery cuts hospital stay. It lowers complication rates, and it speeds bowel recovery. The effect was strongest in older people.

A 2024 systematic review and meta-analysis in Annals of Coloproctology reached the opposite conclusion. It drew on a smaller pool: 7 studies covering 1,042 colorectal cancer patients, 382 of whom had prehabilitation. It found no significant differences in outcomes during surgery. Complication rates after surgery were comparable too. For Clavien-Dindo grades I and II, the risk ratio was 0.82 (95% CI 0.62 to 1.07, P = .15). For grades III and above, it was 1.02 (95% CI 0.72 to 1.44, P = .92). There were no significant differences in length of hospital stay (P = .21). Nor in 30-day readmission risk (P = .68).

Its authors were candid about why. Prehabilitation did not appear to improve short-term outcomes. But the quality of evidence is weakened by limited trials, and by heterogeneity. So larger studies are needed before firm conclusions.

Heterogeneity is the operative word. The 2025 review said as much at the outset. Clear definitions of the modality, content, and duration of prehabilitation are lacking. Two studies both called "prehabilitation" may share almost nothing beyond the label.

It does not mean the idea is worthless. It means three specific things.

First, the outcome that has held up best is complications, not fitness scores. Prehabilitation is studied as a way to reduce what goes wrong after an operation. It is not studied as a way to arrive at surgery visibly fitter.

Second, most of the evidence sits in colorectal cancer surgery. That is where the trials and the meta-analyses are. Stretching these numbers to a different operation is a guess, not a finding. The same goes for stretching them to chemotherapy rather than surgery.

Third, the programs that produced positive results were supervised and specific. PREHAB ran 4 weeks. It used three high-intensity sessions a week, in hospital. Nutrition and psychological support came with it. General encouragement to walk more is not the same thing.

The waiting period between diagnosis and surgery is the window. It is usually short. So asking early matters more here than for almost any other supportive measure.

• How many weeks are there before surgery, and is that long enough for a structured program?
• Does this center run a formal prehabilitation program, and does it include nutrition and psychological support, or exercise only?
• If there is no program, can a referral to physical therapy and a nutrition consult be made now rather than after surgery?
• Is smoking cessation support available, given that it was a component of the trial program?
• What is my baseline functional capacity, and will it be measured so change can be tracked?
• Would starting a program delay surgery? If so, is that trade-off acceptable for this cancer?

That last question has no general answer. Waiting weeks to prepare is reasonable for some cancers and not for others. It depends on how fast the specific disease is expected to move.

Related pages: returning to exercise after cancer surgery covers the other side of the operation. Exercise during cancer treatment covers activity once treatment is underway. And recovering from cancer surgery covers what the complication numbers above actually describe.

• PubMed — the PREHAB randomized trial, JAMA Surg 2023, PMID 36988937
• PubMed — Liao YS, et al. meta-analysis, J Am Geriatr Soc 2025, PMID 40079672
• PubMed — Wee IJY, et al. meta-analysis, Ann Coloproctol 2024, PMID 38752322
• NCI — Physical Activity and Cancer