Impact of Preoperative Exercise on Postoperative Recovery

Disclaimer: This article is intended solely for informational and educational purposes only. It does not constitute medical advice.

Preoperative exercise, commonly referred to as “prehabilitation,” has gained attention as a strategy to prepare patients physically, nutritionally, and psychologically prior to surgery and improve their postoperative recovery (van Koningsveld-Couperus et al., 2025). Research increasingly emphasizes preventive, forward-looking interventions to enhance patient readiness, improve surgical outcomes, and reduce strain on healthcare systems (van Koningsveld-Couperus et al., 2025).  

Surgery is a physiologically stressful event that induces losses of body protein, strength, and function (Gillis et al., 2022). Following surgery, patients frequently experience short-term losses in strength, range of motion, and aerobic fitness (Tazreean et al., 2022). Contributing factors include intraoperative muscle injury, the release of stress-related hormones, and the deconditioning that occurs with reduced movement during recovery (Tazreean et al., 2022).  

By addressing physical and functional deficits before surgery, prehabilitation works as a modifiable strategy that can improve postoperative recovery, blunt surgical stress responses, and facilitate a faster return to mobility (Shakya et al., 2022). Preoperative exercise programs aim to build up the patient’s ability to tolerate surgical stress by enhancing functional capacity (cardiorespiratory fitness, muscle strength), nutritional status, insulin sensitivity, psychological and neuromuscular adaptability, and comorbidity management (Shakya et al., 2022). These factors have all been associated with improved wound healing, reduced complications, and shorter hospital stays (Shakya et al., 2022). A greater physiologic reserve means the body is more equipped to endure the stress of surgery. 

Patients who are active participants in their care are often motivated to improve their condition and may be more receptive to behavioral changes (Shakya et al., 2022). Rather than focusing on a single intervention (e.g., only exercise or only nutrition),  preoperative exercise on postoperative recovery is most effective when it combines several domains tailored to the patient’s risk profile. This personalization includes screening to identify deficits (e.g., anemia, malnutrition, frailty, smoking), then selecting interventions accordingly (Shakya et al., 2022). 

The efficacy of prehabilitation is demonstrated by its use in total hip and knee arthroplasty. Multiple randomized controlled trials have demonstrated that patients who undergo 4–6 weeks of preoperative strength and aerobic exercise show significantly improved postoperative recovery trajectories, with increased strength, earlier ambulation, reduced pain, and reduced length of hospital stay compared to controls (Shakya et al., 2022, Adebero et al., 2024, Konnyu et al 2023).

Despite the potential benefits, implementation remains variable and associations with reduction in postoperative pain and improved gait mechanics have not been consistent enough to determine a consensus on the value of prehabilitation (Adebero et al., 2024, Konnyu et al., 2024). Barriers include limited patient access to physical therapy services, low preoperative compliance, and lack of standardized protocols across institutions (Adebero et al., 2024, Konnyu et al., 2024). Additionally, frail or elderly patients may require individualized, low-impact regimens to balance benefits with safety. 

Preoperative exercise represents a cost-effective, low-risk intervention with strong potential to improve recovery following surgery. As healthcare systems shift toward value-based care and patient-centered outcomes, prehabilitation should be considered a standard component of surgical optimization pathways. 

References 

1. Adebero, T., Omana, H., Somerville, L., et al. (2024). Effectiveness of prehabilitation on outcomes following total knee and hip arthroplasty for osteoarthritis: A systematic review and meta-analysis of randomized controlled trials. Disability and Rehabilitation, 46(24), 5771–5790. https://doi.org/10.1080/09638288.2024.2313128 
2. Gillis, C., Ljungqvist, O., & Carli, F. (2022). Prehabilitation, enhanced recovery after surgery, or both? A narrative review. British Journal of Anaesthesia, 128, 434–448. 
3. Konnyu, K. J., Thoma, L. M., Cao, W., et al. (2023). Prehabilitation for total knee or total hip arthroplasty: A systematic review. American Journal of Physical Medicine & Rehabilitation, 102(1), 1–10. https://doi.org/10.1097/PHM.0000000000002006 
4. Rockwood, K., Song, X., MacKnight, C., Bergman, H., Hogan, D. B., McDowell, I., et al. (2005). A global clinical measure of fitness and frailty in elderly people. Canadian Medical Association Journal, 173(5), 489–495. https://doi.org/10.1503/cmaj.050051 
5. Shakya, P., & Poudel, S. (2022). Prehabilitation in patients before major surgery: A review article. Journal of Nepal Medical Association, 60(254), 909–915. https://doi.org/10.31729/jnma.7545 
6. Tazreean, R., Nelson, G., & Twomey, R. (2022). Early mobilization in enhanced recovery after surgery pathways: Current evidence and recent advancements. Journal of Comparative Effectiveness Research, 11(2), 121–129. https://doi.org/10.2217/cer-2021-0258 
7. van Koningsveld-Couperus, B. H., de Rooij, T., van Meeteren, N. L., Preckel, B., Hollmann, M. W., & Nieuwenhuijs-Moeke, G. J. (2025). Prehabilitation: A catalyst for transforming toward value-based, personalized perioperative health and care. Journal of Clinical Medicine, 14(19), 6747. https://doi.org/10.3390/jcm14196747