Exercise-based prehabilitation programs reduces hospital stay and postoperative complications in surgical patients with cancer: a systematic review and meta-analysis
In brief
Pre-surgery exercise cuts hospital stay by about 0.8 days and complications by 18%
A meta-analysis of 55 randomized trials found that supervised, multidisciplinary aerobic or combined training before cancer surgery shortened length of stay by roughly three-quarters of a day and lowered overall postoperative complications by 18%, with especially strong effects in gastrointestinal and thoracic cancers. Benefits were greater in older patients and women, but heterogeneity was high, so program design matters.
- Journal
- European journal of internal medicine (Q1)
- Published
- 29 July 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Manuel Fernandez-Escabias, Sofia Carrilho-Candeias, Cristian Garcia-Sanchez, Andrea Orellana-Jaen, Alberto Millan-Martin, Almudena Carneiro-Barrera, et al.
- PMID
- 42527160
- DOI
- 10.1016/j.ejim.2026.107104
Why clinicians should know about it
- Picked for Internal Medicine (top studies of the week, 2 August 2026): Cancer prehabilitation, not internist focus
- Picked for Oncology and Radiation Oncology (top studies of the week, 2 August 2026): Exercise-based prehabilitation programs significantly reduced HLOS and complications
Abstract
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 (I2=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, I2=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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.