Relative efficacy of exercise prehabilitation interventions and their components: a systematic review and network meta-analysis of randomised controlled trials
In brief
Combined exercise prehab ranked to shorten hospital stays by 3.4 days
In a review of 96 trials involving 7,396 patients, combined aerobic, pulmonary and functional exercise ranked most likely to shorten hospital stays, by an estimated 3.4 days. It also ranked best for reducing complications, but that evidence was very uncertain; no exercise program significantly improved physical recovery, so stronger trials are needed to confirm which approach works best.
- Journal
- British journal of anaesthesia (Q1)
- Published
- 22 September 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Daniel I McIsaac, Taylor C Gillmore, Mariam Al-Bayati, Karina Branje, Emily Hladkowicz, Dianna M Wolfe, et al.
- PMID
- 42901859
- DOI
- 10.1016/j.bja.2026.08.052
Why clinicians should know about it
- Picked for Anesthesiology and Pain Medicine (top studies of the week, 25 October 2026): Prehabilitation evidence on postoperative outcomes and recovery
Abstract
BACKGROUND: Exercise is the most common approach to prehabilitation; the optimal exercise interventions to improve postoperative outcomes are unknown. METHODS: This was a systematic review with network meta-analysis that followed a prespecified protocol (CRD420251034396). Peer-reviewed search strategies were applied from inception to 4 April 2025, to Ovid MEDLINE, Embase, CINAHL, PsycINFO, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL), without language restrictions. We included all RCTs of prehabilitation that included at least one exercise intervention (aerobic, strength, pulmonary, or functional exercises) and that reported at least one critical outcome (postoperative complications, length of stay, health-related quality of life, or physical recovery). P-scores were used to rank interventions by their probability of being most beneficial. Best practices, including duplicate review, were followed. Confidence in network meta-analysis informed certainty ratings. RESULTS: We screened 7660 citations, reviewed 1480 full-text articles, and included 96 unique RCTs (N=7396). Combined aerobic, pulmonary, and functional exercise were most likely to reduce complications (P-score 0.94, odds ratio 0.16, 95% CI 0.05-0.60; very low certainty) and length of stay (P-score 0.97, mean difference -3.4 days, 95% CI -5.7 to -1.0; moderate certainty). Combined aerobic and strength exercise was most likely to improve health-related quality of life (P-score 0.93, standardised mean difference 0.67, 95% CI 0.07-1.27; low certainty). No exercise interventions significantly improved physical recovery. CONCLUSIONS: The efficacy of exercise prehabilitation interventions may be outcome-specific. Implementation of aerobic and pulmonary exercise prehabilitation may be warranted. Low-risk-of-bias trials are required to confirm or refute available data, which are mostly low certainty.
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.