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Preparing for surgery usually means medical tests, paperwork, and maybe a few last-minute instructions from your care team. But what if the best way to recover from surgery actually starts weeks before you enter the operating room?
That’s the idea behind prehabilitation, often called “prehab.” And according to a major Canadian clinical trial, it can make a very meaningful difference — especially for older adults living with frailty.
What’s Involved in Prehab?
Prehabilitation is a structured program designed to strengthen patients physically and nutritionally before surgery. Think of it as training for a marathon — except the marathon is surgery and recovery.
Surgery places enormous stress on the body. For older adults, particularly those living with frailty, that stress can lead to complications, longer hospital stays, and difficulty regaining independence afterward. Prehab, is a proactive approach to preparing your body for surgery before it happens. Instead of focusing only on recovery afterward, prehab helps patients build strength, improve nutrition, and boost overall resilience in the weeks leading up to an operation. By improving physical fitness, muscle strength, and overall health beforehand, prehab can make it easier to bounce back, reduce the risk of complications, and support a smoother, faster recovery.
The Study: A Closer Look
The large trial was led by researchers at The Ottawa Hospital and the University of Ottawa. It involved 847 older adults living with frailty, recruited from 13 surgical centres across Canada.
Participants were randomly divided into two groups:
The prehab program was carefully designed with input from medical experts and patient partners. It included:
It wasn’t just a handout — it was guided support.
The Results: Participation Was Key
When researchers analyzed the overall results, they found no significant difference between the two groups in terms of surgical complications or overall disability.
But a deeper look revealed something very important. Participants who completed at least 75% of the prescribed prehab exercises experienced significantly lower levels of disability after surgery. In other words, prehab was extremely beneficial when people were able to fully engage in it.
Older adults with frailty who have enough time before surgery — along with the internal motivation and external support needed to participate — are more likely to experience better recovery and reduced disability.
Why This Matters
Globally, more than 300 million surgeries are performed each year. Major surgery carries risks — and more than 20% of patients experience complications afterward.
Older adults living with frailty face the highest risk of setbacks, prolonged hospitalization, and difficulty returning to their previous level of function.
Even small improvements in recovery outcomes could have a significant impact on quality of life — not to mention reducing strain on healthcare systems.
A comprehensive review of global prehab studies published earlier this year reinforced the promise of this approach. The review found that prehabilitation may reduce surgical complications, shorten hospital stays, and improve physical recovery and quality of life.
The concept is gaining traction — but implementation remains complex.
The Barriers to Participation
The biggest takeaway from this latest study isn’t just that prehab works. It’s that access and participation matter.
Older adults preparing for surgery may face barriers such as:
For someone already living with frailty, adding a structured exercise routine can feel daunting.
That’s why researchers emphasize the importance of integrating prehab more effectively into routine care — ensuring patients receive enough time, encouragement, and personalized support to fully participate.
What’s Next? Expanding Access
The Ottawa Hospital’s Aging Innovation in Perioperative Medicine & Surgery (AIMS) Research Group is already building on these findings.
Their newest initiative, the STRIVE trial, is testing a virtual prehab program open to adults across Canada. The updated approach includes:
By moving the program online, researchers hope to remove some of the logistical and geographic barriers that limited participation in earlier models.
The goal is clear: make prehab accessible and achievable for everyone who could benefit.
The Bigger Picture
Prehabilitation represents a shift in how we think about surgery. Instead of viewing surgery as a single event, prehab recognizes it as a journey — one that begins well before the first incision. For older adults living with frailty, this preparation can mean the difference between prolonged disability and a faster return to independence. The evidence now suggests that when patients are supported enough to fully participate, prehab can reduce disability and improve recovery.
The challenge ahead isn’t proving that preparation helps. It’s making sure every patient has the opportunity — and support — to prepare. Because sometimes, the most important part of recovery begins before surgery ever starts.
