Pre-surgical exercise interventions to reduce risk & enhance recovery


Increasingly, pre-surgical exercise interventions are being used to reduce surgical risk for patients and to enhance post-surgical recovery. The benefits of exercise training have the potential to optimise several pre-surgical risks factors, including cardiorespiratory function, frailty and cognitive function.

This page contains a number of relevant journal articles on the use of pre-surgical prehabilitation exercise and has a particular emphasis on those with cancer.

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Key Reading

Loughney, L. A., West, M. A., Kemp, G. J., Grocott, M. P., & Jack, S. (2018). Exercise interventions for people undergoing multimodal cancer treatment that includes surgery. Cochrane Database of Systematic Reviews, (12). doi: 10.1002/14651858.CD012280.pub2

Richardson, K., Levett, D. Z. H., Jack, S., & Grocott, M. P. W. (2017). Fit for surgery? Perspectives on preoperative exercise testing and training. BJA: British Journal of Anaesthesia, 119(suppl_1), i34-i43. ttps://

Recommended Reading

Brunet, J., Burke, S., Grocott, M. P., West, M. A., & Jack, S. (2017). The effects of exercise on pain, fatigue, insomnia, and health perceptions in patients with operable advanced stage rectal cancer prior to surgery: a pilot trial. BMC cancer, 17(1), 153.

Burke, S. M., Brunet, J., Sabiston, C. M., Jack, S., Grocott, M. P., & West, M. A. (2013). Patients' perceptions of quality of life during active treatment for locally advanced rectal cancer: the importance of preoperative exercise. Supportive Care in Cancer, 21(12), 3345-3353.

Ditmyer, M. M., Topp, R., & Pifer, M. (2002). Prehabilitation in preparation for orthopaedic surgery. Orthopaedic Nursing, 21(5), 43-54.

Gillis, C., Li, C., Lee, L., Awasthi, R., Augustin, B., Gamsa, A., ... & Carli, F. (2014). Prehabilitation versus rehabilitation: A randomized control trial in patients undergoing colorectal resection for cancer. The Journal of the American Society of Anesthesiologists, 121(5), 937-947. DOI: 10.1097/ALN.0000000000000393

Grocott, M. P. W., Edwards, M., Mythen, M. G., & Aronson, S. (2019). Peri‐operative care pathways: re‐engineering care to achieve the ‘triple aim’. Anaesthesia, 74, 90-99.

Gurlit, S., & Gogol, M. (2019). Prehabilitation is better than cure. Current Opinion in Anesthesiology, 32(1), 108-115. DOI: 10.1097/ACO.0000000000000678

Heldens, A. F. J. M., Bongers, B. C., de Vos-Geelen, J., van Meeteren, N. L. U., & Lenssen, A. F. (2016). Feasibility and preliminary effectiveness of a physical exercise training program during neoadjuvant chemoradiotherapy in individual patients with rectal cancer prior to major elective surgery. European Journal of Surgical Oncology (EJSO), 42(9), 1322-1330.

Ismail, H., Cormie, P., Burbury, K., Waterland, J., Denehy, L., & Riedel, B. (2018). Prehabilitation Prior to Major Cancer Surgery: Training for Surgery to Optimize Physiologic Reserve to Reduce Postoperative Complications. Current Anesthesiology Reports, 8(4), 375-385.

Jack, S., West, M., & Grocott, M. P. W. (2011). Perioperative exercise training in elderly subjects. Best practice & research Clinical anaesthesiology, 25(3), 461-472.

Jack, S., West, M. A., Raw, D., Marwood, S., Ambler, G., Cope, T. M., ... & Grocott, M. P. W. (2014). The effect of neoadjuvant chemotherapy on physical fitness and survival in patients undergoing oesophagogastric cancer surgery. European Journal of Surgical Oncology (EJSO), 40(10), 1313-1320.

Licker, M., Karenovics, W., Diaper, J., Frésard, I., Triponez, F., Ellenberger, C., ... & Bridevaux, P. O. (2017). Short-term preoperative high-intensity interval training in patients awaiting lung cancer surgery: a randomized controlled trial. Journal of Thoracic Oncology, 12(2), 323-333. ttps://

Loughney, L., West, M. A., Kemp, G. J., Grocott, M. P. W., & Jack, S. (2016). Exercise intervention in people with cancer undergoing neoadjuvant cancer treatment and surgery: a systematic review. European Journal of Surgical Oncology (EJSO), 42(1), 28-38.

Minnella, E. M., & Carli, F. (2018). Prehabilitation and functional recovery for colorectal cancer patients. European Journal of Surgical Oncology.

Moran, J., Wilson, F., Guinan, E., McCormick, P., Hussey, J., & Moriarty, J. (2016). Role of cardiopulmonary exercise testing as a risk-assessment method in patients undergoing intra-abdominal surgery: a systematic review. BJA: British Journal of Anaesthesia, 116(2), 177-191.

Nakajima, H., Yokoyama, Y., Inoue, T., Nagaya, M., Mizuno, Y., Kadono, I., ... & Nagino, M. (2018). Clinical benefit of preoperative exercise and nutritional therapy for patients undergoing hepato-pancreato-biliary surgeries for malignancy. Annals of surgical oncology, 1-9.

Richardson, K., Levett, D. Z. H., Jack, S., & Grocott, M. P. W. (2017). Fit for surgery? Perspectives on preoperative exercise testing and training. BJA: British Journal of Anaesthesia, 119(suppl_1), i34-i43. ttps://

Sebio Garcia, R., Yanez Brage, M. I., Giménez Moolhuyzen, E., Granger, C. L., & Denehy, L. (2016). Functional and postoperative outcomes after preoperative exercise training in patients with lung cancer: a systematic review and meta-analysis. Interactive cardiovascular and thoracic surgery, 23(3), 486-497.

Silver, J. K. (2015, February). Cancer prehabilitation and its role in improving health outcomes and reducing health care costs. In Seminars in oncology nursing (Vol. 31, No. 1, pp. 13-30). WB Saunders.

Singh, F., Newton, R. U., Galvão, D. A., Spry, N., & Baker, M. K. (2013). A systematic review of pre-surgical exercise intervention studies with cancer patients. Surgical Oncology, 22(2), 92-104.

Steffens, D., Beckenkamp, P. R., Hancock, M., Solomon, M., & Young, J. (2018). Preoperative exercise halves the postoperative complication rate in patients with lung cancer: a systematic review of the effect of exercise on complications, length of stay and quality of life in patients with cancer. Br J Sports Med, 52(5), 344-344.

Steffens, D., Young, J., Beckenkamp, P. R., Ratcliffe, J., Rubie, F., Ansari, N., ... & Solomon, M. (2018). Feasibility and acceptability of PrE-operative Physical Activity to improve patient outcomes After major cancer surgery: study protocol for a pilot randomised controlled trial (PEPA Trial). Trials, 19(1), 112.

Tsimopoulou, I., Pasquali, S., Howard, R., Desai, A., Gourevitch, D., Tolosa, I., & Vohra, R. (2015). Psychological prehabilitation before cancer surgery: a systematic review. Annals of surgical oncology, 22(13), 4117-4123.

Valkenet, K., van de Port, I. G., Dronkers, J. J., de Vries, W. R., Lindeman, E., & Backx, F. J. (2011). The effects of preoperative exercise therapy on postoperative outcome: a systematic review. Clinical Rehabilitation, 25(2), 99-111.

Valkenet, K., Trappenburg, J. C., Schippers, C. C., Wanders, L., Lemmens, L., Backx, F. J., & van Hillegersberg, R. (2016). Feasibility of exercise training in cancer patients scheduled for elective gastrointestinal surgery. Digestive surgery, 33(5), 439-447.

van Rooijen, S., Carli, F., Dalton, S., Thomas, G., Bojesen, R., Le Guen, M., ... & Martínez-Palli, G. (2019). Multimodal prehabilitation in colorectal cancer patients to improve functional capacity and reduce postoperative complications: the first international randomized controlled trial for multimodal prehabilitation. BMC cancer, 19(1), 98.

West, M. A., Wischmeyer, P. E., & Grocott, M. P. (2017). Prehabilitation and nutritional support to improve perioperative outcomes. Current anesthesiology reports, 7(4), 340-349.

Weston, M., Weston, K. L., Prentis, J. M., & Snowden, C. P. (2016). High-intensity interval training (HIT) for effective and time-efficient pre-surgical exercise interventions. Perioperative Medicine, 5(1), 2. ttps://

Whittle, J., Wischmeyer, P. E., Grocott, M. P., & Miller, T. E. (2018). Surgical Prehabilitation: Nutrition and Exercise. Anesthesiology clinics, 36(4), 567-580.

Further Resources

Macmillan Cancer Support: Prehabilitation Evidence and Insight Review (2017)