Home-based prehabilitation improves preoperative 6MWT in colorectal cancer surgery but benefits not sustained

This systematic review and meta-analysis evaluated the feasibility and clinical effectiveness of home-based multimodal prehabilitation for patients undergoing colorectal cancer surgery. The primary outcome was change in the 6-minute walk test (6MWT) during the preoperative period. Secondary outcomes included 30-day postoperative complications, emergency department visits, hospital readmission, and mental health outcomes measured using the Hospital Anxiety and Depression Scale (HADS).

Results showed prehabilitation significantly improved preoperative 6MWT performance [MD=40.61, 95% CI (6.23, 74.99), P=0.02]. However, no significant improvement was observed at 4-6 weeks postoperatively [MD=49.67, 95% CI (-35.50, 134.84), P=0.25] or at 8 weeks postoperatively [MD=26.58, 95% CI (-8.88, 62.04), P=0.14]. Prehabilitation did not significantly affect total hospitalization, 30-day postoperative complications, emergency department visits, or readmission rates. Additionally, no significant improvements were found in HADS-anxiety or HADS-depression scores at 8 weeks.

The authors concluded that home-based multimodal prehabilitation significantly improved physical function before colorectal cancer surgery, but these benefits were not sustained postoperatively. They suggested more intensive or prolonged programs, combined with postoperative rehabilitation, may be necessary to maintain preoperative gains, and that larger trials with extended follow-up periods are needed to confirm long-term clinical effects. The study protocol was registered in PROSPERO (CRD42023439715).

If you're facing colon cancer surgery, you might wonder if getting stronger beforehand can help you bounce back faster. A new review looked at home-based 'prehabilitation' programs—these combine exercise, nutrition, and mental health support to prepare patients for surgery. The main finding is clear: these programs did help people walk farther in a six-minute test right before their operation. That's a good sign for being physically ready for the stress of surgery. However, that boost in fitness didn't stick around. When checked 4-6 weeks and 8 weeks after surgery, patients who did prehab weren't walking significantly farther than those who didn't. The programs also didn't make a measurable difference in several important recovery areas. They didn't lower the rate of complications within 30 days of surgery, reduce trips to the emergency room, or cut down on hospital readmissions. Patients' anxiety and depression scores, measured 8 weeks after surgery, weren't significantly improved either. The review concludes that while getting fitter at home before surgery works, the benefits fade afterward. The authors suggest that to keep those gains, programs might need to be more intense, last longer, or continue after the operation.