Relative efficacy of prehabilitation interventions and their components: systematic review with network and component network meta-analyses of randomised controlled trials.

Summary

Across 186 RCTs (n=15,684), exercise and nutrition-focused prehabilitation consistently reduced postoperative complications and length of stay versus usual care. Component network meta-analysis identified exercise and nutrition as the key drivers of benefit, while combined exercise+nutrition+psychosocial interventions improved health-related quality of life and six-minute walk distance.

Key Findings

• Isolated exercise prehabilitation reduced complications versus usual care (OR 0.50, 95% CI 0.39–0.64).
• Isolated nutritional prehabilitation reduced complications (OR 0.62, 95% CI 0.50–0.77).
• Exercise+psychosocial and exercise+nutrition reduced hospital length of stay (−2.44 and −1.22 days, respectively).
• Exercise+nutrition+psychosocial improved SF-36 physical component (MD 3.48) and 6-minute walk distance (MD 43.43 m).
• Component NMA pinpointed exercise and nutrition as primary contributors to benefit across outcomes.

Clinical Implications

Implement exercise and nutrition-centered prehabilitation widely as part of enhanced recovery programs to reduce complications and hospital stay; consider adding psychosocial support when aiming to improve patient-reported outcomes and functional recovery.

Limitations

• Certainty of evidence often low to very low due to trial-level risk of bias and imprecision
• Heterogeneity in interventions and outcomes across trials

Future Directions

Conduct multicentre, adequately powered RCTs with standardized prehabilitation components and core outcome sets to confirm benefits and define optimal duration and delivery models.