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Purpose of Review <p>Prehabilitation has become a central perioperative strategy in cancer surgery, but definitions, intervention components, delivery models, outcome measures, and target populations remain variable across studies and services. This review examines exercise as the core therapeutic element while also addressing the other pillars of contemporary multimodal prehabilitation: nutrition, psychological support, and behaviour change.</p> Findings <p>In cancer surgery, the strongest contemporary evidence comes from high-fidelity multimodal programmes, respiratory prehabilitation for thoracic or upper abdominal surgery, risk-enriched cohorts, and carefully supported home-based or hybrid models. Recent component analyses across surgical trials also suggest that exercise and nutrition are the most consistently beneficial components, with additional signal for multimodal programmes that include psychosocial support. The 2025 Macmillan Cancer Support guideline reframes cancer prehabilitation as a needs-based, multimodal intervention delivered before and during treatment and supported by behaviour-change techniques.</p> Summary <p>Exercise remains the cornerstone of prehabilitation, but it is rarely sufficient as a stand-alone strategy. Nutrition, psychological support, and behaviour-change techniques help patients complete and benefit from exercise, particularly when malnutrition, distress, or access barriers limit participation. The most defensible current model is therefore exercise-centered, multimodal, risk-stratified, and integrated across the cancer pathway rather than confined to a short preoperative window.</p>

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Exercise-centered Multimodal Prehabilitation for Major Cancer Surgery: Current Evidence, Delivery, and Future Directions

  • 期刊论文

  • 发表日期：

    2026年7月13日

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  • Dinuk S Liyanage,
  • Bernhard Riedel,
  • Jonas Alfitian,
  • Tobias Kammerer,
  • Adam Miller,
  • Robert Schier

摘要

Purpose of Review

Prehabilitation has become a central perioperative strategy in cancer surgery, but definitions, intervention components, delivery models, outcome measures, and target populations remain variable across studies and services. This review examines exercise as the core therapeutic element while also addressing the other pillars of contemporary multimodal prehabilitation: nutrition, psychological support, and behaviour change.

Findings

In cancer surgery, the strongest contemporary evidence comes from high-fidelity multimodal programmes, respiratory prehabilitation for thoracic or upper abdominal surgery, risk-enriched cohorts, and carefully supported home-based or hybrid models. Recent component analyses across surgical trials also suggest that exercise and nutrition are the most consistently beneficial components, with additional signal for multimodal programmes that include psychosocial support. The 2025 Macmillan Cancer Support guideline reframes cancer prehabilitation as a needs-based, multimodal intervention delivered before and during treatment and supported by behaviour-change techniques.

Summary

Exercise remains the cornerstone of prehabilitation, but it is rarely sufficient as a stand-alone strategy. Nutrition, psychological support, and behaviour-change techniques help patients complete and benefit from exercise, particularly when malnutrition, distress, or access barriers limit participation. The most defensible current model is therefore exercise-centered, multimodal, risk-stratified, and integrated across the cancer pathway rather than confined to a short preoperative window.