By Ana Espino | Published on February 23, 2026 | 3 min read
Frailty is a multidimensional clinical syndrome characterized by
decreased physiological reserves and increased vulnerability to acute
stressors. In older adults, it is a major predictor of postoperative
complications, functional decline, and prolonged hospital stay.
Surgery represents a significant metabolic stress. In frail patients, it
may lead to a 20–40% reduction in physiological and functional capacity, with
incomplete recovery to baseline for several months. Traditional strategies
focus on postoperative rehabilitation, often initiated in a context of fatigue
and inflammation.
Prehabilitation is a multimodal preoperative intervention combining
exercise, nutritional optimization, and psychological support, aimed at
strengthening functional reserve before surgery. However, data specifically
addressing frail older patients remain limited and heterogeneous.
This meta-analysis, published in the International Journal of
Environmental Research and Public Health (2025), aimed to evaluate the
effect of prehabilitation on aerobic capacity measured by the 6-Minute Walk
Test (6MWT) and on length of hospital stay (LOS) in frail older surgical
patients.
More meters, fewer hospital days?
The authors conducted a systematic review and meta-analysis of
randomized controlled trials in accordance with PRISMA guidelines and the
Cochrane Handbook. Of 1,987 records identified, 5 randomized trials were
included, totaling 400 frail older participants. Most patients underwent
colorectal surgery, intra-abdominal oncologic surgery, or total hip
arthroplasty. Prehabilitation programs lasted 2.5 to 6 weeks and systematically
included physical training, sometimes combined with nutritional or psychological
components.
The effect on aerobic capacity was analyzed at three time points: start
of prehabilitation (T1), preoperative period (T2), and postoperative period
(T3). Between T1 and T2, the pooled mean difference was 9.71 meters, not
statistically significant and without heterogeneity. Between T2 and T3, the
difference was −3.27 meters, with moderate heterogeneity. Between T1 and T3,
improvement reached 15.01 meters, also not statistically significant.
Regarding length of hospital stay, the mean difference was −0.46 days,
with no significant reduction and no heterogeneity.
Methodological assessment showed low to moderate risk of bias according
to the RoB2 tool. The overall quality of evidence was rated as moderate, mainly
limited by imprecision of confidence intervals.
Preserving rather than enhancing
Frailty increases the risk of complications and functional decline after
surgery. Strengthening physiological reserve beforehand is therefore
theoretically attractive.
This meta-analysis sought to determine whether multimodal
prehabilitation improves aerobic capacity and reduces hospital stay in frail
older patients. The results show no statistically significant improvement in
6MWT performance or length of stay.
However, the absence of marked postoperative functional deterioration
may reflect a stabilization effect, which could be clinically meaningful in
this vulnerable population. Limitations include the small number of trials,
heterogeneity of protocols, and short intervention duration.
Although confirmation in larger multicenter trials is needed, these
findings suggest that prehabilitation may help preserve functional capacity
rather than significantly enhance it. In the long term, standardized, longer,
and better-targeted protocols may optimize surgical tolerance and support
autonomy in frail older patients.
Read next: Cardio-neuro: the duo to watch About the author – Ana Espino
PhD in Immunology, specialized in Virology
As a scientific writer, Ana is passionate about bridging the gap
between research and real-world impact. With expertise in immunology, virology,
oncology, and clinical studies, she makes complex science clear and accessible.
Her mission: to accelerate knowledge sharing and empower evidence-based
decisions through impactful communication.
