Researchers tested whether a 6-week program of exercise and special nutrition could help patients with weak muscles recover better after major liver surgery. Sixty patients with muscle weakness were split into two groups: one received daily walking, supervised exercise twice a week, and nutritional supplements, while the other received standard care. The exercise group had far fewer complications after surgery—only 13% experienced problems compared to 50% in the standard care group. This study suggests that preparing your body before surgery through exercise and nutrition can significantly improve how well you heal.

The Quick Take

  • What they studied: Does a 6-week program of exercise and nutrition help patients with weak muscles recover better after major liver surgery?
  • Who participated: 60 adults (average age 69) with confirmed muscle weakness who needed major liver surgery. Most were scheduled to have part of their liver removed.
  • Key finding: Patients who did the exercise and nutrition program had complications in only 13% of cases, compared to 50% in the standard care group—a reduction of about 37 percentage points. Serious complications happened only in the standard care group.
  • What it means for you: If you have weak muscles and need major liver surgery, preparing with exercise and nutrition before surgery may cut your risk of problems in half. However, this was a small study in one hospital, so talk with your doctor about whether this approach is right for you.

The Research Details

This was a randomized controlled trial, which is considered one of the strongest types of medical research. Researchers enrolled 70 patients with weak muscles scheduled for major liver surgery at a specialized liver surgery center in Italy between April 2022 and January 2025. Sixty patients completed the study. Half were randomly assigned to receive a 6-week “prehabilitation” program (exercise and nutrition preparation), while the other half received standard surgical care.

The prehabilitation group did daily walking on their own and attended supervised exercise sessions twice per week at the hospital. They also received special nutritional supplements containing branched-chain amino acids (building blocks for muscles) and immune-supporting nutrients. The standard care group followed their normal routine while waiting for surgery.

Researchers measured muscle mass and strength before and after the program, and tracked complications for 90 days after surgery using a standard medical classification system.

This research design is important because it randomly assigns people to different groups, which helps prove that the exercise program itself—not other factors—caused the better outcomes. The study focused specifically on patients with weak muscles, a group known to have higher surgery risks. By testing a practical, 6-week program that patients could do while waiting for surgery, the researchers created something that could actually be used in real hospitals.

This study has several strengths: it was a randomized controlled trial (the gold standard), it measured both muscle changes and surgical outcomes, and it was published in a top medical journal (JAMA Surgery). However, the study was relatively small (60 patients) and conducted in only one hospital in Italy, so results may not apply everywhere. The study was also “open-label,” meaning both patients and doctors knew who was getting the exercise program, which could influence results.

What the Results Show

The main finding was dramatic: only 4 out of 30 patients (13%) in the exercise group experienced complications after surgery, compared to 15 out of 30 patients (50%) in the standard care group. This means the exercise program reduced the odds of complications by 85%. The absolute difference was 37 percentage points—meaning for every 3 patients who did the program, one person avoided a complication.

All six serious complications (the most dangerous type) occurred only in the standard care group, none in the exercise group. This suggests the program may be especially protective against severe problems.

Patients in the exercise group also showed significant improvements in muscle mass and strength before surgery, while the standard care group showed no improvement. These muscle gains likely explain why surgery went more smoothly for the exercise group.

Beyond the main results, the study found that muscle strength improved significantly in the exercise group but not in the control group. The ability to measure these muscle improvements before surgery helped confirm that the program was actually working to build muscle, not just improving outcomes by chance. The study also tracked that most patients (86.7%) underwent a procedure called portal vein embolization before surgery, and 88.3% had their right liver lobe removed, making this a very high-risk surgical population.

Previous research has shown that patients with weak muscles have worse outcomes after liver surgery. This study is the first randomized trial to test whether a structured exercise and nutrition program can actually prevent these problems. Earlier studies suggested exercise helps before surgery, but this is the strongest evidence yet that it works specifically for liver surgery patients with weak muscles.

The study was relatively small with only 60 patients, which means results could change with a larger group. It was conducted in only one specialized hospital in Italy, so results may not apply to all hospitals or all populations. The study was open-label, meaning patients and doctors knew who was getting the exercise program, which could influence how they reported outcomes. The study didn’t compare the exercise program to other types of preparation, so we don’t know if other approaches might work equally well. Finally, we don’t know how long the benefits last beyond 90 days after surgery.

The Bottom Line

For patients with weak muscles scheduled for major liver surgery: A 6-week program of daily walking, twice-weekly supervised exercise, and nutritional supplements appears to significantly reduce surgery complications (strong evidence from this trial, though based on a single center). Discuss with your surgical team whether this type of prehabilitation program is available and appropriate for you. For healthcare providers: Consider offering structured prehabilitation programs to high-risk patients with weak muscles before major liver surgery (moderate-to-strong evidence, though larger studies would strengthen this).

This research is most relevant to: (1) Adults with weak muscles scheduled for major liver surgery, (2) Liver surgeons and surgical teams planning care for high-risk patients, (3) Physical therapists and nutritionists working with surgical patients. This may be less relevant to: patients with normal muscle strength, those having minor liver procedures, or patients unable to exercise due to other health conditions. Always consult your doctor about whether this approach is right for your specific situation.

The exercise program lasted 6 weeks before surgery. Patients showed improvements in muscle strength during this time. The main benefits appeared in the first 90 days after surgery, with the exercise group having far fewer complications during recovery. It’s unclear how long these benefits last beyond 90 days, so longer-term follow-up would be helpful.

Want to Apply This Research?

  • If preparing for liver surgery, track daily walking minutes (aim for consistent daily activity) and record supervised exercise sessions completed per week (target: 2 sessions). Also log any nutritional supplements taken and note any changes in how strong you feel or how easily you can do daily activities.
  • Users preparing for liver surgery could use the app to: (1) Set a daily walking goal and log completion, (2) Schedule and track twice-weekly exercise sessions, (3) Record nutritional supplement intake, (4) Monitor subjective strength improvements with simple self-assessments (e.g., “Can I climb stairs more easily?”), (5) Receive reminders for exercise sessions and supplement timing.
  • For long-term tracking, maintain a log of: weekly exercise consistency (% of planned sessions completed), changes in daily activity tolerance, any muscle soreness or fatigue patterns, and adherence to nutritional supplementation. Share this data with your surgical team to demonstrate preparation level and discuss any adjustments needed before surgery.

This research describes a specialized medical intervention for patients with weak muscles undergoing major liver surgery. These findings should not be interpreted as medical advice. The study was conducted in one hospital in Italy and involved a relatively small number of patients. Before starting any exercise program or nutritional supplementation before surgery, consult with your surgeon and medical team to determine if prehabilitation is appropriate for your specific condition, overall health status, and surgical plan. Individual results may vary, and this approach may not be suitable for everyone. Always follow your doctor’s recommendations for preoperative preparation.