Researchers tested whether older adults with frailty who did exercises and ate better before surgery would recover faster and have fewer problems after surgery. Over 700 people aged 60 and older participated in this study across 13 Canadian hospitals. Half the group did a home-based exercise and nutrition program with coach support before their surgery, while the other half received standard care. Surprisingly, the exercise group didn’t recover noticeably better or have fewer complications than the regular care group. However, people who actually completed most of their exercises did report slightly better recovery. The study suggests that while pre-surgery exercise might help some people, it doesn’t work as a one-size-fits-all solution for all frail older adults.

The Quick Take

  • What they studied: Does doing exercises and following nutrition advice at home before surgery help older, frail people recover better and have fewer problems after surgery?
  • Who participated: 705 people aged 60 and older (average age 72) who were considered frail and scheduled for planned surgery at 13 hospitals in Canada. About half were women.
  • Key finding: The exercise group and regular care group had almost identical recovery and complication rates. Both groups had about 50% experience complications after surgery. However, people who actually did more than 75% of their prescribed exercises showed slightly better recovery scores.
  • What it means for you: If you’re an older adult facing surgery, doing pre-surgery exercises might help a little if you stick with them, but it’s not guaranteed to dramatically change your recovery. Talk with your doctor about what’s best for your specific situation.

The Research Details

This was a rigorous study called a randomized controlled trial, which is considered one of the best ways to test if something actually works. Researchers recruited 847 older adults with frailty who were scheduled for surgery. They randomly assigned about half to a home-based program that included exercise routines and personalized eating recommendations, with support from coaches who checked in remotely. The other half received standard care with general activity and nutrition guidelines. The study ran from March 2020 to February 2024 across 13 hospitals in Canada.

The researchers carefully measured how well people recovered 30 days after surgery using a standard questionnaire about daily activities and disabilities. They also tracked how many people had complications during their hospital stay. The study was designed so that doctors and assessors didn’t know which group patients were in, which helps prevent bias. Participants in the regular care group knew they weren’t getting the special program, but they didn’t know exactly what the other group was doing.

The researchers used advanced statistical methods to compare the two groups fairly, accounting for differences in age, health conditions, and other factors that might affect surgery outcomes.

This study design is important because previous smaller studies suggested pre-surgery exercise might help, but nobody had tested it in a real-world setting with many hospitals and many frail older adults. By testing this across multiple centers with a large group of people, the researchers could see if the benefits would actually happen in everyday medical practice, not just in controlled research settings.

This is a high-quality study published in a top medical journal (JAMA Surgery). The researchers were careful to prevent bias by blinding doctors and assessors. The study included 705 people who actually had surgery, which is a large enough group to trust the results. However, about 140 people who were enrolled didn’t end up having surgery, which is normal in real-world studies. The researchers clearly reported their methods and results, making it easy to evaluate the study’s reliability.

What the Results Show

The main finding was disappointing for those hoping pre-surgery exercise would be a game-changer: the exercise group and regular care group had nearly identical outcomes. After surgery, the exercise group reported a disability score of 23.5 out of 100, while the regular care group scored 24.7—a difference so small it could easily be due to chance. Similarly, about half of each group (50.1% in the exercise group and 47.7% in the regular care group) experienced some kind of complication after surgery, which is not a meaningful difference.

The researchers also looked at whether the program was safe before surgery. Good news: people in the exercise group didn’t have any more injuries or problems during the pre-surgery training than the regular care group. This means the exercises themselves weren’t harmful.

One interesting finding emerged when researchers looked at people who actually completed most of their exercises. Those who did more than 75% of the prescribed exercises showed slightly better recovery scores compared to people who did less exercise. This suggests that if someone commits to the program, it might help a little. However, even among the most dedicated exercisers, there was no difference in complication rates.

Participants typically enrolled in the program about 4 weeks before surgery, which gave them a reasonable amount of time to prepare. However, many people struggled to stick with the program, with competing priorities and lack of motivation being the main reasons people didn’t complete all their exercises.

The researchers tracked many other outcomes beyond the main ones. These included quality of life, how long people stayed in the hospital, where they went after discharge, how well their legs functioned, whether they fell, and whether they had to come back to the hospital. None of these measures showed a clear advantage for the exercise group. Hospital stays were similar, discharge locations were similar, and readmission rates were similar. This consistent pattern suggests that the pre-surgery exercise program didn’t provide broad benefits across different measures of recovery.

Earlier studies, mostly smaller ones done in single hospitals, suggested that pre-surgery exercise (called prehabilitation) could help people recover better. This new study is much larger and more realistic because it tested the program across many hospitals with many different types of patients. The results suggest that while the idea of pre-surgery exercise is good in theory, it doesn’t work as well in real-world practice as smaller studies suggested. This is a common pattern in medical research—what works in controlled settings sometimes doesn’t translate to everyday medical care.

Several important limitations should be considered. First, only 705 out of 847 enrolled people actually had surgery, which means some people’s plans changed. Second, people in the regular care group still received general activity and nutrition guidelines, so they weren’t doing nothing—they just weren’t getting personalized coaching. This makes it harder to see a big difference between groups. Third, many people didn’t complete all their exercises, which makes it difficult to know if the program would work better if everyone stuck with it. Fourth, the study only looked at people scheduled for planned surgery, so results might not apply to emergency surgeries. Finally, all participants were in Canada, so results might differ in other countries with different healthcare systems.

The Bottom Line

Based on this study, pre-surgery exercise programs for frail older adults don’t appear to be necessary for everyone. However, if you’re an older adult facing surgery and your doctor recommends exercise, it’s probably safe to do and might help you feel slightly better during recovery—especially if you can stick with it. The key is to talk with your surgical team about what’s right for your specific health situation. General activity and good nutrition before surgery remain important, but you don’t necessarily need a special coached program. Confidence level: Moderate—this is a well-done study, but it’s possible that certain groups of people might benefit more than others.

This research is most relevant to older adults (60+) who are frail and scheduled for planned surgery, and their doctors. It’s less relevant to younger, healthier people having surgery or to people having emergency surgery. If you’re in this group and considering pre-surgery exercise, this study suggests it’s optional rather than essential. However, staying active and eating well before surgery is still a good idea for general health.

If you do decide to do pre-surgery exercises, the study participants typically prepared for about 4 weeks before surgery. Recovery improvements, if they happen, would likely be noticed within the first 30 days after surgery. Don’t expect dramatic changes—any benefits are likely to be modest.

Want to Apply This Research?

  • If using an app to prepare for surgery, track daily exercise completion (minutes of activity per day) and nutrition adherence (servings of fruits/vegetables, protein intake). Set a goal of completing 75% or more of prescribed activities, since the study showed this group had better outcomes.
  • Use the app to set up daily reminders for prescribed exercises and meal planning. Start with small, achievable goals rather than trying to do everything at once. Log your actual completion rate to stay accountable—the study showed that people who did more exercises had slightly better recovery.
  • Track pre-surgery metrics like exercise frequency and nutrition quality for 4 weeks before surgery. After surgery, log daily activities and any difficulties with normal tasks for the first 30 days. This helps you see if the pre-surgery preparation made a difference in your personal recovery, even if it doesn’t work for everyone.

This research summary is for educational purposes only and should not replace professional medical advice. The findings suggest that pre-surgery exercise programs don’t universally improve outcomes for all frail older adults, but individual results may vary. Before starting any exercise program before surgery, consult with your surgeon and healthcare team about what’s appropriate for your specific health condition, type of surgery, and medical history. This study does not recommend against pre-surgery exercise—it simply shows it’s not a guaranteed solution for everyone. Always follow your doctor’s personalized recommendations.