Before having major surgery, patients—especially older adults and those with serious health conditions—could benefit from a program called prehabilitation that helps them get stronger and healthier. Research shows these programs reduce complications, hospital stays, and readmissions after surgery. However, hospitals in the UK face three big obstacles: the programs cost too much money, there aren’t enough trained staff to run them, and the government hasn’t created official guidelines. This article explores why these programs aren’t available everywhere, even though they could help many patients have better outcomes.

The Quick Take

  • What they studied: Why hospitals in the UK don’t offer prehabilitation programs (special training to get patients healthier before surgery) even though research shows they work well
  • Who participated: This was a review article that looked at existing research and information about prehabilitation barriers—not a study with patient participants
  • Key finding: The three biggest obstacles preventing hospitals from offering prehabilitation are: (1) uncertainty about whether the programs save money overall, (2) not having enough doctors, nurses, and trainers to run the programs, and (3) lack of official government policies requiring or supporting these programs
  • What it means for you: If you’re facing major surgery, especially if you’re older or have multiple health conditions, you might benefit from asking your doctor about prehabilitation programs. However, availability depends on your hospital’s resources and location. This research suggests hospitals need better support and clearer guidelines to make these programs available to more patients.

The Research Details

This is a review article, which means the authors didn’t conduct their own experiment but instead looked at existing research, data, and information about prehabilitation programs. They examined what’s known about prehabilitation—programs that help patients exercise, eat better, manage stress, and make lifestyle changes before surgery—and investigated why these programs aren’t widely available in UK hospitals despite evidence that they work.

The authors focused specifically on identifying barriers (obstacles) that prevent hospitals from offering prehabilitation. They looked at practical challenges like money, staffing, and policy issues rather than testing a new treatment or comparing different groups of patients.

This type of research is valuable for understanding “why” problems exist in healthcare systems, which is different from studies that test whether a treatment works. By identifying barriers, the authors help policymakers and hospital leaders understand what needs to change.

Understanding barriers is crucial because it’s not enough to know that prehabilitation works—we also need to know why hospitals aren’t using it. If hospitals don’t have the resources, training, or official support, even the best medical treatments won’t reach patients. This type of research helps identify what needs to change at the system level, not just the patient level.

This is a review article published in a respected medical journal, which means it went through expert review. However, because it’s not a research study with participants, it doesn’t have the same type of evidence as clinical trials. The findings depend on what research and information the authors found and how they interpreted it. The specific barriers identified may be most relevant to the UK healthcare system and might differ in other countries.

What the Results Show

The authors identified three major barriers preventing UK hospitals from offering prehabilitation programs:

Cost-Effectiveness Concerns: Hospitals struggle to justify the expense of prehabilitation programs because it’s unclear whether the money saved from fewer complications and shorter hospital stays outweighs the upfront costs of running the programs. This is a common challenge in healthcare—even when something works, hospitals need proof it won’t break their budget.

Workforce Shortage: There aren’t enough trained professionals (doctors, nurses, physical therapists, nutritionists, and psychologists) available to run comprehensive prehabilitation programs. These programs need multiple types of specialists working together, and many hospitals simply don’t have this team available.

Lack of National Policy: At the time of this article, the UK didn’t have official government guidelines or policies requiring or supporting prehabilitation programs. Without clear national direction, individual hospitals have little incentive to invest in these programs, and there’s no standardized approach across the country.

The research also highlights why prehabilitation is increasingly important: the population is aging, more older adults are having complex surgeries, and conditions like obesity, frailty, and multiple chronic diseases are becoming more common. About 12.5% of surgical patients are considered ‘high-risk’ (older, frailer, or with multiple health conditions), but these patients account for 80% of deaths after surgery. Prehabilitation appears to be most effective when it’s personalized and includes multiple components: exercise training, better nutrition, psychological support, and lifestyle changes.

This research builds on existing evidence showing that prehabilitation reduces complications, shortens hospital stays, and decreases readmissions (patients returning to the hospital). The new contribution here is identifying why these proven programs aren’t being widely implemented. Previous research answered ‘does it work?’ This article answers ‘why isn’t it being used?’ This is an important next step in translating research into real-world healthcare.

This is a review article rather than a study measuring actual outcomes, so the findings about barriers are based on the authors’ analysis of existing information rather than new data collection. The barriers identified may be specific to the UK healthcare system and might not apply equally to other countries with different healthcare structures. The article doesn’t provide detailed statistics about how many hospitals face each barrier or how severe each obstacle is. Additionally, the research doesn’t propose specific solutions to these barriers, only identifies them.

The Bottom Line

For Patients: If you’re facing major surgery and are older, overweight, or have multiple health conditions, ask your surgical team whether prehabilitation programs are available. Even if formal programs aren’t offered, discuss with your doctor how you can improve your fitness, nutrition, and mental health before surgery. For Healthcare Systems: Prehabilitation programs should be prioritized, especially for high-risk patients, with government support for funding and workforce training. Confidence Level: High for the importance of prehabilitation (based on existing research), but moderate for specific implementation strategies (this article identifies problems but not solutions).

Should care: Older adults facing surgery, people with multiple chronic health conditions, people with obesity, people with frailty or muscle weakness, and their families. Also important for hospital administrators, surgeons, and policymakers. Shouldn’t assume this applies: People having minor, low-risk procedures may not need formal prehabilitation, though general fitness is always beneficial.

Prehabilitation programs typically run for 4-8 weeks before surgery. Patients may notice improved fitness and confidence within 2-3 weeks. The biggest benefits appear after surgery—reduced complications and faster recovery typically become apparent in the weeks and months following the operation. System-level changes (implementing prehabilitation programs nationally) would take months to years.

Want to Apply This Research?

  • Track pre-surgery fitness metrics: daily steps (aiming for 7,000-10,000), exercise minutes (150 minutes moderate activity per week), and nutrition compliance (servings of fruits/vegetables daily). If prehabilitation is available, log completion of prescribed exercises and appointments.
  • If you’re scheduled for surgery, use the app to: (1) Set a pre-surgery fitness goal with your doctor, (2) Log daily exercise and nutrition, (3) Track mood/stress levels to monitor mental health, (4) Set reminders for prehabilitation appointments if available, (5) Record how you feel (energy, strength, confidence) to see improvements over time.
  • Create a pre-surgery baseline (current fitness level, weight, mood) and track weekly progress toward goals. After surgery, continue tracking recovery milestones (pain levels, mobility, return to activities) to measure the impact of pre-surgery preparation. Share data with your surgical team to adjust the prehabilitation plan if needed.

This article is a review of existing research about barriers to prehabilitation programs and does not provide medical advice. If you are scheduled for surgery, consult with your surgical team about whether prehabilitation is appropriate for you and what specific exercises, nutrition changes, or other preparations are safe and recommended. The barriers identified in this research are based on UK healthcare system analysis and may not apply to all healthcare settings. Always follow your doctor’s specific recommendations for pre-surgery preparation.