Impact of Exercise Therapy in ERAS Prehabilitation for Major Surgery: A Systematic Review

(1) This systematic review evaluates the role of structured exercise within the Enhanced Recovery After Surgery (ERAS) protocol, a multidisciplinary approach designed to reduce surgical stress and enhance recovery. Prehabilitation, primarily through controlled physical activity, is a fundamental component of ERAS, preparing patients, both physically and mentally, for major surgery. (2) A systematic search following PRISMA guidelines was conducted using PubMed, ScienceDirect, Cochrane Library, Web of Science and Wiley databases to identify relevant studies published up to January 2025. Inclusion criteria encompassed randomized controlled trials, cohort studies, and meta-analyses reporting postoperative complications, length of hospital stay (LOS), and overall recovery. (3) A total of 64 studies met the inclusion criteria. The findings consistently demonstrate that structured exercise interventions-such as aerobic activities, resistance training, and flexibility routines-were associated with postoperative complications, shorten hospital stays, and enhance functional recovery. These interventions improve cardiorespiratory fitness, muscle strength, and psychological well-being. (4) Despite potential limitations in the systematic search, as heterogeneity of protocols, publication bias, language restrictions, the evidence supports the integration of structured exercise as a cornerstone of ERAS prehabilitation. Future research should focus on standardizing exercise protocols and exploring personalized strategies to optimize surgical outcomes across diverse patient populations.