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Home-Based Prehabilitation for Older Surgical Patients With Frailty: A Randomized Clinical Trial
Daniel I McIsaac1,2,3, Susan Lee4,5, Dean Fergusson6
1Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada.
JAMA Surgery
|December 3, 2025
Summary
Home-based prehabilitation did not significantly improve postoperative disability or reduce complications in older, frail surgical patients. Adherence to exercise programs showed some benefit, but overall outcomes remained unchanged.
Area of Science:
- Geriatric Medicine
- Surgical Outcomes
- Rehabilitation Medicine
Background:
- Prehabilitation shows promise for improving surgical outcomes.
- The effectiveness of home-based prehabilitation for frail, older adults across multiple centers is not well-established.
Purpose of the Study:
- To assess the effectiveness of coach-supported, home-based prehabilitation in frail, older surgical patients.
Main Methods:
- A pragmatic, multicenter randomized clinical trial involving 847 older adults (≥60 years) with frailty undergoing elective surgery.
- Participants were randomized to home-based prehabilitation (exercise and nutrition) or usual care.
- Coprimary outcomes included postoperative disability (WHODAS 2.0) and complication incidence at 30 days.
Main Results:
- Prehabilitation did not significantly improve postoperative disability (mean difference -1.4; P=.36) or reduce complications (OR 1.05; P=.78).
- Participants completing >75% of exercises had lower disability scores (P=.02), but complications were not significantly different.
- Primary barriers to adherence included competing priorities and motivation.
Conclusions:
- Home-based prehabilitation did not enhance outcomes for frail, older surgical patients in this trial.
- Adherence to exercise may be linked to reduced disability, but further research is needed to optimize interventions.
