[Position paper on prehabilitation in Germany]

Prehabilitation is gaining increasing importance as an integral component of modern, patient-centered perioperative care. The objective of this position paper is to outline the current national and international state of prehabilitation, to highlight existing barriers to its implementation and to provide practical recommendations for clinical application. Particularly in older, multimorbid and oncology patients, targeted preoperative interventions, such as exercise therapy, nutritional support, psychological counselling, and additional measures, can contribute to reducing postoperative complications, accelerating recovery and improving the quality of life. Despite the growing body of international evidence, implementation in Germany has so far been slow, often hindered by a lack of reimbursement structures and limited resources. This paper therefore advocates a stepwise introduction of prehabilitation measures, tailored to high-risk groups and aligned with local healthcare reality. It is emphasized that prehabilitation should not be regarded as an isolated intervention but as an integrative element within established concepts such as enhanced recovery after surgery (ERAS) and rehabilitation. Furthermore, the paper addresses the need for national networking, harmonized standards, digital solutions and structural as well as political support to ensure sustainable integration.