Prehabilitation for Surgery Preparation

Overseen By Emily Hladkowicz, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Ottawa Hospital Research Institute

Disqualifiers: Cardiac, Neurological, Orthopedic, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 30

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores how a home-based program can help people prepare for surgery. The Prehabilitation Intervention includes exercises, nutrition tips, and breathing exercises, all guided through an online platform. Participants are divided into two groups: one uses this program, while the other receives general health advice without extra support. It is designed for individuals scheduled for surgery in the abdominal, thoracic, pelvic, head-and-neck, or vascular areas who have internet access. As an unphased trial, this study offers a unique opportunity to contribute to innovative research that could enhance surgical recovery for future patients.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

What prior data suggests that this prehabilitation program is safe for surgery preparation?

Research shows that prehabilitation, which includes exercise, nutrition, and breathing exercises, is generally safe for people preparing for surgery. Studies have shown that patients who engage in prehabilitation experience fewer problems post-surgery. For example, one study found that these activities could reduce complications by up to 44%. Another study highlighted that exercise, a key part of prehabilitation, effectively lowers the risk of post-surgery issues.

Overall, prehabilitation is well-tolerated, with few negative effects reported. This approach focuses on improving patients' health before surgery, aiming to help, not harm. For those considering joining a trial for this treatment, existing research supports its safety and benefits. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the Prehabilitation Intervention for surgery preparation because it focuses on a proactive, holistic approach to patient readiness. Unlike traditional methods that emphasize post-surgery rehabilitation, this intervention combines exercise, nutrition, and breathing exercises before surgery. Delivered through a home-based, online platform, it empowers patients to enhance their physical condition and potentially improve surgical outcomes. This innovative approach aims to optimize patients' health before surgery, potentially leading to faster recovery times and better overall results.

What evidence suggests that this prehabilitation intervention is effective for surgery preparation?

Research shows that prehabilitation before surgery can lead to better outcomes. In this trial, participants in the intervention arm will engage in a home-based multimodal prehabilitation program, which includes exercises, good nutrition, and breathing techniques. Studies have found that exercise-based prehabilitation can reduce the risk of complications after surgery, such as infections, by up to 44%. It also aids recovery by boosting short-term physical abilities. Most patients find these programs easy to follow and helpful. Overall, prehabilitation offers a promising way to prepare for surgery and enhance recovery. ^{1 2 3 5 6}

Who Is on the Research Team?

Daniel McIsaac, MD

Principal Investigator

The Ottawa Hospital

Are You a Good Fit for This Trial?

This trial is for adults over 18 who are scheduled for inpatient abdominal, thoracic, pelvic, head-and-neck or vascular surgery within the next 3 to 12 weeks. Participants must have a valid health insurance number and access to an internet-enabled device with an email address.

Inclusion Criteria

Valid provincial health insurance number

Access to internet-enabled device

Email address

Exclusion Criteria

No telephone/cell phone

I cannot read or communicate in English.

I am not interested in joining based on my physical activity phone assessment.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Prehabilitation

Participants engage in a home-based multimodal prehabilitation program supported through an online platform, including exercise, nutrition, and breathing exercises

8-10 months

Virtual support through online platform

Surgery and Immediate Recovery

Participants undergo surgery and are monitored for immediate postoperative recovery and complications

Up to 1 month

In-hospital stay

Follow-up

Participants are monitored for safety, effectiveness, and quality of life after surgery

1 year

Follow-up assessments at 30 days, 3 months, and 1 year

What Are the Treatments Tested in This Trial?

Interventions

• Prehabilitation Intervention

Trial Overview The STRIVE Trial is testing a home-based prehabilitation program delivered through an online platform before surgery. Participants are randomly placed into either the prehabilitation group or a control group to compare outcomes.

How Is the Trial Designed?

Group I: Intervention Experimental Treatment 1 Intervention

The intervention includes 3 aspects (exercise, nutrition and breathing). Our intervention is a home-based multimodal prehabilitation program supported through an online platform.

Group II: Control Active Control 1 Intervention

To support blinding, improve enrollment and reflect usual care, widely available physical activity (World Health Organization Recommendations for Physical Activity for ages 18-64 and \>65) and healthy eating recommendations (Canada's Food Guide Snapshot) documents will be provided to control participants (without active or online support).

Who Is Running the Clinical Trial?

Ottawa Hospital Research Institute

Lead Sponsor

Trials

585

Recruited

3,283,000+

Canadian Institutes of Health Research (CIHR)

Collaborator

Trials

1,417

Recruited

26,550,000+

Published Research Related to This Trial

This systematic review aims to evaluate the effectiveness of various prehabilitation interventions, such as physical activity and nutritional support, in improving surgical outcomes for patients undergoing elective surgery, based on randomized controlled trials (RCTs).

The review will follow rigorous guidelines and assess the quality of studies to identify which specific prehabilitation strategies are most effective in reducing postoperative complications and enhancing recovery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Pre-admission interventions to improve outcome after elective surgery-protocol for a systematic review. Perry, R., Scott, LJ., Richards, A., et al.[2021]

Prehabilitation programs for patients undergoing major abdominal cancer surgery include a mix of exercise, nutritional, and psychological interventions, but their composition and delivery methods vary widely across studies, indicating a need for standardization.

In a review of 9 studies involving 549 patients, no significant differences in post-operative complications were found between prehabilitation and standard care, suggesting that while prehabilitation may optimize recovery, its impact on reducing complications needs further investigation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A systematic review of prehabilitation programs in abdominal cancer surgery. Hijazi, Y., Gondal, U., Aziz, O.[2022]

A systematic review of 17 studies, primarily focused on orthopedic surgeries, found that preoperative rehabilitation (prehabilitation) does not significantly improve functional status, quality of life, or pain after surgery.

However, prehabilitation may reduce the need for rehabilitation admissions following knee or hip arthroplasty for osteoarthritis, suggesting a potential benefit in this specific context.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Impact of Prehabilitation on Postoperative Functional Status, Healthcare Utilization, Pain, and Quality of Life: A Systematic Review. Cabilan, CJ., Hines, S., Munday, J.[2018]

A 4-week prehabilitation program involving physical therapy, nutritional support, and psychological preparation was safely implemented in 60 out of 106 patients scheduled for major abdominal surgery, with no cardiovascular events reported during the program.

Patients showed significant improvements in physical function (6-minute walking distance increased by 9.3%) and psychological well-being, suggesting that prehabilitation can enhance recovery and quality of life before surgery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Prehabilitation before major abdominal surgery: Evaluation of the impact of a perioperative clinical pathway, a pilot study. Boukili, IE., Flaris, AN., Mercier, F., et al.[2022]

Prehabilitation aims to improve surgical outcomes by addressing modifiable risk factors before surgery, but understanding which interventions are effective for specific patients is crucial for its success.

Incorporating 'third-variable effects'—such as mediators, moderators, and confounders—into prehabilitation research design can help clarify how and when these interventions work, leading to better clinical implementation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Third-Variable Effects: Tools to Understand Who, When, Why, and How Patients Benefit From Surgical Prehabilitation. Gillis, C., Gramlich, L., Culos-Reed, SN., et al.[2021]

Prehabilitation, which involves preoperative interventions targeting physical, nutritional, and mental health, can significantly enhance postoperative outcomes by optimizing patients' conditions before surgery.

A multidisciplinary approach to prehabilitation creates a synergistic effect, leading to improved recovery, and although more high-quality evidence is needed, prehabilitation programs are being implemented globally, transforming perioperative care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Prehabilitation, making patients fit for surgery - a new frontier in perioperative care. Molenaar, CJL., Papen-Botterhuis, NE., Herrle, F., et al.[2021]

A systematic review of 33 studies involving 3167 citations found that prehabilitation did not significantly improve postoperative function, quality of life, or pain in patients undergoing knee or hip arthroplasty for osteoarthritis.

However, prehabilitation programs lasting over 500 minutes may reduce the need for postoperative rehabilitation, indicating a potential benefit in healthcare utilization, even though no significant reductions in readmissions or nursing home placements were observed.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effectiveness of prehabilitation or preoperative exercise for surgical patients: a systematic review. Cabilan, CJ., Hines, S., Munday, J.[2022]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8487197/

Pre-admission interventions (prehabilitation) to improve ... Immunonutrition reduced infective complications (risk ratio (RR) 0.64 95% CI 0.40 to 1.01) and IMT, and exercise reduced postoperative pulmonary complications ( ...

2. sciencedirect.com sciencedirect.com/science/article/pii/S2161831325000286

Prehabilitation Strategies: Enhancing Surgical Resilience ... Details the outcomes of various prehabilitation studies, including their population characteristics, intervention types, and outcome measurements. Key ...

3. bmj.com bmj.com/content/388/bmj-2024-081164

Relative efficacy of prehabilitation interventions and their ... Most importantly, our data suggest that exercise is the prehabilitation component most likely to improve critical outcomes. ... For cognitive and ...

4. clinicalnutritionjournal.com clinicalnutritionjournal.com/article/S0261-5614(24)00015-3/fulltext

The impact of prehabilitation on outcomes in frail and high ... Ten studies addressed severe complications and a meta-analysis suggested a decline in occurrence by up to 44 % (odds ratio 0.56, 95 % CI 0.37 to ...

5. bmcgastroenterol.biomedcentral.com bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-025-03626-3

The role of exercise-based prehabilitation in enhancing ... Prehabilitation reduces postoperative complications and improves short-term physical function in digestive surgery patients, with good patient acceptance.

6. massgeneral.org massgeneral.org/news/article/prehabilitation-preparing-for-surgery-to-improve-outcomes

Prehabilitation: Preparing for Surgery to Improve Outcomes Research has shown that patients who engage in prehabilitation experience fewer complications, experience less pain, and enjoy faster recoveries ...