MOVEMENT + REHABILITATION · COLORECTAL CANCER
We often think of rehabilitation as something that begins after surgery. Prehabilitation turns that timeline around: use the short window before an operation to build reserve, correct what can be corrected, and arrive less depleted. The idea is intuitive. The evidence is promising, but it is not a blank check for any exercise program labeled “prehab.”
Evidence at a glance
- Studied population: adults with nonmetastatic colorectal cancer preparing for elective surgery.
- Studied program: four weeks of supervised high-intensity exercise three times weekly, plus nutrition, psychological support and smoking cessation when needed.
- Main signal: severe complications occurred in 17.1% with prehabilitation versus 29.7% with standard care.
- Important negative finding: the primary walking-distance comparison four weeks after surgery was not statistically significant.
- Bottom line: worth discussing, especially when a coordinated program is available; no single recipe is established for everyone.
What the trial actually tested
The international PREHAB randomized trial enrolled 251 people, median age 69. This was not simply advice to “walk more.” It was a supervised, multimodal program layered onto modern enhanced-recovery surgical care. Severe postoperative complications were lower: 21 of 123 people in prehab versus 38 of 128 in standard care. Medical complications, including respiratory problems, were also lower—15.4% versus 27.3%.
But the functional result was more restrained. At four weeks after surgery, the difference in six-minute walking distance was 15.6 meters, with a confidence interval crossing zero and a P value of .07. The trial also stopped early during the COVID-19 pandemic. Those details matter. They tell us the complication signal is encouraging, while the recovery story is not settled.
Why the answer is still not one-size-fits-all
A 2024 systematic review found 23 randomized trials involving 2,475 patients, but the programs varied widely: multimodal packages, exercise alone, nutrition alone and psychological support. That heterogeneity makes it difficult to name one best dose. The 2025 ERAS Society colorectal guideline reviewed the growing literature and concluded that no specific prehabilitation regimen could yet be recommended.
Safety is part of the intervention. High-intensity exercise may be inappropriate without modification for someone with anemia, heart or lung disease, fall risk, severe weight loss, obstruction symptoms or treatment-related weakness. Nutrition support should respond to actual malnutrition; it should not become indiscriminate supplementation. And prehabilitation should not quietly delay time-sensitive cancer surgery.
Questions for the care team
- Is there enough time before surgery to benefit without delaying the operation?
- Should I have a baseline exercise, nutrition, anemia or frailty assessment?
- Is there an oncology-trained physical therapist or formal prehabilitation program available?
- Which symptoms should make me stop exercising and call?
- How will the plan continue after surgery?
Prehabilitation is not a cancer treatment, and it has not been shown to control a tumor. Its purpose is narrower and practical: help a person tolerate the treatment already chosen. That is still meaningful.
Evidence checked October 6, 2026. Educational review; individual exercise and surgical decisions belong with your care team. Explore the Missing Script library or visit the podcast—coming soon.
