Prehabilitation means building strength, fitness and nutrition in the weeks before surgery. What the evidence shows and a safe plan to discuss with your team.
Prehabilitation is a structured plan of exercise, nutrition and healthy habits in the weeks before a planned operation. The best evidence is that it can reduce complications, especially lung complications, after major surgery. A sensible plan combines walking or other aerobic exercise, strength work, breathing exercises, enough protein and, if relevant, stopping smoking, all agreed with your surgical team.
Why does preparing before surgery help?
Surgery is a physical stress, and the days afterwards usually involve less movement and rapid muscle loss. If you start with more strength, fitness and nutritional reserve, you have more to draw on. This is the idea behind prehab.
A 2019 systematic review and meta-analysis in the World Journal of Surgery pooled 15 randomised trials in major abdominal surgery. It found significantly fewer overall complications (odds ratio 0.63) and fewer lung complications (odds ratio 0.40) with prehabilitation. Length of stay was shorter by about 2.4 days on average, but that difference was not statistically significant. A 2024 Cochrane review looked at prehabilitation before cardiac surgery. Evidence quality varies between operations, so the honest summary is promising but not guaranteed, and it depends on your procedure.
What does a prehab programme include?
| Component | Typical approach | Notes |
|---|---|---|
| Aerobic exercise | Brisk walking or cycling, 20 to 30 minutes, 3 to 5 days a week | Build gradually. Talking should stay possible |
| Strength | 2 days a week: sit-to-stand, band rows, step-ups, glute bridge, wall push-up, 2 to 3 sets of 8 to 12 | Prioritise the muscles you need for recovery, such as legs for hip and knee surgery |
| Breathing | Deep breathing and cough practice, 5 minutes, 2 to 3 times a day | Often used before chest and abdominal surgery. Your team may give an incentive spirometer |
| Nutrition | Protein at every meal, enough total food | See below |
| Habits | Stop smoking, cut back alcohol, sleep 7 hours | Ask for cessation support |
Learn the strength moves in how to do a squat, how to do a glute bridge and how to do a wall push-up. For the aerobic base, see walking for longevity.
Eating for surgery
Protein supports wound healing and limits muscle loss. The ESPEN practical guideline on clinical nutrition in surgery suggests about 1.5 g of protein per kg of ideal body weight per day for patients at nutritional risk. For a 65 kg person that is roughly 98 g a day, a figure that may be higher than your usual intake. Spread it over meals: eggs or dhal at breakfast, fish or chicken at lunch and dinner, with tofu, tempeh, milk or yoghurt as snacks. Our guides on how much protein after 50 and Malaysian foods for longevity help. People with kidney disease or diabetes need individual advice from their doctor or dietitian. Follow your hospital’s fasting instructions exactly on the day.
Stopping smoking and vaping
The WHO advises that quitting about four weeks before surgery reduces the risk of complications, and that the benefit grows each tobacco-free week after that. In Malaysia, ask your doctor or a clinic for quit support, including nicotine replacement and the MOH Quit Smoking services (Klinik Berhenti Merokok).
A simple 4-week example
- Week 1: walk 15 to 20 minutes daily, breathing practice twice a day, add one extra protein serving.
- Week 2: walk 25 to 30 minutes on most days, start strength 2 days a week, 1 set of each exercise.
- Week 3: add a second set, include a brisk-pace interval of 1 to 2 minutes within walks.
- Week 4: keep the routine, but reduce intensity in the final 2 to 3 days. Practise getting in and out of bed and a chair, as you will after surgery, and prepare your home.
Malaysian context
Waiting times for elective surgery in public hospitals can be several months, which gives a real window for preparation. Ask whether the hospital physiotherapy or dietetic unit can see you before admission. In the heat, walk early or in a shaded park or air-conditioned mall, and keep fluids up unless you have been told to restrict them.
Safety and red flags
Prehab must fit your condition and operation. Check with your surgeon or doctor before starting, and stop and call them if you have:
- Chest pain, pressure or unusual breathlessness
- Dizziness, fainting or a racing heartbeat
- New leg swelling or calf pain
- Fever, or a flare of the problem you are being operated on
- Severe pain that does not settle after exercise
Cancer, heart, lung or kidney conditions need a tailored plan. This is general education, not medical advice. After surgery, the same habits carry into recovery, as in exercise after surgery or joint replacement and exercise after knee or hip replacement. Also see when to get medical clearance before exercise. If you want guided preparation coordinated with your medical team, we run home-visit assessments across KL and Selangor.
Key takeaways
- Prehab combines exercise, breathing work, protein and healthy habits before planned surgery.
- A 2019 meta-analysis found fewer overall and lung complications after major abdominal surgery.
- Start as soon as surgery is planned. Even 2 weeks helps, but do not delay urgent surgery.
- Aim for protein at every meal and stop smoking, ideally at least 4 weeks before.
- Get your surgeon’s clearance first and stop for chest pain, dizziness or leg swelling.