LUMEN ET VIRTUS · Oct 22, 2026
Exercise prehabilitation and functional recovery after surgery in older adults: a systematic review
By BARBACENA PVB, Costa ND, Rodrigues VSM et al.
OBJECTIVE: To assess whether structured exercise-based prehabilitation, performed before major elective surgery, improves functional capacity, physical performance, mobility, independence, or return to preoperative functional status in adults aged 65 years or older. METHODS: An exploratory systematic update was conducted on 28 September 2026. PubMed/MEDLINE, public Cochrane pages, PEDro, PROSPERO, ClinicalTrials.gov, and citation chains were examined. Search protocols were prepared for Embase, CENTRAL, Scopus, and Web of Science; searches of these databases could not be run because of a lack of licensed access or authentication, and the public CENTRAL interface returned no results. Randomized trials involving participants aged ≥65 years, major elective surgery, structured exercise in the preoperative period, a usual care/no structured exercise comparator, and at least one postoperative functional outcome were eligible. RESULTS: Three trials met the strict criteria. The CANOPTIPHYS study demonstrated no significant between-group difference in distance covered in the six-minute walk test or in the 30-second sit-to-stand test at discharge. A trial in frail older adults undergoing gastric surgery reported a favorable signal for return to baseline walking level at four weeks, but had inconsistent denominators and did not provide a confidence interval for the functional effect. A pilot study before hip arthroplasty showed no difference in time to functional independence. Conducting a new meta-analysis was not defensible. CONCLUSIONS: The available evidence does not demonstrate that exercise-based prehabilitation consistently improves postoperative functional recovery in older adults. Effects on preoperative capacity appear more promising than effects on independence, mobility, and return to baseline status. The certainty of the evidence is low or very low.