• Derek K W Yau, Floria F Ng, Man-Kin H Wong, Malcolm J Underwood, WongRandolph H LRHLDivision of Cardiothoracic Surgery, Department of Surgery, Chinese University of Hong Kong, Hong Kong SAR, China., Gavin M Joynt, and Anna Lee.
• Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Hong Kong SAR, China.
• Br J Anaesth. 2025 Jan 1; 134 (1): 455345-53.

BackgroundPhysical prehabilitation can enhance patient resilience to surgical stress, but its effects are unclear in vulnerable and frail patients. We aimed to determine the effect of a structured exercise prehabilitation programme on the quality of recovery after cardiac surgery in vulnerable and frail participants.MethodsThis single-blinded, parallel-arm, superiority, randomised controlled trial recruited patients with a Clinical Frailty Scale of 4-6 undergoing cardiac surgery. Patients were randomised to either physical prehabilitation (twice weekly) or standard care (control); both arms received standard perioperative care. The primary outcome was Quality of Recovery-15 (QoR-15) score on the third day after surgery. Secondary outcomes included major adverse cardiac and cerebrovascular events (MACCE), days alive and at home (DAH30), and the World Health Organization Disability Assessment Schedule (WHODAS) 2.0 metric.ResultsOf 164 randomised patients, 138 were included in the primary analysis (median age 64 [interquartile range 60-69] yr; 70% males). Compliance with the 5-week prehabilitation programme was high (82%), with no adverse exercise-induced events reported. There were no between-group differences in QoR-15 scores (median difference -3, 95% confidence interval [CI] -9 to 3), early and late MACCE, and DAH30 (P=0.779). Prehabilitated patients had lower disability levels than control patients (P=0.022) at 90 days after surgery (mean difference -9%, 95% CI -17% to -2%).ConclusionsA 5-week programme of physical prehabilitation in predominately prefrail patients was safe, but it did not enhance quality of recovery scores after surgery. Prehabilitation resulted in a clinically meaningful decrease in disability scores at 90 days after surgery.Clinical Trial RegistrationChiCTR1800016098.Copyright © 2024 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

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