What is prehab, and how can it help me before my surgery?
Prehab, or prehabilitation, is the window before your treatment or surgery takes place where you can influence your recovery on the other side.
What prehabilitation is
Prehab is the work you do before treatment starts, to be in the best condition you can be when it does.
The UK guidance, published by Macmillan Cancer Support with the Royal College of Anaesthetists and the NIHR Cancer and Nutrition Collaboration, defines it as enabling "people with cancer to prepare for treatment through promoting healthy behaviours and through needs-based prescribing of exercise, nutrition and psychological interventions."
It's not just exercise. Prehab has three domains: physical activity and exercise, nutrition, and psychological support. The guidance notes that a multimodal approach addressing more than one of these "may be more effective than a unimodal approach that addresses just one or the other." A Clinical Exercise Physiologist delivers the exercise and assists your behaviour change, alongside other professionals such as a nutritionist.
It's prescribed. "Needs-based prescribing" is the key phrase. Prehab is built from an assessment of you; it is bespoke.
It isn't simply the opposite of rehab. The guidance is explicit that "prehabilitation is part of a continuum to rehabilitation." What you start now doesn't stop when you go into theatre. The aim is to "maximise resilience to treatment."
Why the weeks before treatment matter
I’ve always liked this phrase: "You wouldn't run a marathon without undertaking any training."
Major surgery asks a great deal of your body in a very short space of time, so does chemotherapy and all cancer treatment. You can give yourself the best opportunity to come through well with how much physical reserve you have for recovery.
The best way I have been able to describe this concept is to think of your capacity like a battery. If your battery is depleted when treatment starts, your treatment will take energy required from your essentials. That is getting up the stairs, washing yourself, staying additional nights in the hospital. If the battery has more in the tank, there's more to lose before daily life is affected. Your physical reserve is one of the few things in cancer treatment you can influence.
What prehab is trying to achieve
UK guidance says prehabilitation can:
- reduce your length of stay in hospital
- reduce complications after treatment
- enhance recovery following treatment
- improve cardiorespiratory fitness
- improve nutritional status
It also names three broader benefits: personal empowerment: "fostering a sense of control and purpose"; physical and psychological resilience; and long-term health.
The strongest surgical evidence comes from abdominal, colorectal and lung surgery, where most of the trials have been done. ASCO's 2022 treatment guideline recommends preoperative exercise specifically for people scheduled for lung cancer surgery.
And the guidance itself notes "variability in the strength of evidence particularly for multi-modal interventions." Prehab is well-founded, and the exciting bit is it's still a developing field.
"I've only got two weeks — is it worth starting?"
Yes, and this is the single most common reason people don't start.
"Prehabilitation interventions can still be effective if begun as little as two weeks prior to treatment." While "the available health benefits will be maximised if people with cancer have as long as possible." Longer is better with prehab typically runs four to six weeks, depending on the time between diagnosis and treatment and two weeks is not too short to bother.
A randomised trial of a two-week home-based prehab programme, which included exercise, breathing work, nutrition and psychological support, in people having keyhole lung surgery measured walking capacity as its primary outcome, because that is a fortnight's realistic target.
Even if you have less than two weeks, I would still encourage you to start.
"I've just been diagnosed and I'm exhausted"
This is completely normal; the weeks after a diagnosis are physically and emotionally exhausting. People sleep badly, eat differently, and spend a lot of energy simply absorbing what they've been told.
The guidance actually sets interventions at three levels: universal, targeted, and specialist. People will sit at different levels in different domains. You might need specialist input on nutrition and something much gentler on exercise for example.
In practice, on a low-energy week, prehab might be a short walk each day, a few simple strength movements in a chair, and a conversation about eating enough protein.
What a prehab programme looks like
An assessment first. Your diagnosis and planned treatment, your surgical date, your medications and other conditions, and some baseline measures, which will depend on who you are and current fitness levels.
A plan built backwards from your date. If surgery is in five weeks, the programme will run to five weeks and peaking just before.
Week by week, adjusted as you go. Progress where you can absorb it, hold steady where you can't, and shift things around the scans, appointments, and pre-op assessments that fill this period.
A handover into treatment. Prehab ends when treatment starts, but the relationship doesn't have to; what you've built becomes the starting point for recovery on the other side.
Is it safe, and does anyone need to sign it off?
Broadly yes, with screening, the same principle that applies to exercise during treatment. Your CEP will work through what needs checking before anything starts, modifying the programme and speaking to your oncology team, where needed. Abdominal and chest surgery, heart or lung disease, significant nutritional problems and cancer affecting the bone it is suggested the CEP speaks to your team.
Ask your team if there is any reason not to, and whether anything specific should be avoided before your operation.
What happens after surgery
A prehabilitation and rehabilitation are one continuum, the assessment, the baselines and the working relationship all carry over. Recovery starts from a known position rather than from scratch, which is the practical argument for not treating prehab as a separate, finished thing. → What does an exercise physiologist actually do for someone going through cancer treatment?
Does the NHS offer this?
Sometimes, it's improving, but it is not everywhere yet. Some trusts and cancer alliances run good services. Greater Manchester's Prehab4Cancer offers free exercise, nutrition and wellbeing support to people with a recent diagnosis, delivered with the NHS through local leisure facilities. If something like that exists where you are, ask your team about it directly.
The National Cancer Plan for England commits to this nationally: "From 2028, we will roll out a national digital-first prehabilitation offer to help all patients get healthier before they start treatment."
Getting started
- Find out your date, or your best estimate of it; everything is planned backwards from it.
- Ask your team Is there any reason I shouldn't be exercising before my operation?
- Start moving today, at whatever level you can manage, and walking counts.
- If there's no NHS service available to you, get someone qualified. With a short window, the assessment is important to make sure you focus on the right thing.
Ready to talk to someone? Tell us about your diagnosis, where you are in treatment, and where you're based. We'll match you with a Clinical Exercise Physiologist who specialises in cancer — AHCS-registered and personally verified by our team.
This article is general information and is not a substitute for advice from your oncology or surgical team. Always speak to them before starting or changing physical activity before treatment.
Sources
- Macmillan Cancer Support, Royal College of Anaesthetists and NIHR Cancer and Nutrition Collaboration. Principles and guidance for prehabilitation within the management and support of people with cancer. 2019. https://www.macmillan.org.uk/healthcare-professionals/news-and-resources/guides/principles-and-guidance-for-prehabilitation
- Faithfull S, Turner L, Poole K, et al. Prehabilitation for adults diagnosed with cancer: A systematic review of long-term physical function, nutrition and patient-reported outcomes. Eur J Cancer Care. 2019;e13023. https://doi.org/10.1111/ecc.13023
- Department of Health and Social Care. The National Cancer Plan for England: delivering world class cancer care. 2026. https://www.gov.uk/government/publications/national-cancer-plan-for-england/the-national-cancer-plan-for-england-delivering-world-class-cancer-care-accessible-version
- Ligibel JA, Bohlke K, May AM, et al. Exercise, Diet, and Weight Management During Cancer Treatment: ASCO Guideline. J Clin Oncol. 2022;40(22):2491–2507. https://pubmed.ncbi.nlm.nih.gov/35576506/
- Campbell KL, Winters-Stone KM, Wiskemann J, et al. Exercise Guidelines for Cancer Survivors: Consensus Statement from International Multidisciplinary Roundtable. Med Sci Sports Exerc. 2019;51(11):2375–2390. https://journals.lww.com/acsm-msse/fulltext/2019/11000/exercise_guidelines_for_cancer_survivors_.23.aspx
- Liu Z, et al. Two-Week Multimodal Prehabilitation Program Improves Perioperative Functional Capability in Patients Undergoing Thoracoscopic Lobectomy for Lung Cancer: A Randomized Controlled Trial. Anesth Analg. 2019. https://doi.org/10.1213/ANE.0000000000004342
- Prehab4Cancer, Greater Manchester. https://prehab4cancer.co.uk/