People preparing for major surgery might instinctively believe they should rest and conserve their energy for the procedure and recovery ahead.
However, research suggests the opposite approach yields better results. A new study has found that “prehabilitation”—especially when personalized with one-on-one coaching—significantly improves surgical outcomes.
The Power of Personalized Preparation
Patients who participated in a customized prehab program featuring twice-weekly coaching sessions were notably better prepared for surgery than those who received only standard pre-surgery recommendations without direct guidance, according to research published on November 12 in the journal JAMA Surgery.
Those receiving personal coaching showed meaningful improvements across every measure of physical and mental fitness before their procedures. They also experienced beneficial immune system changes that supported their post-surgery recovery and had fewer serious complications.
Dr. Brice Gaudilliere, a professor of anesthesiology, perioperative and pain medicine at Stanford University and senior author of the study, explained in a news release: “You can think of prehab as a way to train — not just your physical resilience, but also your immunological, neurocognitive and psychological state, to really prepare for this major trauma of surgery.”
Proper nutrition, regular exercise, and adequate sleep all help strengthen physical and mental health, enabling patients to better endure the significant stress that major surgery places on the body, researchers noted.
Dr. Cindy Kin, an associate professor of surgery at Stanford University and senior author, drew a parallel in a news release: “You would never run a marathon without training for it.”
The Compliance Challenge
Despite medical recommendations, many patients struggle to implement substantial lifestyle changes before their surgeries.
Gaudilliere acknowledged this difficulty: “Even though it’s recommended by physicians, to actually have patients do it, and have compliance and adherence to these prehabilitation programs, is quite difficult.”
Study Design and Results
The research compared 27 patients preparing for major elective surgery who were randomly assigned to receive personalized prehab coaching with a control group of 27 patients who didn’t receive the additional support.
The control group was given exercise guidelines, nutritional advice, stress management techniques, and access to a brain training application.
Participants in the personalized program received one-on-one remote coaching twice weekly—one session with a physical therapist and another with a physician. While the guidance covered similar topics as the control group’s materials, it was tailored to each patient’s specific capabilities and progress.
For instance, patients received nutritional guidance and healthy recipe suggestions based on photographs and videos showing what food they actually had available in their kitchens.
The results were striking: only four of the 27 patients in the personalized program experienced post-surgery complications, compared to 11 of the 27 patients who received standard prehab.
Immune System Benefits
Researchers found the immune system improvements from personalized prehab particularly noteworthy.
The program appeared to modify certain immune cells, making them less prone to excessive reactions, while also reducing patients’ baseline inflammation levels before surgery.
Gaudilliere explained: “From prior studies, we know that people who get an infection after surgery are those who have an abnormally high innate immune response before surgery, so they’re in an overly inflammatory state.” When immune cells become overly activated, they can ironically become less effective at fighting off infections.
The personalized approach also seemed to normalize immune responses in cells associated with post-surgical cognitive decline—a condition that affects up to half of patients following major surgery, according to Dr. Franck Verdonk, a former research fellow in Gaudilliere’s lab at Stanford and senior researcher on the study.
Verdonk remarked in a news release: “I think it’s really impressive as a response. It’s not so much work, and it has a huge impact.”
Next Steps and Practical Advice
Researchers plan to identify which patients would gain the most from personalized prehab programs.
In the meantime, Kin recommends that patients preparing for surgery begin with one small behavioral adjustment—any new habit that enhances their nutrition, exercise routine, or sleep quality.
When asked to prioritize, Kin stated: “If I had to choose one thing, it would probably be exercise.”
The research suggests that thoughtful preparation before surgery, particularly when guided by personalized coaching, can make a substantial difference in both immediate outcomes and overall recovery.