Prehabilitation and Lower GI Cancer: Fewer Complications, Faster Recovery

Colorectal surgery has the deepest evidence base in prehabilitation, and the clearest results

Surgery for colon and rectal cancer is major abdominal surgery, and complications are common: roughly a third of patients experience at least one. Prehabilitation, supervised exercise, nutritional optimisation with adequate protein, psychological support and smoking cessation, uses the weeks before the operation to raise physiological reserve. Lower GI cancer is where this has been tested most rigorously.

What the research shows

•  Fewer severe complications. In the international PREHAB randomised trial of 251 patients, four weeks of multimodal prehabilitation reduced severe postoperative complications from 29.7% to 17.1% (OR 0.47, 95% CI 0.26–0.87) and medical complications, such as chest and cardiovascular events, from 27.3% to 15.4% (OR 0.48).¹

•  A halving of complications in high-risk patients. A blinded randomised trial of personalised prehabilitation in high-risk patients undergoing major abdominal surgery cut the number of patients suffering complications by 51% (relative risk 0.5, 95% CI 0.3–0.8).²

•  Meaningful and lasting fitness gains. A 2026 meta-analysis of 11 randomised trials found prehabilitation improved medium-term physical function after colorectal surgery by 32.95 metres on the six-minute walk test — well above the threshold considered clinically relevant.³

•  Shorter stays in real-world practice. An emulated target trial in older colorectal cancer patients found a 55% lower comprehensive complication score and a reduction in length of stay from seven days to five.⁴

•  Better mood before treatment. A network meta-analysis in colorectal cancer confirmed that multimodal prehabilitation reduces postoperative complications and improves physical function while lowering anxiety.⁵

Why a digital programme (digital prehabilitation) fits this pathway well

Colorectal pathways move fast, and hospital-based prehabilitation is resource-heavy. The team designing a current three-arm trial of digital versus hospital-based prehabilitation put the problem plainly: feasibility is threatened by low compliance with hospital programmes because of burdensome commuting, and prehabilitation must be personalised to individual profiles.⁶ A parallel systematic review found remote, technology-supported prehabilitation feasible and highly acceptable to patients awaiting major surgery,⁷ and home based tele-prehabilitation has already been delivered successfully to high-risk colorectal patients at home.

Delivered digitally (digital prehab), exercise intensity, protein targets and psychological support can be set from an individual’s baseline and adapted as their fitness changes — a level of tailoring that fixed group clinics cannot easily provide, and one that reaches people in rural areas or in work. What the digital health literature adds is a caution: platforms alone lose users over time, and engagement and adherence improve when a trusted human coach supplies feedback and supportive accountability.⁸ Providers that build this “human-in-the-loop” model into their service, such as QuestPrehab, which delivers personalised digital prehabilitation remotely within NHS pathways, aim to capture the scale of digital delivery without losing the human relationship that keeps people going.

Sources

1. Molenaar CJL et al. Effect of multimodal prehabilitation on reducing postoperative complications and enhancing functional capacity following colorectal cancer surgery: the PREHAB randomized clinical trial. JAMA Surg 2023;158:572–581. https://doi.org/10.1001/jamasurg.2023.0198

2. Barberan-Garcia A et al. Personalised prehabilitation in high-risk patients undergoing elective major abdominal surgery: a randomized blinded controlled trial. Ann Surg 2018;267:50–56. https://doi.org/10.1097/SLA.0000000000002293

3. The impact of prehabilitation on postoperative outcomes in colorectal cancer: a meta-analysis of randomized controlled trials. J Am Med Dir Assoc 2026. https://www.jamda.com/article/S1525-8610(26)00022-8/fulltext

4. Improved postoperative outcomes after prehabilitation for colorectal cancer surgery in older patients: an emulated target trial. Ann Surg Oncol 2022. https://doi.org/10.1245/s10434-022-12623-9

5. Multimodal prehabilitation reduces postoperative complications and improves physical function and anxiety in colorectal cancer: systematic review and network meta-analysis. 2025. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12521261/

6. Kleve G et al. Digital home-based multimodal prehabilitation (dHOPE): trial protocol. Front Digit Health 2025;7:1609678. https://doi.org/10.3389/fdgth.2025.1609678

7. Blumenau Pedersen M et al. Digital technologies to support home-based prehabilitation: a systematic review. The Surgeon 2023;21:e305–e315. https://doi.org/10.1016/j.surge.2023.05.006

8. Application of the supportive accountability model in digital health interventions: scoping review. J Med Internet Res 2025;27:e72639. https://doi.org/10.2196/72639