Prehabilitation before cancer treatment: does it work?

Prehabilitation ("prehab") means getting fitter, better nourished and mentally prepared in the weeks before cancer surgery or other cancer treatment, so your body copes better with it. In a 2023 trial of 251 people having bowel cancer surgery, four weeks of supervised prehab cut severe complications from 29.7% to 17.1% [3]. It is one part of cancer rehabilitation in the UK, which carries on during and after treatment.

What is prehabilitation for surgery?

Prehabilitation is preparation in the weeks before cancer treatment: exercise, nutrition and psychological support to make you fitter and stronger for surgery, chemotherapy or radiotherapy, and to help you recover afterwards [1][2].

The current UK guidance, Macmillan's 2025 Prehabilitation for people with cancer: Clinical and Implementation Guidelines, defines it as "a needs-based, multi-modal intervention delivered before and during cancer treatment to optimise physical, nutritional, and psychological health, enhance readiness for and tolerance of treatment, and improve recovery and quality of life" [2]. In plain terms: treatment is a physical stress, and a fitter body has more in reserve.

The 2025 guidelines build on the original UK guidance, published in 2019 by Macmillan with the Royal College of Anaesthetists and the NIHR Cancer and Nutrition Collaboration [1][2]. That 2019 guidance set out three areas of focus: physical activity and exercise; nutrition; and psychological support and behaviour change [1]. Those three pillars are still the core of every UK cancer prehab programme.

Prehab is not the same as rehab. Rehabilitation starts after the operation; prehab uses the waiting time before it. The 2019 guidance describes prehab as "part of a continuum to rehabilitation" [1].

Prehabilitation vs ERAS

The ERAS Society describes Enhanced Recovery After Surgery as "a multimodal perioperative care pathway designed to achieve early recovery for patients undergoing major surgery" [12]. ERAS is what the hospital team does around the operation itself; prehab is what you do in the weeks beforehand. They sit side by side.

Does prehabilitation improve surgical outcomes?

Yes for some outcomes, with the strongest evidence in cancer surgery, though the certainty is still being built and much of the trial evidence comes from bowel and other abdominal cancer surgery [3][4][6].

The PREHAB trial (JAMA Surgery, 2023) was a colorectal cancer trial. 251 adults (median age 69) due for bowel (colorectal) cancer surgery were randomised to standard care or a four-week programme of high-intensity supervised exercise three times a week, plus a nutritional intervention, psychological support and smoking cessation. Severe complications were lower in the prehab group (17.1% vs 29.7%, odds ratio 0.47), as were medical complications such as respiratory problems (15.4% vs 27.3%). Walking distance four weeks after surgery was not significantly different between groups [3]. Our guide to bowel cancer and exercise covers what this means if you have bowel cancer.

Meta-analysis of abdominal cancer surgery (Frontiers in Surgery, 2021). Pooling 21 randomised trials, multimodal prehab improved pre-operative walking capacity by about 33 metres on the six-minute walk test and shortened hospital stay by a mean of 3.68 days, but did not significantly change complication rates, readmission or mortality [6].

Cochrane review, colorectal surgery (2022). Only three trials (250 participants) qualified. Prehab improved pre-operative functional capacity by a mean of 24.91 metres and may reduce complications, but the certainty was rated moderate to very low [4].

Umbrella review of 55 systematic reviews (British Journal of Anaesthesia, 2022). Across all surgery types: moderate-certainty evidence that prehab improves functional recovery after cancer surgery, and low to very-low-certainty evidence for fewer complications and shorter stays. Conclusion: prehab "may improve postoperative outcomes"; better trials are needed [5].

People go into surgery fitter, and the best single trial shows fewer serious complications; the size of the effect for each cancer and operation is less certain.

Prehabilitation for cancer: what does the NHS offer?

The NHS offers prehab in many areas, but not everywhere yet. The 2019 Macmillan guidance said prehab "should be integral to the care of all people with a cancer diagnosis" and should "start as early as possible" after diagnosis, ahead of any treatment, not only surgery but chemotherapy and radiotherapy too [1]. The 2025 guidelines, launched in October 2025 with the Centre for Perioperative Care, the Royal College of Anaesthetists and NIHR partners, contain 20 statements and 54 recommendations for services [2][16].

In England, the National Cancer Plan says: "From 2028, we will roll out a national digital-first prehabilitation offer to help all patients get healthier before they start treatment" [17]. Until then, what you are offered depends on where you are treated.

The guidance uses a three-tier model [1][10]:

• Universal: advice on exercise, eating well and emotional support for everyone with cancer.
• Targeted: assessed and prescribed by a registered professional; delivery may be handed to trained non-registered staff.
• Specialist: assessed, prescribed and delivered by registered healthcare professionals, for complex needs or major surgery.

NHS prehabilitation in practice. The best-known programme is Greater Manchester's Prehab4Cancer, launched in April 2019 for colorectal, lung, oesophago-gastric and head and neck cancers. It runs in community leisure centres, with Level 4 cancer rehabilitation instructors delivering cardiovascular and strength sessions three times a week for up to 12 weeks before surgery, then 12 weeks of rehab; it sees over 1,000 patients a year [11]. An NHS England blog in February 2026 put the typical prehab phase at "around 4 weeks before surgery" and reported shorter hospital stays and fewer A&E attendances from the programme's evaluation [9].

NHS Scotland. The Right Decision Service publishes a national cancer prehabilitation pathway built on the same definition and tiers, with screening "as early as possible after diagnosis and in advance of each treatment" [10].

If you have not been offered prehab, ask your cancer nurse specialist. Our page on cancer prehab in London sets out local NHS and charity routes, and our cancer FAQs answer common questions.

How long before surgery should prehab start?

As early as you can, and some benefit comes quickly. The 2019 Macmillan guidance states that "the benefits of prehabilitation can be seen in as little as two weeks" [1]. The PREHAB trial used four weeks [3]; Prehab4Cancer runs for up to 12 weeks where the surgical timetable allows [11].

There is trial evidence for a short window too. In a randomised trial of 73 people having keyhole lung cancer surgery, a two-week home-based programme of aerobic and resistance exercise, breathing training, nutrition advice with whey protein, and psychological support raised six-minute walk distance by 60.9 metres around the time of surgery compared with usual care. It did not change complications or length of hospital stay [18]. It is one small trial, but it supports starting even when time is short.

Prehab should not hold up your treatment. The Macmillan guidance says services should run "without unnecessarily delaying scheduled treatment", with any exception decided case by case by your team [1]. If your date is two weeks away, two weeks of prehab is still worth doing.

What does prehab involve? Exercise, nutrition and psychological support

Prehab combines exercise to build fitness and strength, nutrition support where needed, and psychological support, tailored to you and to your treatment date [1][2].

Exercise. Trial programmes combine aerobic training (bike, brisk walking, intervals) with resistance work, typically three supervised sessions a week [3][11]. It is prescribed to your fitness, ideally from a baseline test such as a six-minute walk, and progressed as you improve. What to focus on depends on the cancer: our guides to breast cancer and exercise, prostate cancer and exercise and lung, head and neck and other cancers cover the specifics.

Nutrition. Prehab screens for weight loss and malnutrition and, where needed, involves a dietitian [1][2]. Our guide to nutrition during cancer treatment explains when to ask for one.

Psychological support. Programmes screen for anxiety and depression and offer support from information and peer groups to counselling [2]. Smoking cessation and alcohol reduction are bundled in as "teachable moment" interventions [1].

Who runs it. Macmillan calls for a multidisciplinary team of registered professionals (dietitians, physiotherapists, occupational therapists, psychologists) plus trained fitness instructors working under delegated authority [1].

Who should you see?

Prehab exercise is usually led by a physiotherapist or a clinical exercise physiologist (CEP), with Level 4 cancer rehabilitation instructors delivering supervised sessions inside some programmes, as in Greater Manchester [11].

Clinical exercise physiologists hold a one-year AHCS-accredited MSc, can join the Academy for Healthcare Science's voluntary, PSA-accredited register, and are trained in exercise testing and assessment plus the design, delivery and evaluation of exercise for complex conditions [14][15][19]. NHS Health Careers lists them in oncology services [15].

Physiotherapists are the right call for injury, a joint needing hands-on treatment, or a surgeon's protocol. The two professions complement each other. Level 4 instructors supervise exercise for people who have already been assessed [1][11]. Our tiers guide and cancer rehabilitation team guide explain who does what.

When to be cautious: talk to your oncology team first

Prehab is safe for most people, but the 2019 guidance advises asking your oncology team first if cancer has spread to bone or treatment reduces your immunity or blood counts [1]. Also check first if you have:

• Any new chest pain, breathlessness at rest or dizziness during exercise: stop and get it checked
• Unplanned weight loss, which needs a dietitian rather than harder training
• A surgical date within days: ask what is realistic rather than starting something intense

Getting matched with a specialist

Ask your cancer nurse specialist or pre-operative assessment clinic whether your hospital runs a prehab service; many do, and Greater Manchester and Scotland have regional pathways [9][10][11]. If there is nothing local, or you want one-to-one input during a long wait, a clinical exercise physiologist can test your fitness and write a programme to your treatment date, working alongside your NHS team.

Request a match with a verified clinical exercise physiologist through The Health Nav. For related guidance see our pages on exercise and cancer, exercise during chemotherapy and exercise referral schemes.

Prehab before hip or knee replacement

Prehab is also used before joint replacement, with smaller effects. A 2023 meta-analysis of 48 randomised trials (3,570 participants) found moderate-certainty evidence that prehab before knee replacement improved function and strength going into surgery and function six weeks afterwards, and before hip replacement improved quality of life and strength; many trials had a high risk of bias [7]. The NHS advises strengthening exercises before and after either operation [8][13].

This article is general information and does not replace advice from your own healthcare team.

References

1. Macmillan Cancer Support, Royal College of Anaesthetists, NIHR Cancer and Nutrition Collaboration. Prehabilitation for people with cancer: principles and guidance for prehabilitation within the management and support of people with cancer. 2019 (the original UK guidance). https://www.macmillan.org.uk/healthcare-professionals/news-and-resources/guides/principles-and-guidance-for-prehabilitation (accessed 15 Sep 2026)
2. Davis J. Prehabilitation: transforming cancer care before treatment begins. Macmillan Cancer Support blog, 22 December 2025. https://www.macmillan.org.uk/healthcare-professionals/news-and-resources/blogs/prehabilitation-transforming-cancer-care-before-treatment-begins (accessed 12 Oct 2026)
3. Molenaar CJL, Minnella EM, Coca-Martinez M, et al. Effect of multimodal prehabilitation on reducing postoperative complications and enhancing functional capacity following colorectal cancer surgery: the PREHAB randomized clinical trial. JAMA Surgery. 2023;158(6):572-581. https://doi.org/10.1001/jamasurg.2023.0198
4. Molenaar CJ, van Rooijen SJ, Fokkenrood HJ, Roumen RM, Janssen L, Slooter GD. Prehabilitation versus no prehabilitation to improve functional capacity, reduce postoperative complications and improve quality of life in colorectal cancer surgery. Cochrane Database of Systematic Reviews. 2022;5:CD013259. https://doi.org/10.1002/14651858.CD013259.pub2
5. McIsaac DI, Gill M, Boland L, et al. Prehabilitation in adult patients undergoing surgery: an umbrella review of systematic reviews. British Journal of Anaesthesia. 2022;128(2):244-257. https://doi.org/10.1016/j.bja.2021.11.014
6. Waterland JL, McCourt O, Edbrooke L, et al. Efficacy of prehabilitation including exercise on postoperative outcomes following abdominal cancer surgery: a systematic review and meta-analysis. Frontiers in Surgery. 2021;8:628848. https://doi.org/10.3389/fsurg.2021.628848
7. Punnoose A, Claydon-Mueller LS, Weiss O, Zhang J, Rushton A, Khanduja V. Prehabilitation for patients undergoing orthopedic surgery: a systematic review and meta-analysis. JAMA Network Open. 2023;6(4):e238050. https://doi.org/10.1001/jamanetworkopen.2023.8050
8. NHS. Preparing for a hip replacement. https://www.nhs.uk/tests-and-treatments/hip-replacement/preparing-for-a-hip-replacement/ (accessed 15 Sep 2026)
9. Merchant Z, Murphy J. Cancer diagnosis as a catalyst for change: integrating prehabilitation in cancer and surgical care. NHS England blog, 4 February 2026. https://www.england.nhs.uk/blog/cancer-diagnosis-as-a-catalyst-for-change-integrating-prehabilitation-in-cancer-and-surgical-care/ (accessed 15 Sep 2026)
10. NHS Scotland Right Decision Service. Cancer prehabilitation pathway. https://www.rightdecisions.scot.nhs.uk/cancer-prehabilitation-for-healthcare-professionals/cancer-prehabilitation-pathway/ (accessed 15 Sep 2026)
11. Greater Manchester Moving. Greater Manchester programme using local leisure facilities prepares cancer patients for surgery and helps them recover. https://www.gmmoving.co.uk/outcome-and-result/greater-manchester-programme-using-local-leisure-facilities-prepares-cancer-patients-for-surgery-and-helps-them-recover/ (accessed 15 Sep 2026)
12. ERAS Society. Enhanced Recovery After Surgery. https://erassociety.org/ (accessed 15 Sep 2026)
13. NHS. Preparing for a knee replacement. https://www.nhs.uk/tests-and-treatments/knee-replacement/preparation/ (accessed 15 Sep 2026)
14. Clinical Exercise Physiology UK. What is a CEP? https://www.clinicalexercisephysiology.org.uk/what-is-a-cep (accessed 15 Sep 2026)
15. NHS Health Careers. Clinical exercise physiologist. https://www.healthcareers.nhs.uk/explore-roles/healthcare-science/roles-healthcare-science/physiological-sciences/clinical-exercise-physiologist (accessed 15 Sep 2026)
16. Macmillan Cancer Support. Prehabilitation for people with cancer: Clinical and Implementation Guidelines. 2025. https://www.macmillan.org.uk/healthcare-professionals/cancer-pathways/prehabilitation (accessed 12 Oct 2026)
17. Department of Health and Social Care. The National Cancer Plan for England: delivering world-class cancer care. February 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 (accessed 12 Oct 2026)
18. Liu Z, Qiu T, Pei L, et al. Two-week multimodal prehabilitation program improves perioperative functional capability in patients undergoing thoracoscopic lobectomy for lung cancer: a randomized controlled trial. Anesthesia and Analgesia. 2020;131(3):840-849. https://doi.org/10.1213/ANE.0000000000004342
19. Academy for Healthcare Science. PSA accredited register. https://www.ahcs.ac.uk/registration/psa-accredited-register/ (accessed 15 Sep 2026)