# Prehabilitation

> Prehabilitation is structured preparation before surgery — typically exercise, nutrition and psychological support, alongside smoking and alcohol reduction — aimed at improving a patient's physiological reserve before the stress of an operation. It treats the wait for surgery as an intervention window rather than dead time, which requires identifying who would benefit early enough to act.

*Source: https://getpathways.ai/glossary/prehabilitation*

Also known as: prehab, preoperative optimisation, surgery preparation

- **Typical components**: Exercise, nutrition, psychological support, smoking and alcohol reduction
- **Aim**: Improve physiological reserve before the stress of surgery
- **Window**: The period between listing and operating
- **Best suited to**: Patients with reduced functional capacity or frailty facing major surgery

## The waiting list as an intervention window

The premise is straightforward. A patient waiting weeks or months for elective
surgery is usually waiting passively. Prehabilitation asks what that period
could be used for, particularly for patients whose
[functional capacity](/glossary/functional-capacity-mets) is low or who show
signs of [frailty](/glossary/frailty) — the people for whom the physiological
demand of surgery sits closest to their reserve.

## Its dependency is identification, not delivery

Services that attempt prehabilitation tend to discover that the programme is
not the hard part. The hard part is knowing, early enough, which patients
should be in it.

Deciding that requires functional capacity and frailty to have been assessed
across the whole booked list, not just among patients who have already reached
a clinic. And it requires that assessment to happen near the point of listing,
because a referral into prehabilitation two weeks before surgery has almost no
window to work in.

That is the same constraint that governs
[anaemia correction](/glossary/preoperative-anaemia) and glycaemic
optimisation, and it is why screening every booked patient early changes what a
service is able to offer, not just how efficiently it runs.