Prehabilitation for patients with mild to moderate frailty undergoing coronary artery and valve surgery: a pilot randomized controlled trial

AIMS: Although prehabilitation is increasingly studied to address preoperative frailty in cardiac surgery candidates, most interventions overlook recommended exercise principles for frailty. This study evaluated the feasibility and effects of a frailty-specific prehabilitation programme on health outcomes in frail patients undergoing cardiac surgery. METHODS AND RESULTS: Adult patients with mild to moderate frailty scheduled for elective coronary or valve surgery were randomized to prehabilitation (n = 26) or usual care (n = 25). The programme combined education, nutritional optimization, stress management, and individualized resistance-focused exercise training via centre-based, home-based, and online sessions over at least 4 weeks. Primary outcome was functional capacity. The prehabilitation group showed significant improvements in functional capacity measured by the Short Physical Performance Battery at 1 day before surgery (β = 0.99; 95% confidence interval [CI] = 0.08-1.90; P = 0.032) and 3-month post-intervention (β = 1.04; 95% CI = 0.05-2.03; P = 0.040). Frailty level measured by Fried criteria showed significant reductions at 1 day before surgery (P = 0.005) and at 3-month follow-up (P = 0.043), with large effect sizes (Hedges' g = 0.92-1.18). Health-related quality of life measured by the MacNew Questionnaire improved significantly at 1-month (P = 0.006) and 3-month post-intervention (P = 0.007), with large effect sizes (Hedges' g = -0.89 to -0.96). The programme demonstrated high feasibility (89% adherence) and safety (minimal adverse events). No significant differences were found in biomarkers or clinical events, unplanned readmission, or length of stay. CONCLUSION: This frailty-specific prehabilitation programme is feasible and safe for cardiac surgical patients, demonstrating improvements in functional capacity, frailty, and quality of life. A full-scale trial is warranted to confirm its efficacy and guide clinical implementation. REGISTRATION: ClinicalTrials.gov Identifier: NCT06323317.