Prehabilitation for Frail Cardiac Surgery Patients: Building Strength Before the Operating Room

Older adults with frailty face a paradox in cardiac surgery: they need the procedure most, yet are at the highest risk of poor recovery. While prehabilitation programmes are increasingly common, few specifically target the recommended exercise principles for frailty. This pilot randomized controlled trial set out to change that.

Adult patients with mild to moderate frailty scheduled for elective coronary or valve surgery were randomized to a multimodal prehabilitation programme (n = 26) or usual care (n = 25). The intervention combined patient education, nutritional optimization, stress management, and individualized resistance-focused exercise training delivered through centre-based, home-based, and online sessions over at least four weeks before surgery.

Quality of life — measured by the MacNew Questionnaire — improved significantly at both 1-month (p = 0.006) and 3-month post-intervention (p = 0.007), with large effect sizes (Hedges’ g = -0.89 to -0.96). Functional capacity and frailty level also improved markedly, with adherence at an impressive 89%. The MacNew captured what these patients had gained: not just stronger bodies, but a transformed sense of well-being heading into one of the most stressful events of their lives.

The findings make a powerful case for prehabilitation in vulnerable cardiac surgery candidates — and demonstrate once again how MacNew can quantify benefits that go beyond standard physical performance tests. When functional capacity rises but quality of life improves even more, the MacNew tells the human side of the story.

Reference:
Li, P. W. C., Yu, D. S. F., Chan, D. T. L., Ho, C. K. L., Lam, S. C. C., Chiu, P. K. C., Wan, S. H. Y., Lam, L., & Hung, N. (2026). Prehabilitation for patients with mild to moderate frailty undergoing coronary artery and valve surgery: A pilot randomized controlled trial. European Journal of Cardiovascular Nursing. https://doi.org/10.1093/eurjcn/zvag084