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 program 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 program combined education, nutritional optimization, stress management, and individualized resistance-focused exercise training via center-based, home-based, and online sessions over at least four weeks. Primary outcome was functional capacity. The prehabilitation group showed significant improvements in functional capacity measured by the Short Physical Performance Battery at one day before surgery (β=0.99, 95% 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 one 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 - -0.96). The program 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. CONCLUSIONS: This frailty-specific prehabilitation program 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.