Prehabilitation research: a plain-English summary

The short version

  • Prehabilitation means improving fitness, nutrition and wellbeing before treatment. UK guidance recommends it as part of cancer care.1
  • In breast cancer, studies show prehab is safe and practical, with promising effects on physical function and wellbeing, but trials are small and more research is needed.2
  • Digital, home-based prehab has been shown to be feasible and acceptable in UK studies, and England’s National Cancer Plan now includes prehab as a core part of cancer care.3, 4

What UK guidance says

Macmillan, the Royal College of Anaesthetists and the NIHR Cancer and Nutrition Collaboration published UK guidance on prehabilitation, recommending that it should be part of cancer care, covering physical activity, nutrition and psychological support.1 England’s National Cancer Plan (2026) embeds prehabilitation and rehabilitation as core parts of cancer care, with national quality standards from 2027.4

Prehab in breast cancer

  • A systematic review of multimodal prehab in breast cancer found generally positive effects on physical function and quality of life, but the studies were small and varied.2
  • A Canadian feasibility study found that prehab before breast cancer surgery was feasible and acceptable.5
  • A Swedish trial (PhysSURG-B) looked at recovery after breast cancer surgery when people followed recommended physical activity before and after their operation.6
  • A UK study found that prehabilitation could be delivered within the breast cancer treatment pathway.7

Digital and home-based prehab

  • A UK study of a telehealth home-based prehab programme for people with cancer found that 76% of those referred took part, with better self-rated health and less fatigue afterwards.3
  • A cost analysis of a digital multimodal prehab service found an average cost of about £460 per patient.8
  • Kent and Medway‘s telehealth prehab programme was featured by NHS England as a case study.9

These were feasibility and service studies without a comparison group, so they show the approach is practical and acceptable, rather than measuring exactly how much it improves outcomes.

What we can say with confidence

  • Being active during and after treatment helps with fatigue, mood, physical function and quality of life.10 Prehab starts these habits earlier.
  • Prehab before breast cancer treatment appears safe.2
  • Whether prehab reduces surgical complications in breast cancer specifically is still being studied.

Read more: the evidence for prehab in breast cancer and what is prehabilitation?.

Related pages

Everyone’s treatment is different, so talk to your cancer team about what is right for you.

References

  1. Macmillan Cancer Support, Royal College of Anaesthetists and NIHR Cancer and Nutrition Collaboration. Principles and guidance for prehabilitation within the management and support of people with cancer. 2019, updated November 2020. www.macmillan.org.uk/healthcare-professionals/news-and-resources/guides/principles-and-guidance-for-prehabilitation
  2. Toohey K, Hunter M, McKinnon K, Casey T, Turner MR, Taylor S, Paterson C. A systematic review of multimodal prehabilitation in breast cancer. Breast Cancer Research and Treatment. 2023;197(1):1–37. doi.org/10.1007/s10549-022-06759-1
  3. Wu F, Rotimi O, Laza-Cagigas R, Rampal T. The feasibility and effects of a telehealth-delivered home-based prehabilitation program for cancer patients during the pandemic. Current Oncology. 2021;28(3):2248–2259. doi.org/10.3390/curroncol28030207
  4. Department of Health and Social Care. National Cancer Plan for England. February 2026. Summary of prehabilitation commitments as reported by the Royal College of Anaesthetists and Centre for Perioperative Care. rcoa.ac.uk/news/rcoa-cpoc-respond-release-governments-national-cancer-plan
  5. Brahmbhatt P, Sabiston CM, Lopez C, et al. Feasibility of prehabilitation prior to breast cancer surgery: a mixed-methods study. Frontiers in Oncology. 2020;10:571091. doi.org/10.3389/fonc.2020.571091
  6. Heiman J, Onerup A, Wessman C, Haglind E, Olofsson Bagge R. Recovery after breast cancer surgery following recommended pre and postoperative physical activity: (PhysSURG-B) randomized clinical trial. British Journal of Surgery. 2021;108(1):32–39. doi.org/10.1093/bjs/znaa007
  7. Wu F, Rampal T, et al. The feasibility of prehabilitation as part of the breast cancer treatment pathway. PM&R. 2021. doi.org/10.1002/pmrj.12543
  8. Gkaintatzi E, Nikolaou CK, Rampal T, Laza-Cagigas R, Zand N, McCrone P. Cost analysis of a digital multimodal cancer prehabilitation. Current Oncology. 2022;29(12):9305–9313. doi.org/10.3390/curroncol29120729
  9. NHS England Transformation Directorate. Kent and Medway prehabilitation: telehealth-delivered home-based patient optimisation (Perioperative digital playbook). transform.england.nhs.uk/key-tools-and-info/digital-playbooks/perioperative-digital-playbook/Kent-and-Medway-prehabilitation-telehealth-delivered-home-based-patient-optimisation
  10. Campbell KL, Winters-Stone KM, Wiskemann J, et al. Exercise guidelines for cancer survivors: consensus statement from international multidisciplinary roundtable. Medicine & Science in Sports & Exercise. 2019;51(11):2375–2390. doi.org/10.1249/MSS.0000000000002116