Physical fitness, a healthy diet, and psychological well-being are associated with better postoperative outcomes. Prehabilitation aims to improve physical, psychological, and nutritional fitness thereby increasing resilience.

We have shown the harmful effects of cancer treatments on fitness, quality of life, and perioperative outcome. We have demonstrated (10 trials; 1,466 patients) the benefits of prehabilitation; and that individualised, supervised high-intensity exercise programme, improves physical fitness, quality of life, and mitochondrial function.

There is an urgent need to develop a core outcome set, including validation of screening and assessment tools, to enable the implementation of a stepped care model needs-based approach as standard care.

Learning Objectives:

• Have an understanding of the current literature and the evidence gaps.
• Developed some insight into the complexity of the delivery of multimodal prehabilitation.
• Have an overview of the putative mechanism(s) by which poor nutrition, being
  physically unfit and stress act separately and together to impair response to treatment and outcomes, and in turn the mechanism by which improvements through prehabilitation interventions may act.
• An understanding of barriers to implementation of a system-wide stepped care model multimodal prehabilitation service.