Prehabilitation in Cardiovascular Surgery: Concepts, Evidence, and Future Direction

Patients undergoing cardiovascular surgery are increasingly older and multimorbid, with a high prevalence of frailty, sarcopenia, malnutrition, and psychological vulnerability, all of which are strongly associated with adverse postoperative outcomes yet remain incompletely captured by conventional risk models. Prehabilitation has emerged as a proactive, multimodal strategy to address these modifiable vulnerabilities in the preoperative period. This narrative review synthesizes contemporary evidence on prehabilitation in adult cardiovascular surgery, focusing on its core components, reported clinical benefits, feasibility, and barriers to implementation. Current evidence indicates that exercise-based prehabilitation, particularly programs incorporating aerobic training and inspiratory muscle training, is safe and feasible and improves preoperative functional capacity, with consistent reductions in postoperative pulmonary complications and hospital length of stay. Nutritional optimization, smoking and alcohol cessation, psychological preparation, and targeted comorbidity management further support physiological resilience and patient readiness for surgery, although these domains remain underrepresented in cardiac-specific trials. Despite growing interest, the evidence base is limited by heterogeneous program designs, variable outcome measures, short intervention windows, and a lack of adequately powered randomized trials. Integration of prehabilitation into established perioperative care pathways, improved patient selection using frailty and fitness assessment, and scalable delivery models, including tele-prehabilitation, are needed to support wider adoption. Overall, prehabilitation represents a promising patient-centered strategy to improve recovery and resilience in adult cardiovascular surgery.