Digital prehabilitation and functional performance signals in older adults undergoing hepatobiliary cancer surgery: A pilot study.

12039 Background: Older adults undergoing hepatobiliary cancer surgery often have limited functional reserve and face barriers to accessing structured preoperative conditioning. Technology-enabled, home-based prehabilitation may offer a scalable approach to support surgical readiness while generating early signals of functional change. Methods: Adults aged ≥65 years scheduled for hepatobiliary tumor resection with ≥4 weeks before surgery were enrolled in a multimodal, digitally supported prehabilitation program. The intervention combined wearable-monitored aerobic activity (≥90 minutes/week) with twice-weekly, live video–supervised progressive resistance training delivered by certified exercise trainers. Functional performance was assessed using the 30-second chair stand and arm curl tests, and health status was measured with the SF-12 survey at baseline and preoperative follow-up. Implementation and engagement metrics were captured to contextualize delivery in a geographically dispersed population. Analyses of functional outcomes were exploratory and intended to estimate effect sizes and inform future, adequately powered studies. Results: Twenty-one participants (median age 78 years; range 66–88) completed baseline and preoperative assessments over a median intervention duration of 4.5 weeks. Participants resided a median of 127 km from the cancer center, supporting remote delivery of the intervention. Improvements were observed in lower extremity function (30-second chair stand: 12.0 ± 3.2 to 13.8 ± 4.6 repetitions; p = 0.04) and upper extremity strength (30-second arm curl: 17.7 ± 5.4 to 22.2 ± 7.1 repetitions; p < 0.001). Patient-reported physical and mental health scores demonstrated favorable, though not statistically significant, trends. Engagement with wearable-monitored aerobic activity exceeded recommended weekly targets, and completion of tele-supervised resistance sessions remained high across the intervention period. Conclusions: In this pilot cohort of older adults preparing for hepatobiliary cancer surgery, a digitally supported, home-based prehabilitation model was associated with favorable short-term functional performance signals and high levels of engagement across a geographically dispersed population. These findings are hypothesis-generating and support further evaluation of tele-prehabilitation in trials powered to assess perioperative and clinical outcomes.