Short-term home-based multimodal prehabilitation for perioperative functional recovery in prefrail and frail older men undergoing radical prostatectomy: a randomized controlled trial

Abstract Background Prefrailty and frailty are associated with reduced physiological reserve and heightened vulnerability to surgical stress, which may compromise early recovery after radical prostatectomy. Although multimodal prehabilitation may enhance surgical readiness, evidence remains limited for prefrail and frail older men undergoing radical prostatectomy within the short preoperative waiting period typical of routine practice. Methods This prospective, outcome-assessor-blinded, parallel-group randomized controlled trial enrolled 80 men aged 60 or older with prostate cancer who were classified as prefrail or frail and scheduled for elective radical prostatectomy. Participants were randomly assigned to short-term home-based multimodal prehabilitation plus usual care or usual care alone. The intervention was delivered from enrolment until the day before surgery and included lifestyle-integrated exercise, nutritional optimisation, psychological support, pelvic floor muscle training, respiratory exercises, and perioperative health-behaviour guidance. The primary outcome was functional capacity measured by the 6-min walk test (6MWT) across the perioperative period. The primary comparison was the between-group difference in change in 6MWT from baseline to the day before surgery. Supportive secondary outcomes included frailty-related physical performance measures, and exploratory outcomes encompassed selected perioperative recovery indicators. Assessments occurred at baseline, the day before surgery, at discharge, and 4 weeks postoperatively. Results All 80 randomized participants were included in the intention-to-treat analysis. The median duration of prehabilitation was 12 days. For the defined primary comparison, the prehabilitation group improved by 27.70 ± 16.86 m in 6MWT from baseline to the day before surgery, whereas the usual care group changed by − 3.12 ± 3.62 m, yielding a between-group difference of 30.82 m (95% CI, 25.32 to 36.33; P < 0.001). The generalized estimating equation (GEE) analysis showed a more favourable perioperative 6MWT trajectory in the prehabilitation group. Frailty-related physical performance outcomes showed directionally consistent improvements. Exploratory perioperative outcomes showed signals of earlier ambulation, faster gastrointestinal recovery, and shorter postoperative hospital stay. The mean overall programme execution rate was 79.3%, and no intervention-related adverse events were reported. Conclusions Short-term home-based multimodal prehabilitation improved the perioperative trajectory of functional capacity in prefrail and frail older men undergoing radical prostatectomy. Supportive and exploratory findings suggest potential benefits for early functional recovery; however, larger multicentre trials with longer follow-up are needed to confirm durability and broader clinical relevance. Trial registration Chinese Clinical Trial Registry, ChiCTR2400094812. Registered on 27 December 2024. Retrospectively registered.