AMBULATORY ANAESTHESIA: Edited by Peter Kranke and Leopold EberhartPreoperative exercise and prehabilitationEsser, Tobiasa; Zimmer, Philippa; Schier, Robertb Author Information aInstitute of Sports and Sports Medicine, TU Dortmund University, Dortmund bUniversity of Cologne, Faculty of Medicine and University Hospital Cologne, Department for Anaesthesiology and Intensive Care Medicine, Cologne, Germany Correspondence to Robert Schier, PhD, Priv.-Doz. Dr med. Department for Anaesthesiology and Intensive Care Medicine, University Hospital Cologne, Kerpenerstr. 62, Cologne 50924, Germany. Tel: +49221 478 0; e-mail: [email protected] Current Opinion in Anaesthesiology: December 2022 - Volume 35 - Issue 6 - p 667-673 doi: 10.1097/ACO.0000000000001188 Buy Metrics Abstract Purpose of review The purpose of this narrative review is to give an overview about the effects of multimodal prehabilitation and current existing and prospectively planned studies. The potential efficacy of exercise in the context of prehabilitation ranges from preoperatively improving patients’ functional capacity to inducing cellular mechanisms that affect organ perfusion via endothelial regeneration, anti-inflammatory processes and tumour defense. Recent findings Current studies show that prehabilitation is capable of reducing certain postoperative complications and length of hospital stay in certain patient populations. These findings are based on small to mid-size trials with large heterogeneity, lacking generalizability and evidence that prehabilitation has positive effects on long term survival. Summary The concept of prehabilitation contains the features, namely preoperative exercise, nutritional intervention and psychological support. Preoperative exercise holds potential molecular effects that can be utilized in the perioperative period in order to improve patients’ postoperative outcome. Future multimodal prehabilitation trials must specifically clarify the clinical impact of this concept on patients’ quality of life after major cancer surgery and cancer-specific survival. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.