Getting Fit for Surgery: Why Pre-Surgery Exercise Matters in Cancer Care

When someone is diagnosed with cancer and told they need surgery, the instinct is often to conserve energy and wait for the operation. But a growing body of evidence, much of it led by Professor Catherine Granger and colleagues at the University of Melbourne, suggests the opposite may be true: getting physically active before surgery, known as prehabilitation, can meaningfully improve how patients fare afterwards.

What is prehabilitation?

Prehabilitation is the practice of building physical capacity in the window between a cancer diagnosis and surgery. Rather than a passive wait, it is an active preparation phase, typically involving structured exercise (aerobic and resistance training, sometimes combined with inspiratory muscle training), alongside nutrition and psychological support.

The rationale is straightforward. Cancer surgery is a major physiological stressor, and many patients enter the operating theatre already deconditioned from the disease itself, from reduced activity, or from other treatments. Building reserve capacity beforehand gives the body more to draw on during recovery.

What does the evidence show?

Granger’s research has focused heavily on lung cancer surgery, where the case for prehabilitation is now well established. Her 2022 Cochrane systematic review, an update of the original 2017 review, found that preoperative exercise training led to a substantial reduction in the risk of postoperative pulmonary complications compared to no exercise beforehand. The review also found that exercise before surgery likely shortened hospital stay by around two days and improved fitness levels by the time of surgery, with no exercise-related side effects reported.

Other outcomes measured across her body of work include reduced length of chest drain time, and improvements in exercise capacity and lung function heading into the operation itself.

Importantly, this isn’t limited to lung cancer. Related work on prehabilitation across abdominal and other cancer surgeries points in a similar direction, and international collaborations Granger has contributed to, including Delphi studies on research priorities in this space, reflect just how quickly the field is growing.

Why it matters

Beyond the clinical numbers, Granger’s qualitative work has captured something equally important: how patients experience this period. Her research has described the psychological value of prehabilitation, patients often describe wanting to feel like an active participant in their own recovery rather than someone simply waiting for a date on a calendar.

For a diagnosis that can feel entirely out of a patient’s control, exercise offers something rare: a concrete, evidence-backed action they can take that improves their own odds.

The takeaway

The evidence base is still evolving, and much of it remains of low to moderate certainty due to small trial sizes. But the direction is consistent. Preoperative exercise appears safe, feasible, and likely to reduce complications and speed recovery after cancer surgery. As prehabilitation moves from a niche idea to standard pathway design in major cancer centres, the work of researchers like Catherine Granger has been central to making that shift evidence-based rather than aspirational.