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Exercise before major surgery: a 2014 review

2014 review: high-quality evidence for exercise before cardiovascular surgery; for other surgery, only circumstantial.

Updated October 20, 2026

A 2014 review, available on PMC (NIH), gathers the evidence on exercise before and after major surgery. The main conclusion: there is high-quality evidence that pre-operative exercise is well tolerated and effective in patients scheduled for cardiovascular surgery.

For thoracic, abdominal and major joint replacement surgery the evidence is circumstantial: it suggests that exercise is effective, provided it is offered to high-risk patients.

The level of evidence: high quality

On the scale of medical evidence, “high quality” means results that come from randomised controlled trials and meta-analyses.

For cardiovascular surgery, then, the effectiveness of pre-operative exercise rests on controlled studies, not on impressions.

Before and after surgery, the care team decides.

Two women play tennis on a red-clay court overlooking the sea, with wooden rackets, on a sunny day.

For which types of surgery it applies

The evidence covers four areas: cardiovascular surgery, thoracic surgery, major abdominal surgery and major joint replacement (hip and knee prostheses).

According to the authors, exercise before and after the operation might improve functional status and reduce complications and mortality.

The high-risk patient

High-risk patients, that is older people and people with obesity or with cardiovascular or respiratory disease, are those to whom the review says pre-operative exercise should be offered.

With age, the capacity to adapt declines: those who start with less reserve are more exposed to long hospital stays, complications and death after major surgery. For this group the authors point to a training protocol before and after the operation, known as “Better in, Better out”.

A study's numbers hold for the group it studied.

The Digital Twin and this research

The Digital Twin lines up the data your devices write to your phone, such as steps, heart rate and sleep, and shows you how they change over time. It does not certify readiness for surgery and it does not diagnose: this research describes groups of people, not you. Preparation for surgery is decided and followed by the care team.

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