Multimodal prehabilitation,
does it really help with Reduction in severe postoperative complications within 30 days?
research showsThe grade is C with 54 points. PREHAB randomized 269 patients and included 251 in the primary analysis; severe complications occurred in 21/123 (17.1%) versus 38/128 (29.7%), OR 0.47 (95% CI 0.26 to 0.87). However, the coprimary postoperative six-minute-walk difference was 15.6 m (-1.4 to 32.6), P=.07, and failed. COVID-19 caused early termination and the complication analysis changed from the plan, leaving the overall evidence at C.
ads claimThis was not exercise alone cutting complications in half. It combined supervised high-intensity exercise, nutritional assessment and protein, psychological support, and medical optimization, and its two coprimary results split.
Useful facts when choosing a product
- The four-week program combined supervised high-intensity exercise three times weekly, nutrition and protein support, psychological support, and cessation support when indicated.
- Severe complications were 17.1% versus 29.7%, while the coprimary six-minute-walk outcome was not significant.
- Existing postoperative-complication verdicts concern other operations or interventions; this combination is specific to multimodal prehabilitation before colorectal cancer surgery.
What the research actually shows
The international open-label randomized trial by Molenaar CJL, Minnella EM, Coca-Martinez M, Ten Cate DWG, Regis M, Awasthi R, Martínez-Palli G, López-Baamonde M, Sebio-Garcia R, Feo CV, van Rooijen SJ, Schreinemakers JMJ, Bojesen RD, Gögenur I, van den Heuvel ER, Carli F, Slooter GD, and PREHAB Study Group randomized 269 patients and included 251 after exclusions, 123 prehabilitation and 128 control, in the primary analysis. Coprimary outcomes were 30-day complications and postoperative six-minute walking. Severe complications were positive while walking was null. Máxima Medical Center received Dutch Cancer Society and Johnson & Johnson support; FrieslandCampina and Immunotec supplied protein products, and Philips supplied accelerometers. Registration was NTR5947.
Why this is classified as C (54)
A large reduction in an actual severe-complication event is limited by a split coprimary result, early stopping, and a changed planned analysis, giving C with 54 points.
Counterpoint. Complication reduction does not itself prove better fitness or quality of life. Conversely, the null walking result does not erase the severe-complication contrast.
Rejudgment record. Cross-check applied — Cross-checked coprimary outcomes, 269 randomized and 251 analyzed, complication and walking results, funding, and early termination against the JAMA Surgery report and NTR5947
| Endpoint | H | Hard endpoint - actual events such as death |
| Replication | R1 | Single confirmatory trial |
| Independence | I1 | Mixed funding sources |
| Effect size | E+ | Meets the clinically important threshold |
The scoring table and the verdict agree (C).
Sub-claim grades by effect
This ingredient is marketed for several effects. A single overall grade blends strong and weak claims together, so each effect is graded separately here. The overall grade reflects the strongest disconfirming or core claim.
| Effect (sub-claim) | Grade | Basis |
|---|---|---|
| Reduction in severe 30-day postoperative complications | C | Rates were 17.1% versus 29.7%, but coprimary results split and design limitations accumulated. |
| Improved postoperative six-minute walking | D | The 15.6-m between-group interval included zero. |
Cross-check — Codex and Claude
Evidence Table
| Study | Design | Sample | Funding | Endpoint | Result | Weight |
|---|---|---|---|---|---|---|
| Molenaar CJL, Minnella EM, Coca-Martinez M, Ten Cate DWG, Regis M, Awasthi R, Martínez-Palli G, López-Baamonde M, Sebio-Garcia R, Feo CV, van Rooijen SJ, Schreinemakers JMJ, Bojesen RD, Gögenur I, van den Heuvel ER, Carli F, Slooter GD, PREHAB Study Group. 2023 | International multicenter open-label randomized trial with coprimary outcomes | 128 | Dutch Cancer Society and Johnson & Johnson support; protein products from FrieslandCampina and Immunotec and accelerometers from Philips | Coprimary 30-day CCI complications and postoperative six-minute walking | CCI greater than 20: 21/123 (17.1%) versus 38/128 (29.7%), OR 0.47 (0.26 to 0.87); six-minute-walk difference 15.6 m (-1.4 to 32.6), P=.07 | Positive clinical complication event but failed coprimary functional outcome, early stopping, and analysis change |
Receipt — 1 References
All 1 cited sources were verified for existence at the original page (as of 2026-08-15).
Reviewed and approved: Chamgap Editorial Team · Approval date: 2026-08-15 · Corrections: none
Cite this verdict
[Chamgap] Multimodal prehabilitation x fewer severe complications after colorectal cancer surgery — Evidence Grade C·54. 1 cited sources checked. Source: https://chamgap.com/en/verdicts/sports/multimodal-prehabilitation-colorectal-surgery-severe-complications/ · CC BY 4.0CC BY 4.0 — free to use with attribution; do not distort grades, numbers, or verdict meaning.
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