Prehabilitation for patients undergoing metabolic/bariatric surgery: a retrospective cohort study using propensity score matching.
Yiling Yan, Shengdi Lu, Heming Wang and 4 others
PMID 42572833WHAT IT FOUND
A 6-week prehabilitation programme (exercise, diet, psychology) before bariatric surgery did not change 12-month weight loss versus standard education.
Small 3-month gains in weight and grip strength faded by 6 months. No added safety risk.
Key findings
01Total weight loss at 12 months was 23.7 kg (SD 5.1) with prehabilitation and 23.4 kg (SD 2.7) with standard care, a 0.3 kg difference (95% CI −1.3 to 1.8; p = 0.75) that was not statistically significant and not clinically meaningful.
02At 3 months, prehabilitation showed a 2.9 kg advantage in weight loss (p < 0.001) and significant improvements in body fat percentage, diastolic blood pressure, grip strength, and SF-36 mental score, but none of these differences remained significant at 6 or 12 months.
03No serious adverse events occurred in either group over 12 months, and the safety profile was identical between groups; the prehabilitation group incurred an additional ¥6,792 in total cost, entirely from the programme fee, with no sustained effectiveness gain to offset it.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Retrospective, non-randomized design: patients chose to enrol in prehabilitation or not, and propensity score matching on 31 measured variables cannot rule out unmeasured differences in motivation, health literacy, or social support between the groups. Single institution in China; results may not apply to other surgical teams, healthcare systems, or patient populations. Sixty patients per group provides limited power to detect small but meaningful differences, especially in secondary outcomes. The prehabilitation programme lasted 6 weeks; a longer or more intensive programme might produce different results. Twelve-month follow-up may be too short to capture delayed or cumulative benefits of preoperative conditioning. The two groups were not drawn from identical calendar periods (consecutive programme enrolees versus a concurrent pool), leaving open the possibility of time-varying confounders such as seasonal variation in activity or bodyweight. The economic analysis captured costs at 3 months only and did not include quality-adjusted life-years, so a full cost-utility comparison was not possible.
Declared interests
The authors state the research did not receive any specific grant from public, commercial, or not-for-profit funding agencies. No conflicts of interest are declared.
The easy way to misread this
Do not read the significant 3-month differences in weight loss, grip strength, and mental well-being as evidence that prehabilitation works for bariatric surgery patients. The primary outcome (12-month total weight loss) was null (0.3 kg difference, p = 0.75), and every secondary advantage had faded to non-significance by 6 months. The early gains appear to be a transient acceleration that the surgery itself overrides, not a sustained treatment effect, and the programme added ¥6,792 in cost without a durable benefit.