Lifestyle Medicine and Surgical Prehabilitation in Viet Nam: Preoperative Functional Assessment, Nutritional Support, and Postoperative Outcomes

Lifestyle Medicine and Surgical Prehabilitation in Viet Nam: Preoperative Functional Assessment, Nutritional Support, and Postoperative Outcomes

Primary category: Evidence & Clinical Practice

Secondary category: Lifestyle Medicine in Viet Nam

Article type: VLMA Perspective

Last reviewed: October 31, 2026

The weeks before an operation are usually occupied by medical appointments, investigations, anesthesia assessments, and practical arrangements. For patients whose illness has already affected their appetite, mobility, or physical strength, this period can also bring further deterioration.

Two people scheduled for the same procedure may arrive at the hospital with very different levels of physiological reserve. One may remain physically active, eat adequately, and manage daily activities independently. The other may have experienced unintentional weight loss, reduced muscle strength, or increasing difficulty walking. Even when both undergo technically successful surgery, their recovery may differ considerably.

Surgical prehabilitation aims to use the period before an operation to improve a patient's functional capacity and physiological reserve through appropriately selected interventions. Depending on individual needs, these may include exercise, nutritional support, respiratory training, psychological preparation, and other measures intended to support recovery.

The concept is appealing, particularly when a patient has problems that could potentially be improved before surgery. However, better physical fitness does not necessarily translate into fewer postoperative complications, shorter hospitalization, or improved long-term outcomes. Research findings vary across surgical procedures, patient populations, and intervention programs.

For healthcare professionals in Viet Nam, the important question is not whether every surgical patient should participate in prehabilitation. It is how to recognize patients who may benefit, provide appropriate preparation without compromising surgical safety or timing, and determine whether the interventions improve outcomes that matter to patients.

Understanding Prehabilitation Within Perioperative Care

Prehabilitation and postoperative rehabilitation address different stages of the surgical pathway, although they are closely connected.

Prehabilitation begins before surgery and aims to strengthen the patient's ability to tolerate the physiological demands of the procedure. Postoperative rehabilitation focuses on restoring or improving function afterward.

A patient who improves walking endurance before surgery may still need structured rehabilitation following the operation. Similarly, nutritional problems identified during preoperative assessment may require continued treatment throughout hospitalization and recovery at home.

Prehabilitation also overlaps with broader preoperative medical optimization. Managing anemia, stabilizing cardiovascular conditions, reviewing medications, improving diabetes control, and treating other medical problems are important components of perioperative care. Some prehabilitation programs incorporate selected aspects of this work, while others regard medical optimization as a complementary process.

The Enhanced Recovery After Surgery approach is broader. It brings together coordinated interventions before, during, and after surgery, including patient education, anesthesia management, pain control, nutritional care, and early mobilization.

Prehabilitation may form part of an enhanced recovery pathway, but the two concepts should not be used interchangeably.

Lifestyle Medicine contributes through evidence-based approaches to physical activity, nutrition, smoking cessation, harmful alcohol use, sleep, and sustainable health behaviors. These interventions should support established surgical, anesthetic, and rehabilitation care rather than operate as a separate treatment system.

A useful prehabilitation program identifies problems that can reasonably be addressed during the time available. Its value depends on selecting interventions that are clinically relevant to the patient, rather than attempting to introduce every possible lifestyle intervention before an operation.

Functional Assessment Should Guide Preoperative Preparation

Before recommending an exercise program, clinicians need to understand the patient's baseline functional condition and the demands of the planned surgery.

Assessment may consider usual physical activity, exercise tolerance, mobility, muscle strength, previous functional decline, nutritional status, frailty, and relevant medical conditions.

The planned operation matters because different procedures create different physiological demands. A patient awaiting major abdominal surgery may require a different approach from someone preparing for orthopedic reconstruction. A person receiving neoadjuvant cancer treatment may also experience fatigue, anemia, reduced appetite, or other treatment-related problems affecting exercise tolerance.

In September 2026, the American Heart Association and American College of Cardiology reaffirmed their guideline on perioperative cardiovascular management for noncardiac surgery. The reaffirmed guideline retained the recommendations published in 2024 following a review of newer evidence through March 2026. [1]

For patients undergoing elevated-risk noncardiac surgery, the guideline considers structured assessment of functional capacity, including the Duke Activity Status Index, reasonable for estimating perioperative cardiovascular risk.

The Duke Activity Status Index uses questions about everyday activities, such as personal care, walking, climbing stairs, and household tasks, to estimate functional capacity.

Other assessments may be appropriate in selected circumstances. The six-minute walk test, cardiopulmonary exercise testing, and measures of strength or mobility can provide additional information, but they assess different aspects of physical function.

Cardiopulmonary exercise testing requires appropriate equipment, expertise, and clinical indications. It is not a routine requirement for every patient being considered for prehabilitation.

These tools can help characterize functional limitations and guide clinical decisions. However, identifying poor functional capacity does not automatically establish that exercise training will reduce postoperative complications.

Assessment should provide information that can influence care, including whether additional evaluation, clinical optimization, or targeted support is appropriate. Testing without a clear purpose may increase costs and treatment burden or create unnecessary delays.

Frailty and Muscle Health Require Individual Assessment

Frailty is particularly relevant to surgical care because it describes increased vulnerability to stressors associated with reduced physiological reserve across multiple body systems.

However, chronological age alone does not determine frailty.

Two patients of the same age may differ substantially in mobility, independence, nutritional health, and physiological reserve. A physically active older person may tolerate a planned procedure differently from someone with significant frailty or multiple chronic conditions.

The 2026 reaffirmed American cardiovascular guideline recognizes the usefulness of validated frailty assessment in patients aged 65 years and older, as well as younger patients with suspected frailty, when elevated-risk noncardiac surgery is planned. [1]

Sarcopenia, characterized by reduced skeletal muscle strength and mass, may contribute to functional vulnerability but is not equivalent to frailty. Malnutrition may also coexist with either condition.

Recognizing these problems can help clinicians understand potential treatment needs, although the presence of a risk factor does not determine which intervention will be effective.

A patient with reduced muscle strength may benefit from appropriately selected resistance training. Someone with significant nutritional deficits may require nutritional therapy, while another patient with unstable cardiovascular disease, severe anemia, or other concerning medical problems may need clinical stabilization before attempting more demanding exercise.

Frailty assessment can support risk estimation and discussions about treatment, but it should not be used as a stand-alone prescription for intensive exercise or an automatic reason to postpone surgery.

The clinical value of screening depends on whether its findings lead to appropriate decisions about patient safety, preparation, and the likely benefits and burdens of treatment.

Nutritional Assessment Should Come Before Supplementation

Nutrition deserves particular attention during surgical preparation because illness, inadequate dietary intake, inflammation, and metabolic changes can affect muscle function and recovery.

Some patients awaiting surgery experience unintentional weight loss, poor appetite, swallowing difficulties, or reduced food intake. Others may have obesity while also experiencing nutritional deficiencies or low muscle mass.

Body weight and body mass index alone cannot reliably identify every form of malnutrition.

The European Society for Clinical Nutrition and Metabolism published an updated guideline on clinical nutrition in surgery in September 2025. [2]

The guideline emphasizes nutritional assessment and treatment throughout the perioperative pathway, particularly for patients undergoing major surgery and those at nutritional risk.

Validated nutritional screening tools can help identify individuals who require more detailed assessment. When malnutrition is suspected, evaluation should consider recent weight changes, dietary intake, muscle-related findings, illness burden, and other relevant factors.

The Global Leadership Initiative on Malnutrition criteria may support diagnosis in appropriate clinical circumstances.

Laboratory measurements such as serum albumin can provide useful clinical information but should not be treated as independent measures of nutritional adequacy. Albumin concentrations are influenced by inflammation, illness severity, fluid balance, and other physiological processes.

Nutritional support should address the patient's actual needs.

For some individuals, dietary counseling and appropriately planned meals may be sufficient. Others may require oral nutritional supplements, enteral nutrition, or more specialized medical nutrition therapy.

The choice depends on nutritional status, gastrointestinal function, the planned procedure, and the patient's ability to meet nutritional requirements.

A universal recommendation to increase protein intake or purchase a particular supplement is not appropriate. Patients with chronic kidney disease, significant metabolic abnormalities, swallowing disorders, or other relevant conditions may require specialized nutritional assessment and monitoring.

Those with severe nutritional depletion may also face risks when nutritional intake increases rapidly, including refeeding syndrome. These circumstances require professional management rather than general dietary advice.

The aim is to identify nutritional problems that may affect surgical recovery and address them through interventions appropriate to the patient's clinical condition. Increasing nutrient intake without understanding the underlying problem may provide little benefit and, in selected circumstances, create additional risks.

When Nutritional Optimization May Affect Surgical Timing

The period before surgery creates an opportunity to address nutritional problems, but the timing of an operation must remain a clinical decision.

The 2025 European Society for Clinical Nutrition and Metabolism guideline recommends preoperative nutritional therapy for patients with severe malnutrition or high metabolic risk, even when this requires postponing an elective procedure. A preparation period of approximately 10–14 days should be considered. [2]

This recommendation applies to patients with defined nutritional vulnerability. It is not a general instruction to postpone surgery for everyone requiring nutritional advice.

The expected benefits of nutritional treatment must be weighed against the risks of delaying the operation.

For a patient with progressive cancer, urgent symptoms, or another time-sensitive condition, postponement may introduce risks that outweigh uncertain benefits from additional preparation.

A short period of nutritional optimization may be justified in one patient but inappropriate in another. Decisions should involve the responsible surgical and anesthesia teams, together with relevant medical and nutritional expertise.

There is also a distinction between postponing surgery for a significant clinical problem and delaying an operation merely to complete a preferred number of exercise sessions.

Completing a prehabilitation program should not become a requirement that automatically overrides surgical urgency.

The time available for preparation must be considered alongside the underlying disease, the expected benefits of intervention, and the risks associated with delaying treatment. Patients should not independently postpone necessary surgery because an educational resource recommends a particular preparation period.

Exercise Prehabilitation Must Reflect the Patient and Procedure

Exercise is among the most frequently studied components of prehabilitation.

Programs may include aerobic conditioning, resistance training, functional activities, respiratory exercises, or combinations of these approaches.

Different activities address different capabilities. Aerobic exercise may improve cardiorespiratory fitness and endurance, while resistance training may help address muscle weakness. Functional exercises can support activities such as walking, standing, climbing stairs, and transferring between surfaces.

Respiratory training may be particularly relevant for selected patients at risk of postoperative pulmonary complications.

A specialist review published in BMJ Medicine in June 2026 examined the evidence for exercise, respiratory, nutritional, cognitive, and psychosocial prehabilitation. [3]

The authors found comparatively strong evidence that preoperative respiratory interventions can reduce postoperative pulmonary complications in certain surgical populations. However, the strength of evidence differed by procedure and type of intervention.

Findings concerning respiratory training in cardiac or thoracic surgery should not automatically be extended to every operation. The effectiveness of specific respiratory interventions may also differ between surgical populations.

The selection of exercise should therefore reflect the patient's functional condition, medical history, planned procedure, and time available for preparation.

Someone with substantial frailty or mobility impairment may require supervised or modified exercises. A patient receiving cancer treatment may experience changes in exercise tolerance related to fatigue, anemia, neuropathy, or other treatment effects.

Clinical supervision is particularly important when safety is uncertain.

Chest pain, fainting, new or worsening breathlessness, symptomatic arrhythmia, significant dizziness, or other concerning symptoms may require medical evaluation rather than continued exercise progression.

Prehabilitation should not create an expectation that patients must exercise through severe symptoms to demonstrate readiness for surgery.

For some patients, the most appropriate initial intervention may involve simple functional activities and gradual progression. Others may be able to participate in more structured conditioning, provided the program has been selected according to their clinical condition.

The purpose is to improve relevant physical capacity where feasible without introducing unnecessary risk or treatment burden.

What the Systematic Reviews Show

Recent systematic reviews suggest that exercise-based prehabilitation may improve selected postoperative outcomes, although findings vary across surgical populations and intervention programs.

A systematic review and meta-regression analysis published online in December 2025 and included in the October 2026 issue of Anesthesia & Analgesia examined 99 randomized controlled trials involving 8,222 adults undergoing major elective surgery. [4]

The pooled analysis found that exercise prehabilitation was associated with lower odds of postoperative complications, with an odds ratio of 0.54 and a 95% confidence interval from 0.44 to 0.67.

The certainty of evidence for this outcome was rated moderate.

Hospital length of stay was also approximately 0.90 days shorter on average among participants receiving exercise prehabilitation.

However, the certainty of evidence for length of stay was low, and substantial heterogeneity existed between studies.

These findings are encouraging, but they do not establish that every patient will experience a clinically meaningful benefit.

An odds ratio is a relative measure derived from the included studies. It does not indicate an individual patient's absolute probability of avoiding a complication.

Similarly, a pooled reduction in hospital stay does not mean that every hospital implementing prehabilitation should expect an identical improvement.

Another systematic review and meta-analysis, published in the Journal of the American College of Surgeons in July 2026, included 23 randomized trials involving 2,182 participants. [5]

It reported lower odds of postoperative complications among patients receiving exercise- or nutrition-based prehabilitation, with a pooled odds ratio of 0.52 and a 95% confidence interval from 0.35 to 0.78.

Hospital length of stay was also shorter, with an average difference of approximately 0.44 days.

However, the effects differed across intervention types and surgical settings. For example, the review reported different estimates for nutrition-only and exercise-only interventions, while the available quality-of-life data were not equally distributed across these intervention categories.

The evidence supports the potential value of prehabilitation but does not establish that a single program is equally effective across all operations.

An additional consideration is that systematic reviews may include overlapping randomized trials. Their participant numbers should not be added together as though they represent independent evidence from entirely different populations.

The most useful interpretation is that prehabilitation may improve selected postoperative outcomes, while important uncertainty remains concerning the patients most likely to benefit and the interventions best suited to particular surgical contexts.

Is One Exercise Program Better Than Another?

A network meta-analysis published online in the British Journal of Anaesthesia on September 22, 2026, compared different exercise-based prehabilitation approaches. [6]

The review included 96 randomized controlled trials involving 7,396 participants.

Programs combining aerobic, pulmonary, and functional exercises ranked favorably for reducing postoperative complications and hospital length of stay.

Programs combining aerobic and resistance training ranked favorably for improving health-related quality of life.

However, these findings require careful interpretation.

The certainty of evidence varied across comparisons, and approximately three-quarters of the included trials were assessed as having a high risk of bias.

The analysis also found no statistically significant improvement in postoperative physical recovery across the exercise interventions evaluated.

A high ranking in a statistical network does not necessarily establish that one intervention is clinically superior to all alternatives.

For example, the combined aerobic, pulmonary, and functional exercise approach ranked highly for reducing complications, but the certainty of the corresponding estimate was very low.

Such findings may help identify promising interventions for further study, but they should not be treated as definitive prescriptions for routine care.

The analysis suggests that different exercise components may have different effects depending on the outcome being measured. It does not establish one universally superior regimen for every surgical population.

This is particularly relevant when hospitals are deciding how to allocate rehabilitation resources. Choosing a program solely because it ranks highly in a network meta-analysis may overlook differences in patient needs, clinical risks, available expertise, and treatment feasibility.

Why Guidelines Remain Cautious

The European Society for Clinical Nutrition and Metabolism's 2025 guideline recommends offering prehabilitation on a risk-stratified basis. [2]

This approach supports identifying patients with relevant vulnerabilities and providing preparation according to clinical need.

However, the Enhanced Recovery After Surgery Society's 2025 guideline for elective colorectal surgery reached a more cautious conclusion concerning specific prehabilitation regimens. [7]

After reviewing the available evidence, it stated that no particular prehabilitation regimen could be recommended because findings concerning functional capacity, complications, and hospital length of stay remained inconsistent.

These positions are not necessarily contradictory.

One recommendation supports the broader principle of risk-based preparation. The other addresses whether the available evidence is sufficient to endorse a specific regimen for patients undergoing elective colorectal surgery.

The distinction reflects differences in scope, patient populations, interventions, and outcomes.

Evidence from orthopedic surgery cannot automatically be applied to major abdominal or oncological procedures. Likewise, results obtained in relatively fit patients may not apply to individuals with substantial frailty or complex medical conditions.

A guideline recommendation should therefore be interpreted according to the clinical question it addresses and the certainty of the supporting evidence.

For professional education, explaining these differences is more useful than presenting one guideline as definitive while overlooking conflicting findings.

What the October 2026 Randomized Trial Adds

A randomized clinical trial published in JAMA Network Open on October 28, 2026, provides an important counterpoint to the favorable findings reported in several systematic reviews. [8]

The study investigated exercise training during neoadjuvant treatment among patients with gastroesophageal cancer receiving treatment with curative intent.

The primary objective was to determine whether structured exercise could reduce the likelihood that patients would be unable to undergo their planned tumor resection.

Participants assigned to the intervention received aerobic and resistance exercise training before surgery.

Although 207 participants were randomized, the modified intention-to-treat analysis included 202 patients, with 101 in each group.

Ten patients in the exercise group did not undergo the intended curative tumor resection, compared with eight in the usual-care group.

The difference was not statistically significant. The trial also found no significant reduction in postoperative complications or permanent discontinuation of neoadjuvant treatment.

Exercise training produced favorable differences in selected physical fitness measures, but these changes did not translate into improvement in the primary surgical outcome.

A particularly important finding concerned overall survival.

At three years, estimated survival was 51.0% in the exercise group compared with 65.0% in the control group. The reported hazard ratio was 1.58, with a 95% confidence interval from 1.02 to 2.45.

This difference is concerning and warrants further investigation. However, its interpretation requires caution.

The trial did not achieve its planned sample size because recruitment ended early due to insufficient funding. It was not designed primarily to establish differences in long-term survival.

In the post hoc five-year analysis, estimated overall survival was 46.3% in the exercise group and 54.8% in the control group. The difference was smaller and was no longer statistically significant.

The per-protocol analysis also did not demonstrate the same statistically significant survival difference.

These findings should be considered alongside differences in baseline clinical characteristics, the possibility of chance findings, and other factors that may have influenced outcomes.

The observed survival difference does not, by itself, establish that exercise training caused increased mortality.

Nevertheless, it should not be dismissed simply because it differs from the generally favorable conclusions of some systematic reviews. The finding represents an important signal that future research needs to examine.

The results also apply to a specific population receiving neoadjuvant treatment for gastroesophageal cancer and to the intervention evaluated in the trial. They should not be generalized to every type of cancer surgery or interpreted as evidence that appropriately prescribed physical activity is generally harmful for people with cancer.

The study illustrates a clinically important distinction: an intervention can improve physical fitness without necessarily improving the major outcomes it was intended to influence.

Prehabilitation research must therefore evaluate postoperative complications, treatment tolerance, survival, functional recovery, and other patient-important outcomes directly rather than relying only on improvements in exercise performance.

What Happens When Prehabilitation Becomes Routine Hospital Care?

Controlled trials provide important evidence, but their findings do not always predict what happens when a program becomes part of routine hospital practice.

A prospective, nonrandomized stepped-wedge implementation study published in the British Journal of Surgery in February 2026 evaluated a hospital-wide multimodal prehabilitation program in the Netherlands. [9]

The study included 4,131 patients undergoing elective surgery across 20 clinical pathways.

Of these, 2,660 received usual care and 1,471 were included in the prehabilitation group.

The program combined supervised exercise, nutritional support, psychological counseling, and assistance with smoking and alcohol cessation.

Despite this comprehensive approach, the main adjusted analyses did not demonstrate statistically significant reductions in postoperative complications or hospital length of stay.

Participation was a notable challenge.

Only 24.9% of patients in the prehabilitation group attended at least nine exercise sessions. The median number of supervised exercise sessions completed was five.

This finding illustrates the difficulty of delivering structured interventions to patients with different medical conditions, surgical schedules, work obligations, and personal circumstances.

However, the absence of measurable benefit cannot be attributed solely to limited adherence.

The study was not randomized, and several factors may have influenced its findings, including differences in patient characteristics, intervention intensity, variation across clinical pathways, and implementation quality.

The results nevertheless demonstrate that establishing a program and proving its clinical effectiveness are different achievements.

A hospital may recruit staff, develop protocols, and offer prehabilitation, yet patients may be unable to participate sufficiently to receive the intended intervention.

It is also possible that benefits differ across patient groups. In the study's high-risk gastrointestinal oncology subgroup, the estimated reduction in complication risk was not statistically significant, leaving uncertainty about whether more targeted programs might produce better outcomes.

Implementation evaluation should therefore consider whether patients can access the service, whether the intervention is delivered as planned, and whether participation produces meaningful clinical benefits.

What Research From Viet Nam Can Tell Us

Vietnamese research provides useful preliminary information about integrating functional assessment and rehabilitation into surgical care pathways.

A study published in the Vietnam Journal of Community Medicine in September 2026 described the development and implementation of a multidisciplinary rehabilitation model for patients undergoing anterior cruciate ligament reconstruction at Hospital 199. [10]

The descriptive case series included 521 patients who underwent surgery during 2025.

The model incorporated care before and after surgery, including functional assessment, rehabilitation, nutritional counseling, and selected perioperative management measures.

All 521 patients underwent pre-anesthetic assessment and cardiovascular risk evaluation.

Nutritional counseling was provided to 475 patients, representing 91.2% of the study population.

Preoperative rehabilitation screening was completed for 484 patients.

Among those screened, 194 met the program's functional criteria for immediate surgery, while 290 were identified as requiring preoperative rehabilitation.

After the initial rehabilitation period, 254 of these 290 patients, or 87.6%, met the functional criteria used by the program to assess surgical readiness.

The study also reported early postoperative rehabilitation and nutritional counseling, together with frequent use of multimodal analgesia.

These findings demonstrate that a multidisciplinary, function-based pathway can be organized and implemented in a Vietnamese hospital.

They also show how preoperative assessment may help distinguish patients who meet functional readiness criteria from those who could benefit from additional preparation.

However, the study has important limitations.

It was a descriptive case series without an appropriately matched comparison group. Consequently, it cannot establish whether the intervention reduced postoperative complications, shortened hospitalization, or improved long-term recovery compared with usual care.

Meeting the program's functional readiness criteria also does not independently demonstrate that a patient will experience better surgical outcomes.

The pathway included both preoperative and postoperative interventions, making it difficult to attribute any observed benefits to prehabilitation alone.

Furthermore, the study population consisted of patients undergoing anterior cruciate ligament reconstruction.

The findings should not automatically be generalized to major abdominal, cardiothoracic, vascular, or oncological surgery.

The study is best understood as preliminary evidence concerning implementation feasibility and care process standardization.

Its value lies in demonstrating a local model that could inform future program development while highlighting the need for stronger comparative research.

Designing Prehabilitation Around Patients in Viet Nam

Introducing prehabilitation into Vietnamese healthcare requires more than adopting an intervention protocol developed in another country.

Programs need to reflect the surgical population, available professional expertise, treatment schedules, and practical circumstances affecting patient participation.

A feasible pathway may begin when an elective operation is being considered.

The surgical and anesthesia teams can assess whether the patient has functional limitations, nutritional risk, frailty, or other clinically important problems that may benefit from targeted intervention.

Patients requiring additional preparation can then be referred to appropriately qualified rehabilitation professionals, clinical nutrition specialists, or other healthcare practitioners.

The intervention should follow the problems identified during assessment.

A patient with reduced exercise tolerance may benefit from individualized conditioning. Someone with significant nutritional deficits may require structured nutritional therapy. Another patient may need support to stop smoking or address harmful alcohol use.

Not every patient needs every intervention.

The time available before surgery is also important. A person scheduled for an elective operation several weeks away may have more opportunity for preparation than someone whose condition requires treatment sooner.

Travel costs, employment obligations, caregiving responsibilities, and physical accessibility may influence attendance.

Some patients may be suitable for home-based exercises following appropriate assessment and instruction. Others may require supervised rehabilitation because of frailty, medical complexity, or safety concerns.

Remote follow-up may be useful in selected circumstances, but it should not replace necessary clinical examination or supervision.

Family members can help some patients maintain recommended activities at home, particularly when mobility is limited. Their involvement should remain consistent with patient consent and preferences.

Someone who cannot attend repeated appointments should not automatically be considered unmotivated.

A program may be appropriate in principle but poorly matched to the person's circumstances. Identifying these barriers and adapting the approach when clinically appropriate are important parts of responsible implementation.

For healthcare organizations, this may require offering different levels of support rather than creating one intensive program that every patient is expected to complete.

A patient with substantial functional limitations may need closer supervision, while someone with fewer risks may be able to follow a simpler plan supported by periodic professional review.

The appropriate model will depend on available resources, patient safety, and evidence of benefit.

Smoking, Alcohol, and Medical Optimization

Prehabilitation should not be considered separately from established preoperative care.

Smoking cessation, management of harmful alcohol use, anemia assessment, diabetes management, and optimization of relevant medical conditions may all be important before surgery.

The Enhanced Recovery After Surgery Society's 2025 guideline for colorectal surgery recommends smoking cessation with appropriate behavioral support, preferably beginning at least four weeks before surgery when feasible. [7]

It also advises patients with high alcohol consumption to stop drinking before surgery, while acknowledging limitations in the evidence supporting some outcomes.

These recommendations apply within a particular surgical context and should not be converted into fixed requirements for every procedure.

Patients who have less time before an operation may still benefit from appropriate cessation support. However, necessary surgery should not automatically be postponed to achieve a predetermined period of behavior change.

People with significant alcohol dependence may require medically supervised withdrawal management because abrupt cessation can cause serious complications.

Similarly, anemia may require medical investigation and treatment rather than dietary advice alone.

Uncontrolled diabetes, unstable cardiovascular disease, significant infection, and other medical conditions may require condition-specific management.

These interventions are part of professional medical care and should not be described merely as general lifestyle counseling.

Medication review and preoperative fasting instructions also require careful coordination.

Although modern enhanced recovery pathways emphasize avoiding unnecessarily prolonged fasting, patients must follow the instructions provided by their surgical and anesthesia teams.

They should not independently consume food, nutritional supplements, or carbohydrate-containing drinks close to anesthesia because a general educational article discusses perioperative nutrition.

The preparation plan must support established clinical safety requirements.

Measuring Whether Prehabilitation Improves Outcomes

A prehabilitation program can be evaluated through both implementation measures and clinical outcomes, but these answer different questions.

The proportion of patients screened, identified as high risk, or referred for intervention indicates whether the care pathway is functioning.

Attendance, completion rates, adverse events, and reasons for discontinuation provide information about feasibility and acceptability.

These measures matter because patients cannot benefit from an intervention that is not delivered or cannot be completed.

However, successful implementation does not independently demonstrate clinical effectiveness.

Postoperative outcomes may include complications, complication severity, hospital length of stay, readmissions, functional recovery, and health-related quality of life.

The choice of outcomes should reflect the planned procedure and the goals of the intervention.

Complications need consistent definitions and appropriate follow-up periods. A program may, for example, assess complications within 30 days using a recognized classification such as Clavien–Dindo.

Hospital length of stay can be useful, but it is influenced by factors beyond physical recovery, including discharge policies, bed availability, organizational practices, and social circumstances.

A shorter hospital stay should not automatically be interpreted as better recovery unless patient safety and other outcomes are also considered.

Functional improvement may be assessed through changes in walking capacity, mobility, strength, independence in daily activities, or the ability to return to usual activities after surgery.

Patient-reported outcomes provide another perspective.

For one patient, the most meaningful goal may be returning home independently. Another may prioritize resuming employment, managing personal care, or participating in family activities.

These goals can help determine whether an intervention has produced benefits that matter in everyday life.

Potential harms and treatment burdens also deserve attention. Exercise-related symptoms, nutritional intolerance, unnecessary investigations, additional costs, and delays in indicated surgery should not be overlooked.

Economic outcomes may be relevant, but claims of cost savings require appropriate analysis.

When hospitals compare patients who received prehabilitation with those who did not, differences in baseline risk must also be considered.

Patients referred for prehabilitation may be frailer or have more medical problems than those who are not referred. Simple comparisons of complication rates can therefore be misleading.

Prospective evaluation and appropriately designed comparative studies are needed to establish whether a program provides additional benefit beyond usual care.

The distinction between service activity and clinical improvement is particularly important when a program is being introduced for the first time. Measuring how many patients completed an intervention is useful, but it cannot replace evaluation of whether their recovery was safer or more effective.

Research Priorities for Viet Nam

The international evidence raises several questions that are particularly relevant to Vietnamese healthcare organizations.

Which surgical patients are most likely to benefit from prehabilitation? How much preparation is needed to produce meaningful improvement? Can shorter or partly home-based programs be effective for patients who cannot attend frequent hospital sessions?

These questions are important because surgical waiting periods, rehabilitation resources, and patient circumstances vary considerably.

Research should also examine how different professional groups coordinate care and which assessments can be performed reliably across healthcare settings.

Future Vietnamese studies could begin with standardized assessment of functional and nutritional vulnerability among patients undergoing selected elective procedures.

Feasibility studies could then evaluate participation, adherence, adverse events, and barriers to completing interventions.

Subsequent comparative studies should use clearly defined eligibility criteria, consistent intervention descriptions, appropriate control groups, and meaningful postoperative outcomes.

Prospective trial registration and prespecified analyses can strengthen research credibility.

Studies also need to distinguish the effects of prehabilitation from broader perioperative improvements, including changes in anesthesia, pain control, nutritional management, and postoperative rehabilitation.

For multidisciplinary programs, separating the contribution of each component may be difficult. Nevertheless, transparent reporting can help identify which approaches are feasible and deserve further evaluation.

Patient participation in research design is equally important.

A program developed without considering transportation costs, work obligations, treatment burden, and patient priorities may be difficult to sustain even when its physiological rationale is strong.

Research independence should also be protected.

Funding sources, commercial relationships, and potential conflicts of interest should be disclosed. Partnerships involving rehabilitation providers, nutritional product manufacturers, medical device companies, or digital health services should not determine how outcomes are interpreted or reported.

The purpose of research should be to generate knowledge that improves patient care rather than support predetermined claims about program success.

Professional and Legal Considerations in Viet Nam

Surgical prehabilitation may involve medical examination, functional assessment, clinical exercise prescription, nutritional treatment, rehabilitation, and decisions affecting surgical timing.

These activities must comply with applicable healthcare legislation and professional requirements in Viet Nam.

The Law on Medical Examination and Treatment No. 15/2023/QH15, effective January 1, 2024, as amended, provides the principal legal framework for medical examination and treatment. Its consolidated text is reflected in Consolidated Document No. 26/VBHN-VPQH issued by the Office of the National Assembly on February 26, 2026. [11]

Healthcare professionals and facilities must act within their qualifications, professional responsibilities, and legally authorized scopes of practice.

Completion of a Lifestyle Medicine course, professional certification, or health coaching program does not independently authorize someone to perform medical examinations, prescribe clinical rehabilitation, manage complex nutritional disorders, modify medications, or make decisions concerning surgical timing outside the applicable legal framework.

International guidelines and research findings can inform professional education and clinical understanding, but they do not automatically become binding Vietnamese clinical requirements.

Patient information also requires appropriate protection.

Functional assessments, nutritional records, medical histories, exercise monitoring results, and other identifiable health information may contain sensitive personal data.

The Law on Personal Data Protection No. 91/2025/QH15 and Decree No. 356/2025/NĐ-CP, both effective January 1, 2026, establish relevant requirements governing the processing and protection of personal data. [12,13]

Healthcare organizations must ensure that patient information is collected, accessed, used, stored, and shared through appropriate legal and professional arrangements.

For the Vietnam Lifestyle Medicine Alliance, surgical prehabilitation is a relevant subject for evidence-based professional education and scientific knowledge exchange.

Educational content can help healthcare professionals understand risk-based preoperative preparation, critically interpret intervention research, recognize patient safety considerations, and appreciate the importance of multidisciplinary coordination.

Such activities should remain within the organization's educational and knowledge-sharing role. They should not be presented as individualized surgical assessment, clinical rehabilitation, medical nutrition treatment, or perioperative care services provided by VLMA.

Preparing Patients for Surgery With Realistic Expectations

Surgical prehabilitation reflects an important development in perioperative care because it recognizes that the patient's condition before surgery may influence recovery afterward.

The period before an operation can provide an opportunity to identify and address functional limitations, nutritional problems, and other potentially modifiable vulnerabilities.

Recent systematic reviews suggest that appropriately selected exercise and nutritional interventions may reduce postoperative complications and shorten hospital stays in some surgical populations.

However, the evidence does not support treating prehabilitation as a universal intervention with predictable benefits for every patient.

The 2025 enhanced recovery guideline for colorectal surgery could not recommend a particular prehabilitation regimen, and a large hospital-wide implementation study published in 2026 did not demonstrate significant improvements in its main clinical outcomes.

The randomized trial published in October 2026 further illustrates why improvements in fitness should not automatically be equated with better surgical outcomes. Its unexpected survival findings also warrant further investigation.

Research from Hospital 199 provides a useful Vietnamese example of integrating functional assessment and multidisciplinary rehabilitation into a surgical pathway. However, comparative evidence is still required to establish whether such models improve postoperative outcomes across different patient populations.

For healthcare professionals in Viet Nam, the priority should be to identify patients with meaningful and potentially modifiable vulnerabilities, provide appropriate preparation, and avoid unnecessary delays in indicated surgery.

Lifestyle Medicine can contribute through individualized physical activity, nutritional care, behavioral support, and patient engagement.

Its role should remain coordinated with surgical, anesthetic, rehabilitation, and other medical services.

For healthcare organizations, the value of a prehabilitation program should be determined by whether patients can participate safely, whether relevant vulnerabilities are addressed, and whether postoperative outcomes improve.

Preparing patients well means understanding their condition before surgery, addressing problems that can reasonably be improved, and evaluating whether those efforts make a meaningful difference to recovery.

This provides a practical foundation for the responsible development of evidence-based surgical prehabilitation in Viet Nam.

Selected References

1. Thompson A, Fleischmann KE, Smilowitz NR, et al. 2026 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Journal of the American College of Cardiology. 2026;88(13):1543–1643. Reaffirmation of the 2024 recommendations. doi:10.1016/j.jacc.2026.06.017.

2. Weimann A, Bezmarevic M, Braga M, et al. ESPEN Guideline on Clinical Nutrition in Surgery – Update 2025. Clinical Nutrition. 2025;53:222–261. doi:10.1016/j.clnu.2025.08.029.

3. McIsaac DI, Amado L, Kidd G, et al. Prehabilitation in Preparation for Surgery. BMJ Medicine. 2026;5(1). doi:10.1136/bmjmed-2025-001969.

4. Ramic L, Branje K, Al-Bayati M, et al. Pooled Efficacy and Exploration of Effect Modifiers of Exercise Prehabilitation: A Systematic Review and Meta-regression Analysis of Randomized Controlled Trials. Anesthesia & Analgesia. 2026;143(4):701–716. Published online December 16, 2025. doi:10.1213/ANE.0000000000007882.

5. Cascavita CT, Hall AE, Shariati K, et al. Exercise- and Nutrition-Based Prehabilitation Programs in Surgery: A Systematic Review and Meta-Analysis. Journal of the American College of Surgeons. 2026;243(1):168–181. doi:10.1097/XCS.0000000000001891.

6. McIsaac DI, Gillmore TC, Al-Bayati M, et al. Relative Efficacy of Exercise Prehabilitation Interventions and Their Components: A Systematic Review and Network Meta-analysis of Randomised Controlled Trials. British Journal of Anaesthesia. Published online September 22, 2026. doi:10.1016/j.bja.2026.08.052.

7. Gustafsson UO, Rockall TA, Wexner S, et al. Guidelines for Perioperative Care in Elective Colorectal Surgery: Enhanced Recovery After Surgery Society Recommendations 2025. Surgery. 2025;184:109397. doi:10.1016/j.surg.2025.109397.

8. Simonsen C, de Heer P, Thomsen SN, et al. Exercise Training During Neoadjuvant Treatment for Gastroesophageal Cancer and Tumor Surgery: A Randomized Clinical Trial. JAMA Network Open. 2026;9(10). Published October 28, 2026. doi:10.1001/jamanetworkopen.2026.40136.

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10. Võ Thị Hồng Hướng. Xây dựng và triển khai mô hình phục hồi chức năng đa ngành dựa trên tiêu chí chức năng cho người bệnh tái tạo dây chằng chéo trước: Kết quả bước đầu tại Bệnh viện 199. Tạp chí Y học Cộng đồng. 2026;67(CĐ13). doi:10.52163/yhc.v67iCD13.6401.

Vietnamese Regulatory References

11. National Assembly of Viet Nam. Law on Medical Examination and Treatment No. 15/2023/QH15. January 9, 2023. Effective January 1, 2024, as amended. Office of the National Assembly. Consolidated Document No. 26/VBHN-VPQH. February 26, 2026.

12. National Assembly of Viet Nam. Law on Personal Data Protection No. 91/2025/QH15. June 26, 2025. Effective January 1, 2026.

13. Government of Viet Nam. Decree No. 356/2025/NĐ-CP Detailing Certain Articles and Measures for Implementing the Law on Personal Data Protection. December 31, 2025. Effective January 1, 2026.

Editorial and Medical Disclaimer

This article is published by the Vietnam Lifestyle Medicine Alliance (VLMA) for general professional education, scientific information, and knowledge exchange. It reflects selected scientific evidence and regulatory information reviewed as of October 31, 2026.

The article does not constitute individualized medical advice, a preoperative medical assessment, an exercise or nutritional prescription, a surgical recommendation, or an official clinical practice guideline issued by Vietnamese health authorities.

International guidelines and scientific studies discussed in this article should be interpreted according to their intended populations, evidence quality, surgical contexts, and clinical circumstances. Their application in Viet Nam requires appropriate professional judgment and compliance with applicable laws and professional scope-of-practice requirements.

VLMA is a physician-led professional education and knowledge-sharing platform operated by Vietnam Lifestyle Medicine Alliance Company Limited. Publication of this article does not constitute the provision of medical examination, preoperative assessment, individualized clinical rehabilitation, medical nutrition treatment, or surgical care services by VLMA.

Clinical decisions concerning surgical timing, prehabilitation eligibility, exercise intensity, nutritional therapy, medication management, anesthetic preparation, and postoperative treatment must remain under the responsibility of appropriately qualified and authorized healthcare professionals and facilities.

Patients should not independently postpone or cancel necessary surgery, begin intensive exercise programs, take nutritional supplements or prescription medications, or change preoperative fasting instructions based solely on this article.

Patients with unstable medical conditions, significant new symptoms, or other concerning problems require appropriate medical assessment. Lifestyle-related interventions and prehabilitation programs must not delay necessary surgical, anesthetic, emergency, or other medical care.

This article does not endorse any particular rehabilitation provider, nutritional supplement, exercise equipment, digital application, healthcare organization, or commercial prehabilitation program. References to scientific studies and international recommendations do not imply that VLMA has independently tested, validated, certified, or clinically implemented the interventions discussed.