Dueblin SW; Bern University Hospital, University of Bern,Switzerland
Wuethrich PY; Engel D; Eser P; et al

BMC Geriatrics. 26(1), 2026 Jul 07. VI 1

BACKGROUND: Older adults awaiting major surgery often present with reduced
physical fitness and respiratory muscle weakness, which are associated
with increased postoperative complications. Prehabilitation may improve
functional capacity, but evidence for its effect on inspiratory muscle
strength in high-risk older adults remains limited. The main objective was
to assess the change in maximal inspiratory pressure (MIP) in the
preoperative period in high-risk patients receiving home-based
tele-supervised prehabilitation compared to standard care.

METHODS: This exploratory analysis included a subset of secondary outcome
data from a prospective, two-arm, parallel-group randomised controlled
trial conducted at a single university hospital in Switzerland. Patients
aged >= 65 years awaiting elective cardiac or major non-cardiac surgery
with a proven fitness deficit measured by cardiopulmonary exercise testing
(CPET) were included. Participants randomized in the intervention arm
received a multimodal, home-based tele-supervised prehabilitation
programme over 2-4 weeks addressing deficits in physical fitness,
nutrition, and anaemia, while controls received standard preoperative
care.

RESULTS: Eighty eight participants were analysed (intervention n = 48;
control n = 40). Patients in the intervention group showed improvement in
MIP after the training period, whereas the control group demonstrated a
decline (median change + 10.5 [0.00; 16.2] vs. – 3.00 [-8.00; 1.50] cmH2O;

CONCLUSIONS: Home-based tele-supervised IMT, delivered as part of a
multimodal prehabilitation programme, improved maximal inspiratory
pressure over the preoperative period in elderly high-risk surgical
patients. The observed MIP decline in the control group suggests that the
preoperative waiting period itself may carry a risk of functional
deterioration in this population. Whether MIP improvements translate into
reduced postoperative morbidity will be addressed by the primary outcome
of the ongoing PREHABIL trial.