Training before surgery eased anxiety, not depression

Surgery for colorectal cancer is a physical and psychological ordeal, and Enhanced Recovery After Surgery (ERAS) pathways have mostly been judged on physical recovery markers. Prehabilitation — preparing patients in the weeks before an operation — usually combines exercise, nutritional support and psychological counselling, but whether that package shifts mental health outcomes such as anxiety, depressive symptoms and quality of life has been much less studied. This trial set out to test whether adding trimodal prehabilitation to an existing ERAS pathway could reduce perioperative anxiety and depression and improve health-related quality of life, and whether baseline fitness predicted how patients fared psychologically.

This was a single-centre, single-blind randomised controlled trial, reported here as an interim analysis of 45 patients scheduled for elective colorectal cancer surgery. Twenty were assigned to trimodal prehabilitation — exercise, nutritional support and psychological counselling — and 25 to standard ERAS care. The primary outcome was the longitudinal change in anxiety severity on the GAD-7 scale, from four weeks before surgery out to 52 weeks after. Secondary outcomes included depressive symptoms on the PHQ-9 across five time points, quality of life via SF-36 and the EORTC QLQ-C30/CR29, plus exploratory correlations between baseline physical performance (six-minute walk test and cardiopulmonary exercise testing) and psychological trajectories.

GAD-7 anxiety scores fell from 6.2 ± 5.1 to 2.2 ± 3.1 in the prehabilitation group and from 4.7 ± 4.8 to 2.9 ± 2.8 in controls, a statistically significant between-group difference. On the SF-36 "Health Change" item at 52 weeks, the intervention group scored 76.6 ± 26.6 versus 74.8 ± 29.2 in controls, also reported as statistically significant despite the small numerical gap. Emotional functioning and cancer-related fatigue domains of the EORTC QLQ-C30 improved significantly. Notably, PHQ-9 depression scores showed no significant between-group difference over time, and correlations between baseline physical performance and psychological outcomes were not statistically significant.

Prehabilitation research has largely focused on physical capacity and postoperative complications; this trial extends the question to the psychological side and suggests anxiety may be the more responsive target. The null result for depression complicates any assumption that a multimodal programme lifts mood globally, and the absence of any link between baseline walking or exercise-test performance and psychological trajectories argues against fitness being the mechanism. Because the design bundles exercise, nutrition and counselling together, it cannot say which component did the work, and the very small difference on the perceived-health measure raises questions about clinical meaningfulness. Larger multicentre trials are needed.

For anyone facing major abdominal surgery, this is a reason to think that structured preparation in the weeks beforehand may help with the anxiety that surrounds an operation, and that the benefit can still be visible a year later. It is not evidence that prehabilitation treats depression — that outcome was flat here. Nor does it tell you which ingredient matters, since exercise, diet support and counselling arrived as one package. Treat it as an early, encouraging signal from a small interim analysis rather than a settled conclusion, and note that psychological support was part of the programme, not just training.relatedContent