The Role of Preoperative Physical Fitness in Reducing Anesthesia-Related Risk and Improving Recovery in Elderly Surgical Patients: A Narrative Systematic Review

Population ageing has increased the number of elderly patients presenting for elective surgery, a group characterised by reduced physiological reserve, a high prevalence of frailty and sarcopenia, and elevated anesthesia-related risk. Prehabilitation — structured exercise, nutritional, and psychological intervention delivered in the interval between the decision for surgery and the operation itself — has emerged internationally as a strategy to modify this risk before, rather than after, the physiological insult of surgery and anesthesia. This paper presents a narrative systematic review, informed by PRISMA reporting principles, of the evidence linking preoperative physical fitness to anesthesia-related risk and postoperative recovery in elderly patients. Six major bodies of evidence were synthesised: two large syntheses (an umbrella review of ۵۵ systematic reviews and a meta-analysis of ۳۳ studies in abdominal cancer surgery), two meta-analyses specific to frail older adults, a randomised controlled trial directly comparing prehabilitation with postoperative rehabilitation, and the cardiopulmonary exercise testing (CPET) literature on preoperative risk stratification. Across this evidence, exercise-based and multimodal prehabilitation are associated with reduced postoperative complications and improved functional recovery, most consistently measured through the ۶-minute walk test, although certainty of evidence remains low to moderate and effects on mortality and length of stay are inconsistent. Objective CPET indices, particularly a low anaerobic threshold, identify elderly patients at elevated cardiopulmonary risk and can guide both anesthetic planning and prehabilitation targeting. The paper proposes an integrated conceptual model linking preoperative assessment, multimodal prehabilitation, physiological mechanisms, and perioperative outcomes, and discusses implications for anesthesiology and exercise-science practice in the perioperative care of elderly patients.

کلیدواژه ها:

prehabilitation ، elderly surgical patients ، anesthesia risk ، frailty ، sarcopenia ، cardiopulmonary exercise testing ، postoperative recovery