SYSTEMATIC REVIEW article
Front. Med.
Sec. Family Medicine and Primary Care
This article is part of the Research TopicClinical and Basic Research on Chronic Spinal Cord Injury Associated with Spinal DegenerationView all 17 articles
Efficacy of Exercise-based Prehabilitation for Patients Undergoing Elective Spinal Surgery: A Systematic Review and Meta-analysis
Provisionally accepted
- 1Department of spinal surgery, Ningbo No.6 Hospital, Ningbo, China
- 2Ningbo No.6 Hospital, Ningbo, China
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Background: To investigate the efficacy of exercise-based prehabilitation for preoperative and postoperative outcomes in patients undergoing elective spinal surgery. Methods: Five databases were searched from their inception to March 2025 with no date restrictions. Standardized mean differences (SMDs) and mean differences (MDs) with 95% confidence intervals (CIs) were pooled using random‑effects models. The certainty of the evidence was assessed using the GRADE approach. Results: Six studies with 365 participants were included. Preoperative (after prehabilitation): exercise-based prehabilitation produced modest improvements versus control: back pain (SMD −0.32, 95% CI −0.54 to −0.11; I²=0%; GRADE: moderate), leg pain (SMD −0.43, −0.79 to −0.08; I²=53%; GRADE: moderate), knee-extensor strength (SMD 0.33, 0.07 to 0.58; I²=0%; GRADE: moderate), disability (SMD −0.44, −0.65 to −0.23; I²=0%; GRADE: moderate), kinesiophobia (SMD −0.30, −0.53 to −0.07; I²=0%; GRADE: moderate), and depressive symptoms (SMD −0.24, −0.47 to −0.01; I²=0%; GRADE: moderate); health-related quality of life (HRQoL) favored prehabilitation but CI included no effect (SMD 0.51, −0.04 to 1.07; I²=71%; GRADE: moderate). Postoperative short-term (≤1 month): early back pain improved (SMD −0.51, −0.93 to −0.08; I²=36%; GRADE: moderate). One trial reported improved short-term HRQoL. Moreover, length of hospital stay (days) was shorter but not statistically significant (MD −1.30 days, −2.89 to 0.29; I²=77%; GRADE: low). As for other short-term, intermediate-term (1–6 months), and long-term (≥6 months) results: pooled estimates for back pain, leg pain, disability, kinesiophobia, depression, and HRQoL clustered near the null with moderate-certainty evidence for most outcomes and no consistent durable benefit. Conclusion: Exercise-based prehabilitation confers consistent small-to-moderate standardized benefits in most preoperative outcomes and shows a favorable signal for early postoperative back pain for adults undergoing elective spinal surgery, yet evidence of sustained intermediate and long-term postoperative improvement is not established with current data. Trial registration: A prespecified protocol was registered on PROSPERO (CRD420251120535).
Keywords: Exercise-based prehabilitation, elective spinal surgery, Preoperative outcomes, postoperative recovery, Meta-analysis
Received: 17 Sep 2025; Accepted: 04 Nov 2025.
Copyright: © 2025 Lu, Sun, Li and Yuan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Zhenshan Yuan, yzhenshan_2025@163.com
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