{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T22:18:43Z","timestamp":1791584323576,"version":"4.3.4"},"reference-count":124,"publisher":"The Korean Society of Anesthesiologists","issue":"5","license":[{"start":{"date-parts":[[2025,7,18]],"date-time":"2025-07-18T00:00:00Z","timestamp":1752796800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["ekja.org"],"crossmark-restriction":true},"short-container-title":["Korean J Anesthesiol"],"published-print":{"date-parts":[[2025,10,1]]},"abstract":"<jats:p>This narrative review explores multimodal prehabilitation, a patient-centered, evidence-based, and multidisciplinary approach to enhance postoperative recovery. It shifts the focus from traditional intraoperative and postoperative care to a comprehensive process beginning at diagnosis. Multimodal prehabilitation integrates exercise, nutrition, and psychological strategies to improve preoperative functional capacity and physiological reserve, enabling better management of surgical stress. The review examines prehabilitation\u2019s clinical efficacy, highlighting enhanced functional capacity as a key outcome. It details prehabilitation components: exercise (aerobic, resistance, and respiratory muscle training), nutritional optimization targeting modifiable risk factors such as malnutrition and sarcopenia, and psychological support to lower anxiety and boost patient motivation and adherence. Individualized approaches are emphasized due to significant patient variability. This review also presents a successful multimodal prehabilitation program implemented at the Montreal General Hospital, which has a strong track record in this area. The program is structured around four key phases: screening, assessment, intervention, and follow-up. It also discusses the barriers to implementation and the roles of stakeholders, including the government, hospitals, healthcare professionals, and patients and their families, within the context of South Korea\u2019s unique healthcare system and socio-cultural environment.<\/jats:p>","DOI":"10.4097\/kja.25320","type":"journal-article","created":{"date-parts":[[2025,7,21]],"date-time":"2025-07-21T00:52:46Z","timestamp":1753059166000},"page":"401-417","update-policy":"https:\/\/doi.org\/10.4097\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Enhancing postoperative recovery with multimodal prehabilitation:  the journey begins before surgery"],"prefix":"10.4097","volume":"78","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7108-1384","authenticated-orcid":true,"given":"Ah-Reum","family":"Cho","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9235-513X","authenticated-orcid":true,"given":"Wariya","family":"Vongchaiudomchoke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3625-7449","authenticated-orcid":true,"given":"Detlef","family":"Balde","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-5003-1996","authenticated-orcid":true,"given":"Do Jun","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0610-4057","authenticated-orcid":true,"given":"Francesco","family":"Carli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2573","reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2016.4952"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2021.0586"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1056\/evidra2400012"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1016\/j.xjon.2021.07.007"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2019.0995"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.17310"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1097\/aln.0000000000003331"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.4278\/0890-1171-12.1.38"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1186\/s13741-019-0133-z"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2024.02.035"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2019.5474"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1097\/aln.0000000000000393"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2018.1645"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1053\/j.jvca.2021.02.049"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2023.0198"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2025.02.013"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.18858\/smn.2019.10.2.32"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.17085\/apm.23096"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1513\/annalsats.201610-780fr"},{"key":"ref20","first-page":"1278","volume-title":"Guidelines for perioperative cardiovascular evaluation for noncardiac surgery. Report of the American College of Cardiology\/American Heart Association Task Force on Practice Guidelines. Committee on Perioperative Cardiovascular Evaluation for Noncardiac Surgery","author":"Eagle","year":"1996"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehu282"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001285"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.1111\/anae.13312"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.1007\/s12630-014-0263-1"},{"key":"ref25","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2648.2006.04156.x"},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.1007\/s12630-015-0508-7"},{"key":"ref27","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.9324"},{"key":"ref28","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpa.2018.06.001"},{"key":"ref29","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.106.184461"},{"key":"ref30","doi-asserted-by":"publisher","DOI":"10.1161\/cir.0000000000000483"},{"key":"ref31","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aev454"},{"key":"ref32","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)31131-0"},{"key":"ref33","doi-asserted-by":"publisher","DOI":"10.1093\/jn\/123.suppl_2.465"},{"key":"ref34","doi-asserted-by":"publisher","DOI":"10.1093\/bmb\/ldq008"},{"key":"ref35","doi-asserted-by":"publisher","DOI":"10.1139\/apnm-2021-0299"},{"key":"ref36","doi-asserted-by":"publisher","DOI":"10.1007\/s12630-021-01933-3"},{"key":"ref37","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinane.2018.02.011"},{"key":"ref38","doi-asserted-by":"publisher","DOI":"10.14336\/ad.2019.1024"},{"key":"ref39","doi-asserted-by":"publisher","DOI":"10.1037\/hea0000781"},{"key":"ref40","doi-asserted-by":"publisher","DOI":"10.1111\/anae.15215"},{"key":"ref41","doi-asserted-by":"publisher","DOI":"10.1016\/j.clnu.2024.01.020"},{"key":"ref42","doi-asserted-by":"publisher","DOI":"10.1111\/ans.18684"},{"key":"ref43","doi-asserted-by":"publisher","DOI":"10.1097\/aco.0000000000001188"},{"key":"ref44","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2021.11.014"},{"key":"ref45","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2024-081164"},{"key":"ref46","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2023.01.024"},{"key":"ref47","doi-asserted-by":"publisher","DOI":"10.1007\/s11154-005-6726-5"},{"key":"ref48","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1990.68.1.329"},{"key":"ref49","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa1616338"},{"key":"ref50","doi-asserted-by":"publisher","DOI":"10.1620\/tjem.217.109"},{"key":"ref51","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/85.1.109"},{"key":"ref52","doi-asserted-by":"publisher","DOI":"10.1213\/ane.0000000000004455"},{"key":"ref53","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2017.10.020"},{"key":"ref54","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2022.10.039"},{"key":"ref55","first-page":"1","volume-title":"Diabetes, oxidative stress and physical exercise","author":"Atalay","year":"2002"},{"key":"ref56","doi-asserted-by":"publisher","DOI":"10.1113\/jp272255"},{"key":"ref57","doi-asserted-by":"publisher","DOI":"10.1210\/er.2017-00211"},{"key":"ref58","doi-asserted-by":"publisher","DOI":"10.1007\/s12630-014-0274-y"},{"key":"ref59","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-017-4106-4"},{"key":"ref60","doi-asserted-by":"publisher","DOI":"10.1111\/dme.15380"},{"key":"ref61","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.j5916"},{"key":"ref62","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.cd010356.pub2"},{"key":"ref63","doi-asserted-by":"publisher","DOI":"10.1378\/chest.105.6.1782"},{"key":"ref64","doi-asserted-by":"publisher","DOI":"10.1152\/ajpendo.00525.2011"},{"key":"ref65","doi-asserted-by":"publisher","DOI":"10.1007\/s00726-018-2640-5"},{"key":"ref66","doi-asserted-by":"publisher","DOI":"10.1016\/j.clnu.2021.03.031"},{"key":"ref67","doi-asserted-by":"publisher","DOI":"10.1213\/ane.0000000000002743"},{"key":"ref68","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2018.05.012"},{"key":"ref69","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2021.12.007"},{"key":"ref70","doi-asserted-by":"publisher","DOI":"10.7812\/tpp\/12-019"},{"key":"ref71","doi-asserted-by":"publisher","DOI":"10.1101\/cshperspect.a029769"},{"key":"ref72","doi-asserted-by":"publisher","DOI":"10.1002\/pri.1755"},{"key":"ref73","doi-asserted-by":"publisher","DOI":"10.1002\/pon.4464"},{"key":"ref74","doi-asserted-by":"publisher","DOI":"10.1111\/anae.14507"},{"key":"ref75","doi-asserted-by":"publisher","DOI":"10.1177\/1474515115602678"},{"key":"ref76","doi-asserted-by":"publisher","DOI":"10.1097\/jcn.0b013e3182189c4d"},{"key":"ref77","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.cd008646.pub2"},{"key":"ref78","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-015-4550-z"},{"key":"ref79","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2021.634223"},{"key":"ref80","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-020-05078-9"},{"key":"ref81","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-020-05341-z"},{"key":"ref82","doi-asserted-by":"publisher","DOI":"10.21037\/jtd.2019.02.12"},{"key":"ref83","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afz046"},{"key":"ref84","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2016.05.036"},{"key":"ref85","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-021-11002-0"},{"key":"ref86","doi-asserted-by":"publisher","DOI":"10.1007\/s10388-024-01049-9"},{"key":"ref87","doi-asserted-by":"publisher","DOI":"10.1111\/cob.12445"},{"key":"ref88","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdu042"},{"key":"ref89","doi-asserted-by":"publisher","DOI":"10.1097\/xcs.0000000000001348"},{"key":"ref90","doi-asserted-by":"publisher","DOI":"10.2106\/jbjs.rvw.19.00161"},{"key":"ref91","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2016.10.061"},{"key":"ref92","doi-asserted-by":"publisher","DOI":"10.1097\/aco.0000000000001359"},{"key":"ref93","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-023-02977-6"},{"key":"ref94","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2023.107302"},{"key":"ref95","doi-asserted-by":"publisher","DOI":"10.1097\/sla.0000000000005662"},{"key":"ref96","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2011.11.006"},{"key":"ref97","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2024.1321493"},{"key":"ref98","doi-asserted-by":"publisher","DOI":"10.1111\/jhn.13050"},{"key":"ref99","doi-asserted-by":"publisher","DOI":"10.1213\/ane.0000000000005471"},{"key":"ref100","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2020.09.041"},{"key":"ref101","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2019.11.025"},{"key":"ref102","doi-asserted-by":"publisher","DOI":"10.1016\/j.clnu.2015.03.001"},{"key":"ref103","doi-asserted-by":"publisher","DOI":"10.1016\/s0022-3999(01)00296-3"},{"key":"ref104","doi-asserted-by":"publisher","DOI":"10.1002\/pon.3430"},{"key":"ref105","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2019.04.058"},{"key":"ref106","doi-asserted-by":"publisher","DOI":"10.5763\/kjsm.2020.38.2.85"},{"key":"ref107","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-024-10993-2"},{"key":"ref108","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2020.04.042"},{"key":"ref109","doi-asserted-by":"publisher","DOI":"10.35301\/ksme.2024.27.2.89"},{"key":"ref110","doi-asserted-by":"publisher","DOI":"10.1186\/s12961-023-00993-9"},{"key":"ref111","volume-title":""},{"key":"ref112","doi-asserted-by":"publisher","DOI":"10.4178\/epih.e2017030"},{"key":"ref113","doi-asserted-by":"publisher","DOI":"10.1001\/jama.282.15.1458"},{"key":"ref114","first-page":"e64","volume-title":"Guidance for structuring team-based incentives in healthcare","author":"Blumenthal","year":"2013"},{"key":"ref115","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-publhealth-032315-021457"},{"key":"ref116","doi-asserted-by":"publisher","DOI":"10.7475\/kjan.2025.37.1.1"},{"key":"ref117","doi-asserted-by":"publisher","DOI":"10.2147\/jmdh.s501077"},{"key":"ref118","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2012.02.060"},{"key":"ref119","doi-asserted-by":"publisher","DOI":"10.3389\/fcomm.2021.606445"},{"key":"ref120","doi-asserted-by":"publisher","DOI":"10.1186\/s12966-023-01474-6"},{"key":"ref121","doi-asserted-by":"publisher","DOI":"10.1177\/0969733014523168"},{"key":"ref122","doi-asserted-by":"publisher","DOI":"10.1177\/1477750917704156"},{"key":"ref123","doi-asserted-by":"publisher","DOI":"10.1037\/a0028609"},{"key":"ref124","doi-asserted-by":"publisher","DOI":"10.1111\/ecc.12846"}],"container-title":["Korean Journal of Anesthesiology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/ekja.org\/upload\/pdf\/kja-25320.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/ekja.org\/journal\/view.php?doi=10.4097\/kja.25320","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/ekja.org\/upload\/pdf\/kja-25320.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T00:51:01Z","timestamp":1759193461000},"score":1,"resource":{"primary":{"URL":"http:\/\/ekja.org\/journal\/view.php?doi=10.4097\/kja.25320"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,1]]},"references-count":124,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2025,10]]}},"URL":"https:\/\/doi.org\/10.4097\/kja.25320","relation":{},"ISSN":["2005-6419","2005-7563"],"issn-type":[{"value":"2005-6419","type":"print"},{"value":"2005-7563","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,1]]},"assertion":[{"value":"2025-04-21","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-06-15","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-07-18","order":2,"name":"published","label":"Published online","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-01","order":3,"name":"published","label":"Print publication","group":{"name":"publication_history","label":"Publication History"}}]}}