Highlights
– In a pragmatic, multicenter RCT of 847 older adults with frailty scheduled for elective noncardiac surgery, offer of a coach-supported, home-based multimodal prehabilitation program did not reduce 30‑day postoperative disability (WHODAS 2.0) or in-hospital complications compared with usual care.
– Median prehabilitation exposure was 4 weeks; no differences in preoperative safety events were observed.
– A per-protocol signal: participants who completed >75% of prescribed exercises had lower postoperative disability, suggesting adherence may be a key mediator of benefit.
– Primary barriers to adherence were competing priorities and motivation, highlighting implementation challenges for home-based models in older adults with frailty.
