PREP-WELL project enhances patient health through innovative prehabilitation approach

Built on pilot work by Professor Gerry Danjoux at South Tees Hospitals NHS Foundation Trust, it addressed inactivity, smoking, and excessive alcohol consumption - behaviours affecting 30 to 50 per cent of surgical patients. Results showed 73 per cent of inactive patients achieved WHO-recommended activity levels, with benefits sustained three months post-surgery. At £400 per patient, the programme reduced hospital stays by two days, saving over £800 per patient. The programme evolved to include digital delivery (iPREP-WELL), supporting 535 patients total and influencing the regional Waiting Well programme.

Up to 90 per cent of patients presenting for major surgery in South Tees had at least one lifestyle risk factor (inactivity, smoking, excessive alcohol, obesity), with prevalence of individual behaviours at 30 to 50 per cent. Complications following surgery led to significant morbidity, reduced quality of life, and decreased independence. Preoperative patients cited lack of opportunity and health concerns as barriers to physical activity, yet 90 per cent were prepared to be active with proper support. The challenge was creating a flexible, person-centred prehabilitation programme that could adapt to different surgical timeframes and individual needs while changing hospital culture around physical activity.

PREP-WELL delivered a six-to-eight-week tailored programme including initial assessment of health and lifestyle risk factors, personalized packages addressing physical activity, smoking cessation, alcohol reduction, healthy eating, and mental wellbeing support, and follow-up assessments examining fitness, activity levels, and quality of life changes. YGT worked collaboratively with James Cook University Hospital to embed physical activity as lifestyle-based rather than purely clinical. When COVID-19 hit, the team pivoted to digital delivery (iPREP-WELL), offering home-based exercise, virtual classes, and paper-based resources, creating a menu of options (face-to-face, remotely supervised, digital) to suit patient preferences and circumstances.

• 495 patients accessed PREP-WELL; 40 accessed iPREP-WELL (535 total)
• 73 per cent moved from inactive to WHO-recommended activity levels (150 minutes weekly plus strength training)
• 63 per cent met WHO aerobic guidance at three months post-surgery vs 17 per cent at entry, with sustained benefits three months after surgery
• Substantial reduction in risk factors and improved quality of life
• Hospital stay reduced by approximately two days per patient
• Cost: £400 per patient; savings: over £800 per patient
• Learning influenced Waiting Well programme supporting 458 additional patients across larger geographical area.

While the hospital trust couldn't continue funding face-to-face PREP-WELL delivery, iPREP-WELL continues at South Tees with training designed for healthcare professionals to deliver as part of routine clinical care. The learning directly influenced the NHS North East and North Cumbria ICB's Waiting Well programme, which received funding for eight areas including South Tees to support patients awaiting non-urgent surgery. You’ve Got This actively participates in Waiting Well.

• one size doesn't fit all: offering a menu of options (face-to-face, digital, paper-based) improves engagement and satisfaction
• approximately one-third of patients preferred home-based programmes during COVID-19, with 50/50 split between digital and paper-based
• digital delivery enables scalability and reaches patients unable to access face-to-face support (travel difficulties, weekday commitments, confidence barriers)
• physical activity doesn't need to be prescriptive or delivered in health settings - it can be built into daily lifestyle
• supporting patients in addressing personal barriers to engagement improves participation.

James Hartley James, [email protected]

Links to relevant documents: Prepwell