Local therapies have previously had limited utility in the context of metastatic cancer owing to an inability to account for radiologically occult sites of disease. The traditional treatment of patients with metastatic solid tumors involved the use of systemic therapies with the goal of delaying disease progression and extending overall survival (OS).^1,2 In 1995, Hellman and Weichselbaum³ at the University of Chicago formally defined the oligometastatic paradigm. This paradigm suggests that in certain tumors, anatomic and physiologic factors may limit and concentrate the number of metastases to single or few organs. This concept has been recently expanded in the context of patients with synchronous oligometastatic disease or those with oligoprogressive cancer (defined as patients with the majority of the disease being stable or responding to therapy with a limited number of sites exhibiting progression).⁴ Subsequent work building on this hypothesis has found that distinct molecular subgroups exist that, in combination with clinical risk factors, define subpopulations who may preferentially benefit from aggressive local therapy and potentially delay tumor seeding of other sites and the development of more aggressive phenotypes.⁵

Objective: The purpose of this study was to determine the impact of prehabilitation exercise intervention with respect to (1) acceptability, feasibility, and safety; and (2) physical function, measured by 6‐minute‐walk test (6MWT).Data sources: PRISMA guidelines were used to systematically search PubMed, Embase, and CINAHL databases evaluating prehabilitation exercise interventions.Study selection: The inclusion criteria were studies investigating patients who underwent surgery for their cancer and underwent prehabilitation exercise.Data extraction and synthesis: Guidelines were applied by independent extraction by multiple observers. Data were pooled using a random‐effects model.Main outcome(s) and measure(s): Acceptability, feasibility, and safety rates were calculated. 6MWT (maximum distance a person can walk at their own pace on a hard, flat surface, measured in meters, with longer distance indicative of better performance status) was compared using two arms using the DerSimonian and Laird method.Results: Objective 1. Across 21 studies included in this review, 1564 patients were enrolled, 1371 (87.7%) accepted the trial; of 1371, 1230 (89.7% feasibility) completed the intervention. There was no grade 3+ toxicities. Objective 2. Meta‐analysis of five studies demonstrated a statistically significant decrease in 6MWT distance postoperatively in the control group (mean difference = +27.9 m; 95% confidence interval (CI): 9.3; 46.6) and a significant improvement postoperatively in the prehabilitation group (mean difference = −24.1 m; 95% CI: −45.7; −2.6). Meta‐analysis demonstrated improvements in 6MWT distance 4–8 weeks postoperatively in the prehabilitation group compared to the control group (mean difference = −58.0 m, 95% CI: −92.8; −23.3).Conclusions and relevance: Prehabilitation exercise for cancer patients undergoing surgery was found to be safe, acceptable, and feasible with a statistically significant improvement in the 6MWT, indicating that prehabilitation can improve postoperative functional capacity.