Implementing Cardiac Prehabilitation in Brazil: Building an Evidence-based Framework for Surgical Outcomes.

Patients undergoing cardiac surgery often face multiple challenges, including comorbidities, frailty, and psychosocial factors, which complicate recovery. Multimodal prehabilitation programs have emerged as a promising strategy to address these issues, aiming to reduce the length of hospital stay, mitigate pulmonary complications, and enhance functional recovery. This Review Article examines the components and benefits of a comprehensive cardiac prehabilitation program, with a focus on exercise-based prehabilitation. Additionally, it underscores the importance of integrating prehabilitation into Brazilian clinical guidelines as a valuable preoperative opportunity. Emerging evidence, albeit of low to moderate quality, suggests that exercise-based prehabilitation, as a unimodal approach or integrating a multimodal program, can significantly improve functional capacity and postoperative outcomes in patients undergoing elective cardiac surgery. International guidelines have already supported cardiac prehabilitation as a valuable approach in this context. Globally, ongoing multicenter intervention trials seek to refine this evidence, pinpointing the ideal patient population and the most effective cardiac prehabilitation program. Given the growing burden of cardiovascular disease in Brazil, there is an unmet need for local research to assess the benefits of prehabilitation in patients undergoing cardiac surgery.