Protein Optimization Plan
Surgery spends muscle. We set a daily protein target from your weight and kidney function, then build lean mass with supervised strength work so you have reserve to spend.
Physician-led surgical prehabilitation · In clinic & virtual
Get Strong Before Surgery
Strength training, nutrition, heart and lung conditioning and a medication review in the weeks before your operation, supervised by a physician. In randomised trials, patients who prepare this way have fewer complications and go home sooner. See the research.
- Columbia & Laurel, Maryland, and by video
- Half at enrollment, half by week 4
- Itemized superbill for your insurer
Now enrolling for October · 12 new clients a month, physician-supervised
Speak with us · 844-348-6348
Prepare For Surgery Right
Recovery starts weeks before the operation.
An operation costs muscle, and older adults rebuild it slowly. Anesthesia leans on the heart and lungs. A wound closes at the pace that blood sugar and protein allow. Each of these can be improved in four to twelve weeks, and we measure each one at your first visit and again before surgery.
Your physician designs the program around the operation you are having, whether that is a knee, a colon resection or a valve. Sessions run in our Columbia and Laurel clinics and by video, with one team from start to finish.
Get Strong Before Surgery
Eight disciplines, one plan
Weight Optimization First
Fat loss that spares muscle. Body composition is measured at every phase, so you reach the operating room lighter without arriving weaker.
Heart & Lung Training
Monitored aerobic conditioning and breathing work that raises the capacity you will lean on under anesthesia and in the first days after.
Nutrition Before Surgery
Counseling for you and whoever cooks at home: protein targets, meal timing, and the alcohol and sugar rules that matter in the weeks before an operation.
Blood Sugar & Medication Review
Blood sugar brought under control, and every prescription and supplement reviewed against your surgery so nothing surprises the anesthesia team.
Hydration & Vitamin Plans
Hydration therapy and essential-vitamin infusions in a quiet private suite, scheduled around your training and your labs.
Mind & Spirit Support
Counseling and spiritual care for the fear many people carry into surgery, plus sleep and breathing practice you can use the night before.
Recover Faster From Surgery
After surgery the same team continues: mobility work, wound-healing nutrition and a plan back to work and sport, for as long as your package runs.
The evidence
What the research shows, and how firmly
Prehabilitation has been studied in abdominal, lung, heart, colorectal and joint surgery, mostly in randomised trials. Below are the results we rely on, with every figure taken from the paper's abstract on PubMed. Where the authors rate their own evidence as weak, we say so.
- 186randomised trials pooled in a 2025 analysis of prehabilitationBMJ 2025
- 15,684adults studied across those trialsBMJ 2025
- 51%fewer high-risk patients with a complicationAnn Surg 2018
- 2.5fewer days in hospital after lung surgeryAnesth Analg 2025
01All major surgery
Exercise before surgery was linked to half the odds of a complication
A 2025 network meta-analysis pooled 186 randomised trials of adults preparing for major surgery. Exercise alone, nutrition alone, and exercise with nutrition and psychosocial support were the approaches most likely to lower the odds of a postoperative complication compared with usual care. Exercise and nutrition were the components most likely to improve all four critical outcomes the authors measured.
Read with care: The authors rate the certainty of every result shown here as very low, and of the evidence overall as low to very low, and call for larger trials. The exercise and nutrition results held when trials at high risk of bias were removed.
McIsaac et al. · BMJ · 2025Network meta-analysis · 186 randomised trials · 15,684 adults
PubMed 39843215
02High-risk abdominal surgery
51% fewer patients had a complication
Patients over 70, or rated ASA III or IV by their anesthesiologist, were randomised before elective major abdominal surgery. The prehabilitation group trained at high intensity and was coached to stay active. Their endurance time on a cycling test rose 135% on average, and they averaged 0.5 complications per patient against 1.4 with usual care.
Read with care: One hospital in Barcelona; 144 patients randomised and 125 analysed, after 19 had their surgical plan changed.
Barberan-Garcia et al. · Annals of Surgery · 2018Randomised blinded controlled trial · 144 randomised, 125 analysed
PubMed 28489682
03Lung cancer surgery
About half the complications, and 2.5 fewer days in hospital
Across 11 randomised trials of patients having lung resection, exercise before surgery cut postoperative complications by roughly half and shortened the hospital stay by two and a half days. A separate 2025 meta-analysis of 16 trials found lower odds of complications (0.33) and better percent-predicted lung function and peak oxygen uptake before the operation.
Read with care: The authors grade the evidence as low to moderate quality, and most trials had some risk of bias. The same review found no clear benefit from exercise alone before genitourinary or gastrointestinal cancer surgery.
Steffens et al. · Anesthesia & Analgesia · 2025Meta-analysis · 32 trials, 11 in lung cancer · 717 lung patients
PubMed 39383108
04Major elective surgery
Three kinds of preparation cut the stay by about two days
A review of 178 randomised trials compared eight kinds of preparation. Three of them, breathing-muscle training, immune-supporting nutrition and multimodal programs, each shortened the hospital stay. Breathing-muscle training and exercise each cut lung complications after surgery by close to half.
Read with care: The authors grade the overall quality of evidence as low and conclude that some prehabilitation interventions may reduce stay and complications.
Perry et al. · BMJ Open · 2021Systematic review and meta-analysis · 178 randomised trials
PubMed 34593498
05Colorectal cancer surgery
Starting before surgery brought walking capacity back sooner
Both groups received the same program of exercise, nutrition with protein supplementation, and relaxation. One group began about four weeks before surgery; the other began immediately after surgery. Eight weeks after the operation, 84% of the prehabilitation group walked as far as they had at baseline, against 62% of those who started afterward.
Read with care: Complication rates and length of stay were similar between groups; the gain was in physical recovery.
Gillis et al. · Anesthesiology · 2014Randomised controlled trial · 77 patients · McGill University
PubMed 25076007
06Heart surgery
Two-thirds less atrial fibrillation after surgery, age 65 and under
Exercise-based prehabilitation before elective cardiac surgery added 75 metres to the six-minute walk before the operation and shortened the hospital stay by a day. In patients 65 or younger, the risk of postoperative atrial fibrillation fell to roughly a third of usual care.
Read with care: Six studies and 665 patients; randomised and non-randomised designs were pooled. The atrial fibrillation result is for the 65-and-under subgroup only, with a wide range of uncertainty (risk ratio 0.14 to 0.83).
Steinmetz et al. · Am J Phys Med Rehabil · 2023Systematic review and meta-analysis · 6 studies · 665 patients
PubMed 36149383
07Hip and knee replacement
Patients who had therapy first were less likely to use a rehab facility or home health care
Among 4,733 Medicare hip and knee replacements in one regional referral area, 54.2% of patients who had physical therapy before surgery went on to use post-acute care, against 79.7% of those who did not. After adjusting for demographics and other illnesses, preoperative therapy was associated with 29% less use of post-acute care and an $871 lower Medicare payment per 90-day episode.
Read with care: An observational claims study: it shows association, not proof of cause. A 2017 meta-analysis of 35 trials (Moyer et al.) found better function, stronger quadriceps and shorter stays after knee replacement, with small to moderate effects.
Snow et al. · J Bone Joint Surg Am · 2014Medicare claims cohort · 4,733 joint replacements
PubMed 25274793
Sources (9 papers, all on PubMed)
- McIsaac DI, Kidd G, Gillis C, et al. Relative efficacy of prehabilitation interventions and their components: systematic review with network and component network meta-analyses of randomised controlled trials. BMJ. 2025;388:e081164. PubMed 39843215 · DOI
- Barberan-Garcia A, Ubré M, Roca J, et al. Personalised Prehabilitation in High-risk Patients Undergoing Elective Major Abdominal Surgery: A Randomized Blinded Controlled Trial. Ann Surg. 2018;267(1):50-56. PubMed 28489682 · DOI
- Steffens D, Hancock M, Jiang W, et al. An Updated Systematic Review and Meta-Analysis of Unimodal Prehabilitation with Exercise Intervention to Enhance Postoperative Outcomes in Cancer Surgery. Anesth Analg. 2025;140(4):811-820. PubMed 39383108 · DOI
- Li C, Meng H, Wei Y, et al. Postoperative outcomes of preoperative exercise training in patients with operable non-small cell lung cancer: a systematic review and meta-analysis. Front Oncol. 2025;15:1563478. PubMed 41018094 · DOI
- Perry R, Herbert G, Atkinson C, et al. Pre-admission interventions (prehabilitation) to improve outcome after major elective surgery: a systematic review and meta-analysis. BMJ Open. 2021;11(9):e050806. PubMed 34593498 · DOI
- Gillis C, Li C, Lee L, et al. Prehabilitation versus rehabilitation: a randomized control trial in patients undergoing colorectal resection for cancer. Anesthesiology. 2014;121(5):937-47. PubMed 25076007 · DOI
- Steinmetz C, Bjarnason-Wehrens B, Walther T, et al. Efficacy of Prehabilitation Before Cardiac Surgery: A Systematic Review and Meta-analysis. Am J Phys Med Rehabil. 2023;102(4):323-330. PubMed 36149383 · DOI
- Snow R, Granata J, Ruhil AVS, et al. Associations between preoperative physical therapy and post-acute care utilization patterns and cost in total joint replacement. J Bone Joint Surg Am. 2014;96(19):e165. PubMed 25274793 · DOI
- Moyer R, Ikert K, Long K, Marsh J. The Value of Preoperative Exercise and Education for Patients Undergoing Total Hip and Knee Arthroplasty: A Systematic Review and Meta-Analysis. JBJS Rev. 2017;5(12):e2. PubMed 29232265 · DOI
Results come from groups of patients in published studies and vary with the person, the operation and the program. They describe what prehabilitation has achieved in research, not a promise about any one patient.
See the program
The program in fifty-one seconds
From the first assessment to the first walk after surgery. Titles are on screen, so no sound is needed.
A Care Team By Your Side
Hands-on work in clinic, the rest by video
Strength sessions, infusions and body-composition checks happen in our Columbia and Laurel clinics. Check-ins, nutrition coaching and support sessions come to you by secure video. You choose the mix, and your physician changes it if progress stalls.
- 1Enroll
Choose a program and pay the first half. Your place is held once the deposit clears.
- 2Physician assessment
Within a few days: strength, mobility, labs, medications and surgical risk. These numbers become your baseline.
- 3Your program
Sessions in Columbia and Laurel and by video. Each week has a target, and we measure whether you reached it.
- 4Surgery, then recovery
Your surgeon receives a readiness letter. If your package includes recovery care, the same team sees you afterward.
Support Before & After
Choose your program length
Every program includes physician oversight, in-clinic and virtual appointments, and a superbill for your insurer. Half is paid at enrollment; the rest by the start of week 4.
Foundation
For surgery in the next month
$999
$499.50 today · $499.50 by week 4
Up to 4 weeks before surgery
- 4 in-clinic sessions
- 4 virtual visits
- 1 infusion
- Physician assessment and surgical-risk review
- Protein and nutrition plan
- Blood sugar and medication review
- Heart and lung conditioning
- One hydration and essential-vitamin infusion
- Pre-operative readiness letter for your surgeon
Most chosen
Signature Prehab
Up to 8 weeks of prehabilitation
$1,499
$749.50 today · $749.50 by week 4
Up to 8 weeks before surgery
- 8 in-clinic sessions
- 8 virtual visits
- 2 infusions
- Protein gain and lean-muscle building
- Fat loss and weight optimization
- Blood sugar control
- Heart and lung strengthening
- Nutritional counseling
- Emotional and spiritual support
- Medication review
- Hydration therapy
- Two essential-vitamin infusions
- Pre-operative readiness letter for your surgeon
Signature + Recovery
8 weeks before surgery, 4 weeks after
$2,499
$1,249.50 today · $1,249.50 by week 4
8 weeks before surgery · 4 weeks after
- 12 in-clinic sessions
- 12 virtual visits
- 3 infusions
- Everything in Signature Prehab
- Four weeks of post-operative recovery care
- Wound-healing nutrition and protein targets
- Swelling, pain and mobility plan
- Coordination with your surgeon's protocol
- A third recovery infusion
Complete Continuum
12 weeks before, 8 weeks after
$3,999
$1,999.50 today · $1,999.50 by week 4
12 weeks before surgery · 8 weeks after
- 20 in-clinic sessions
- 20 virtual visits
- 4 infusions
- Everything in Signature + Recovery
- Twelve weeks to build reserve before surgery
- Eight weeks of guided recovery
- Body-composition tracking at every phase
- Return-to-activity plan
- Four infusions across the program
Private Concierge
12 weeks before, 12 weeks after, with a direct line to your physician
$6,500
$3,250 today · $3,250 by week 4
12 weeks before surgery · 12 weeks after
- 24 in-clinic sessions
- Virtual visits: weekly, plus on request
- 6 infusions
- Everything in Complete Continuum
- A direct line to your physician
- Priority same-week scheduling
- Post-operative visits at home in the first two weeks
- Family briefing and caregiver coaching
- Six infusions across the program
Enroll
Reserve your place
Two minutes here, then Square's secure checkout. We call you within one business day to schedule your physician assessment.
Prefer to talk first? Call or text 844-348-6348, or book a consult.
Insurance, payment and the questions people ask
Will my insurance pay for this?
You pay the clinic directly; we do not bill insurance. Many plans reimburse part of this care out of network, so we give you an itemized superbill with the codes your plan asks for. Reimbursement is between you and your plan and is not guaranteed.
How does payment work?
Half when you enroll and the other half by the start of week 4, or the full amount today if you prefer. The second half is paid through a secure link; we send one reminder three days before and one on the due date.
Can I use an HSA or FSA card?
Many clients do. Whether a given card covers this care is set by your plan administrator; if they ask for a letter of medical necessity, our physician can provide one.
What if my surgery date moves?
Your program moves with it. Call or text us and we re-plan the remaining weeks around the new date.
In clinic or virtual?
Both, in the mix you choose. Strength sessions, infusions and body-composition checks are in clinic; check-ins, nutrition and support work as well by video from home.
What if prehab is not right for me?
Every program begins with a physician assessment. If our physician finds prehabilitation is not appropriate before your first session, we refund what you have paid in full.
Book Your Prehab Consult
The more weeks you have before surgery, the more we can change. Programs begin within days of enrollment, in Columbia & Laurel and by video.