Gram Research analysis of a 2026 randomized controlled trial found that intensive lifestyle coaching before hernia surgery helped patients successfully improve smoking, nutrition, alcohol, and exercise habits, with 68 percent of coached patients optimizing all risky factors compared to zero percent in standard care. While the study was too small to confirm whether this reduces surgical complications, patients who received coaching maintained their quality of life after surgery, whereas standard care patients experienced significant decline.
Researchers tested whether helping patients improve their lifestyle habits before hernia surgery could reduce complications after the operation. The study focused on four risky habits: smoking, poor nutrition, alcohol use, and physical inactivity. While the trial didn’t recruit enough patients to give definitive answers, early results showed that patients who received intensive lifestyle coaching before surgery successfully improved their habits, and they reported better quality of life after surgery compared to those who received standard care. This research suggests that preparing your body before surgery might be worth exploring.
Key Statistics
A 2026 randomized controlled trial of 43 patients found that 13 out of 19 hernia surgery patients who received intensive lifestyle coaching successfully optimized all four risky habits (smoking, nutrition, alcohol, and exercise), compared to zero out of 22 in standard care.
According to research reviewed by Gram, patients receiving prehabilitation coaching before hernia repair maintained their quality of life scores 30 days after surgery, while standard care patients experienced a statistically significant decline in quality of life (p equals 0.03).
The STRONG-Hernia trial showed that 3 out of 16 prehabilitation patients experienced postoperative complications within 30 days compared to 4 out of 19 standard care patients, though the trial was underpowered to detect statistical significance in this outcome.
The Quick Take
- What they studied: Whether six weeks of intensive coaching on smoking, nutrition, alcohol, and exercise before hernia surgery could help patients recover better and have fewer complications after surgery.
- Who participated: 43 adults scheduled for elective ventral hernia repair (a surgical procedure to fix a bulge in the abdominal wall) who had at least one risky lifestyle factor. About 75 percent had one risky habit, and 25 percent had two or more. Obesity was the most common risk factor.
- Key finding: Patients who received the intensive lifestyle coaching program successfully improved all their risky habits (13 out of 19 patients), while none of the standard care patients made similar improvements. After surgery, the coached group reported better quality of life scores compared to the standard care group.
- What it means for you: Preparing your body before surgery through lifestyle changes may help you feel better after the operation, though more research is needed to confirm whether it actually reduces surgical complications. Talk to your doctor about what lifestyle improvements might help before your scheduled surgery.
The Research Details
This was a randomized controlled trial, which is considered one of the most reliable types of medical research. Researchers recruited adults scheduled for hernia repair surgery at two Danish university hospitals. Half the participants were randomly assigned to receive the STRONG prehabilitation program, which included six weekly in-hospital sessions. These sessions provided education about healthy habits, motivational support to help patients make changes, and pharmaceutical assistance (like medications to help quit smoking). The other half received standard surgical preparation with no special lifestyle coaching.
The study was designed to include 398 patients total (199 in each group) to have enough power to detect real differences in surgical outcomes. However, the trial faced significant recruitment challenges and only enrolled 43 patients before being stopped early. This means the study was underpowered, or too small, to draw firm conclusions about whether the program actually reduces surgical complications.
The research approach matters because it attempted to test whether lifestyle changes before surgery could prevent complications. This is important because smoking, poor nutrition, excessive alcohol, and physical inactivity are known to slow healing and increase infection risk after surgery. By testing an intensive intervention before surgery rather than after, researchers hoped to catch problems early. The randomized design (where patients were randomly assigned to groups) helps ensure that differences in outcomes were due to the program itself, not other factors.
This study has both strengths and significant limitations. The strength is that it used randomization and blinded outcome assessment, which are gold-standard research practices. However, the study was terminated early due to poor recruitment, enrolling only 43 of the planned 398 patients. This means the results are preliminary and should not be considered definitive. The small sample size makes it impossible to draw reliable conclusions about whether the program actually reduces surgical complications. The researchers were transparent about these limitations, which is a positive sign of research integrity.
What the Results Show
The primary outcome was surgical complications within 30 days of surgery. In the prehabilitation group, 3 out of 16 patients who completed surgery experienced complications. In the standard care group, 4 out of 19 patients experienced complications. This difference was not statistically significant, meaning it could easily have occurred by chance. However, this finding should be interpreted cautiously because the study was far too small to detect real differences in complication rates.
The most striking finding was in lifestyle changes. Among patients who received the intensive coaching program, 13 out of 19 successfully optimized all their risky lifestyle factors (smoking, nutrition, alcohol, and exercise). In contrast, zero patients in the standard care group made similar comprehensive improvements. This difference was highly statistically significant (p less than 0.01), meaning it almost certainly reflects a real effect of the program.
Quality of life measurements showed interesting patterns. Patients in the prehabilitation group maintained their quality of life scores from before surgery to 30 days after surgery. Patients in the standard care group experienced a significant decline in their quality of life scores during the same period. This suggests that the lifestyle preparation may have helped patients maintain their wellbeing through the surgical experience.
Secondary outcomes included changes in health-related quality of life measured using standardized questionnaires. The EQ-5D VAS (a visual scale where patients rate their health from 0 to 100) remained stable in the prehabilitation group but decreased significantly in the control group, with a p-value of 0.03. This suggests the coaching program may have helped patients maintain their sense of wellbeing. However, the EQ-5D-5L index, which measures quality of life across five dimensions, showed similar changes in both groups (p equals 0.92), suggesting the benefit may be limited to overall health perception rather than specific quality of life domains.
This research builds on existing knowledge that lifestyle factors like smoking, poor nutrition, alcohol use, and physical inactivity increase surgical risk. Previous studies have shown that patients with these risk factors experience more complications after surgery. However, few studies have tested whether intensive coaching before surgery can improve these factors and reduce complications. The STRONG trial was designed to fill this gap by testing a structured prehabilitation program. While the trial couldn’t reach its enrollment goal, the finding that intensive coaching successfully changed multiple lifestyle factors aligns with other research showing that patients can make significant changes when given structured support and motivation.
This study has several important limitations that readers should understand. First, the trial was terminated early and enrolled only 43 of 398 planned patients, making it severely underpowered to detect differences in surgical complications. Second, recruitment challenges meant that the researchers couldn’t fully test whether the program actually reduces complications. Third, some patients randomized to surgery didn’t actually undergo the procedure, which reduced the final sample size further. Fourth, the study was conducted at only two Danish university hospitals, so results may not apply to other healthcare settings or populations. Finally, the researchers noted that outsourcing of patients and insufficient recruitment strategy contributed to the failure to meet enrollment targets, suggesting that future trials will need better recruitment planning.
The Bottom Line
Based on this preliminary research, patients scheduled for hernia repair surgery should discuss with their surgical team whether lifestyle improvements in smoking, nutrition, alcohol use, and exercise might help their recovery. The evidence suggests that making these changes is beneficial for overall health and may help maintain quality of life after surgery, though definitive proof that it reduces complications requires larger studies. Confidence level: Low to Moderate. The lifestyle changes themselves are well-established as beneficial for health, but the specific benefit for this surgery needs more research.
This research is most relevant to adults scheduled for elective ventral hernia repair who have risk factors like smoking, poor nutrition, excessive alcohol use, or physical inactivity. It may also interest surgeons and surgical teams looking for ways to help patients prepare for operations. People without scheduled surgery should not interpret this as a reason to undergo surgery. Those with other types of surgery should discuss with their doctors whether similar prehabilitation approaches might help them.
Based on this study, patients in the prehabilitation program made lifestyle changes within six weeks. Quality of life benefits were observed within 30 days after surgery. However, longer-term benefits and whether these changes persist beyond 30 days remain unknown. Patients should expect that meaningful lifestyle changes take several weeks to accomplish and that benefits may continue to accumulate over months.
Frequently Asked Questions
Does lifestyle coaching before hernia surgery reduce complications?
This trial suggests it may help, but the study was too small to confirm. Patients who received coaching successfully improved their habits and maintained quality of life after surgery, while standard care patients declined. Larger research is needed to prove whether it actually reduces complications.
What lifestyle changes should I make before hernia surgery?
Focus on the four SNAP factors: quit or reduce smoking, improve nutrition with more fruits and vegetables, limit alcohol consumption, and increase physical activity. The STRONG program showed that intensive coaching on these factors over six weeks helped patients make meaningful changes before surgery.
How long does prehabilitation take before surgery?
The STRONG program involved six weekly in-hospital sessions, so about six weeks total. Each session included education, motivational support, and pharmaceutical assistance tailored to your specific risk factors. Your surgeon can discuss whether this timeline works for your scheduled surgery.
Can lifestyle changes before surgery help me recover faster?
This study found that patients who improved their lifestyle habits maintained better quality of life after surgery compared to those who didn’t make changes. While faster recovery wasn’t directly measured, better overall health before surgery typically supports better healing afterward.
Who should consider prehabilitation before hernia repair?
Adults scheduled for elective hernia repair who have at least one risky lifestyle factor should discuss prehabilitation with their surgical team. Risk factors include smoking, poor nutrition, excessive alcohol use, or physical inactivity. About 75 percent of surgical patients have at least one of these factors.
Want to Apply This Research?
- Track the four SNAP factors weekly: smoking status (cigarettes per day or quit date), nutrition quality (servings of fruits and vegetables daily), alcohol consumption (drinks per week), and physical activity (minutes of exercise per week). Set specific reduction goals for each factor.
- Use the app to schedule weekly check-ins mimicking the six-session structure of the STRONG program. Set reminders for lifestyle goals, log progress on each SNAP factor, and track motivation through journaling. Connect with a healthcare provider through the app for accountability and support.
- Establish baseline measurements for all four SNAP factors before surgery. Track changes weekly during the prehabilitation period. After surgery, continue monitoring for at least 30 days to assess whether lifestyle improvements are maintained and how they correlate with recovery speed and quality of life.
This research is preliminary and was terminated early due to insufficient enrollment, so findings should not be considered definitive. The study was too small to confirm whether prehabilitation reduces surgical complications. Always consult with your surgeon or healthcare provider before making any changes to your lifestyle or surgical preparation plan. This article is for educational purposes and should not replace professional medical advice. Individual results may vary based on personal health status, medications, and other factors.
This research translation is published by Gram Research, the science division of Gram, an AI-powered nutrition tracking app.