{ "schemaVersion": 1, "capturedAt": "2026-11-13T04:08:26.748Z", "sha256": "457f66fa9393eb6400dabb16ed6adbaf189d96c714cfdbf37e3923a14e796040", "work": { "type": "FTR", "kind": "article", "key": "improve-physiological-reserve", "id": "TAP-FTR-0017", "locale": "en", "path": "/articles/improve-physiological-reserve/", "title": "Can Physiological Reserve Be Improved? Ageing, Exercise and Recovery", "description": "Which abilities can change with exercise and preparation for surgery? Compare mobility and complication outcomes, then choose a concrete function to follow.", "rights": "© The Allostasis Project. All rights reserved. Reproduction or adaptation requires separate permission, subject to applicable legal exceptions.", "version": "1.0", "updatedAt": "2026-11-13", "editorial": { "contentType": "evidence-review", "reviewState": "draft", "reviewedAt": null, "reviewedVersion": null, "updatedAt": "2026-11-13", "version": "1.0", "byline": "team", "author": null, "reviewer": null, "workflow": { "ai": { "usage": "used", "system": "OpenAI Codex", "scope": "Assisted source-based writing and bilingual comparison; consulted materials and unresolved source issues are recorded in the reading notes.", "version": "1.0", "tasks": [ "Literature comparison and evidence extraction", "Bilingual explanatory writing and source-linked tables" ] } }, "revisions": [] }, "sections": [ { "id": "short-answer", "title": "Yes—some specific abilities can change", "paragraphs": [ "The useful goal is to improve or preserve a particular ability, such as walking capacity or strength. “More physiological reserve” is a broader interpretation that needs a defined domain and test. Trials show benefits for some functional and clinical outcomes, while other outcomes remain uncertain.[1][2][4][5][6]", "This guide separates three questions: What capacity matters? Can an intervention change a relevant outcome? Does that change help when a real challenge arrives? A positive answer to one does not settle the others." ] }, { "id": "age-and-frailty", "title": "Does age determine how much reserve you have?", "paragraphs": [ "Age alone cannot supply a personal reserve percentage. Research on older adults distinguishes available capacity, vulnerability and the response to a stressor. Health conditions, the task and the surrounding support belong in the assessment.[1][2]", "Frailty is one way of describing vulnerability. Fried’s phenotype uses unintentional weight loss, exhaustion, weak grip, slow walking and low activity; three or more criteria identify frailty in that framework. It predicts adverse outcomes, but does not directly show how quickly a person recovers after a particular event.[3]", "Feeling tired after a busy week is therefore not, by itself, a frailty assessment. Equally, a person who manages a familiar routine may still struggle when the demand changes." ] }, { "visual": { "kind": "comparison", "title": "From a broad aim to a specific question", "caption": "Illustrative goals; none produces a validated total reserve score.", "columns": [ "Aim", "A more useful question", "What to keep comparable" ], "rows": [ { "label": "Walk with greater ease", "cells": [ "Can I complete the same familiar route with less difficulty?", "Distance, pace, terrain, assistance and symptoms." ] }, { "label": "Improve lower-body function", "cells": [ "Has performance on an appropriately chosen chair-rise or strength task changed?", "Technique, support, test protocol and relevant pain." ] }, { "label": "Prepare for a planned operation", "cells": [ "Which fitness, nutritional or functional problems can the care team address beforehand?", "The operation, available preparation time and outcome being targeted." ] }, { "label": "Understand recovery", "cells": [ "How does the selected function change before and after the challenge?", "Starting level, challenge severity and follow-up dates." ] } ] }, "id": "capacity-examples", "title": "Turn “build reserve” into an observable goal", "paragraphs": [ "Start with a task that matters in daily life. The examples below are ways to frame a discussion or record change, not a diagnostic checklist. A clinician or physiotherapist can select standardized tests when assessment is needed." ] }, { "id": "exercise-evidence", "title": "What does exercise evidence actually show?", "paragraphs": [ "The LIFE trial randomized 1,635 sedentary adults aged 70–89 with functional limitations to structured physical activity or health education. Over an average 2.6 years, major mobility disability occurred in 30.1% versus 35.5%: an absolute difference of 5.4 percentage points. The hazard ratio was 0.82 (95% CI 0.69–0.98).[4]", "That supports preserving walking ability in the studied population. It does not measure a universal reserve level or promise the same benefit at every age. The programme was supported and progressive; it was not a one-off effort test." ], "callout": "Improving a relevant function is useful in its own right. A study need not prove that the whole body has become more resilient for that improvement to matter." }, { "visual": { "kind": "comparison", "title": "Two questions within prehabilitation", "caption": "Read the original trials and the PREHAB figure correction through the linked research notes.", "columns": [ "Question", "What the evidence addresses", "What it cannot isolate" ], "rows": [ { "label": "Fewer complications?", "cells": [ "A defined clinical outcome after surgery.", "The independent contribution of exercise, protein or psychological support." ] }, { "label": "Better walking at four weeks?", "cells": [ "A functional outcome at a specified follow-up.", "All later recovery, or recovery in another organ." ] }, { "label": "Useful for me?", "cells": [ "Similarity of patients, operation and available care.", "A guaranteed result from a study average." ] } ] }, "id": "prehabilitation", "title": "Does preparation before surgery improve recovery?", "paragraphs": [ "Prehabilitation means preparing before a planned stressor. Multimodal programmes combine elements such as exercise, nutrition and psychological support. Their results depend on the patients, comparison treatment and outcome.[5][6]", "In PREHAB, severe complications occurred in 17.1% of the intervention group and 29.7% of standard-care patients. However, the four-week walking-distance comparison was not statistically significant. Recruitment stopped early, and missing walking data limit interpretation.[5]", "In Carli’s trial of frail or prefrail older colorectal-cancer patients, preoperative preparation did not show a clear advantage over postoperative rehabilitation for 30-day complication burden. Its uncertainty interval still allowed benefit. Different comparators and patients help explain why these trials should not be reduced to a simple “works/does not work” vote.[6]" ] }, { "id": "practical-next-step", "title": "A practical way to follow an improvement", "paragraphs": [ "Choose one meaningful task and record the circumstances before changing anything. For example: the same short walking route, how difficult it feels and whether assistance is needed. Repeat under similar conditions at agreed intervals; record illness, pain or unusual workload rather than treating every change as training progress.", "Use the pattern to ask a more precise question: is the task becoming easier, is performance improving, or is recovery after it changing? These are related observations, not interchangeable scores. Avoid testing yourself to exhaustion to “find your reserve”. Formal stress tests and surgical preparation need an appropriate professional plan.", "Nutrition is relevant when intake or nutritional status limits activity and recovery. A combined prehabilitation trial cannot show that a particular supplement raises whole-body reserve. Match the nutritional question to its own evidence." ], "links": [ { "label": "What physiological reserve means", "url": "/articles/reserve-and-resilience/" }, { "label": "Nutrition and recovery: which outcomes improve?", "url": "/articles/nutrition-recovery-evidence/" }, { "label": "Why rest and recovery differ", "url": "/foundations/recovery/" } ] }, { "id": "sources-and-scope", "title": "Evidence and disclosures", "paragraphs": [ "This guide combines conceptual work with selected human trials; functional tests and surgical outcomes answer different questions. The linked notes identify the materials consulted and study-specific funding and interests. The PREHAB correction is retained with its original study.[1][2][3][4][5][6]", "LIFE received NIH support and reported author relationships with commercial and nonprofit organizations. PREHAB and Carli’s trial also reported commercial or donated support. Those details remain visible in the source records; a supported trial is assessed by its design and results, rather than treated as automatically reliable or unreliable." ] } ], "question": "Can Physiological Reserve Be Improved? Ageing, Exercise and Recovery", "references": [ { "id": "whitson-2016", "title": "Physical Resilience in Older Adults: Systematic Review and Development of an Emerging Construct", "authors": "Heather E. Whitson · Wei Duan-Porter · Kenneth E. Schmader · Miriam C. Morey · Harvey J. Cohen · Cathleen S. Colón-Emeric", "journal": "The Journals of Gerontology: Series A", "year": "2016", "url": "https://pubmed.ncbi.nlm.nih.gov/26718984/", "doi": "10.1093/gerona/glv202", "pmid": "26718984" }, { "id": "gijzel-2019", "title": "Resilience in Clinical Care: Getting a Grip on the Recovery Potential of Older Adults", "authors": "Sanne M. W. Gijzel · Heather E. Whitson · Ingrid A. van de Leemput · Marten Scheffer · Dieneke van Asselt · Jerrald L. Rector · Marcel G. M. Olde Rikkert · René J. F. Melis", "journal": "Journal of the American Geriatrics Society", "year": "2019", "url": "https://doi.org/10.1111/jgs.16149", "doi": "10.1111/jgs.16149", "pmid": "31498881" }, { "id": "fried-2001", "title": "Frailty in older adults: evidence for a phenotype", "authors": "Fried LP · Tangen CM · Walston J · Newman AB · Hirsch C · Gottdiener J · Seeman T · Tracy R · Kop WJ · Burke G · McBurnie MA · Cardiovascular Health Study Collaborative Research Group", "journal": "The Journals of Gerontology Series A: Biological Sciences and Medical Sciences", "year": "2001", "url": "https://doi.org/10.1093/gerona/56.3.m146", "doi": "10.1093/gerona/56.3.m146", "pmid": "11253156" }, { "id": "pahor-2014", "title": "Effect of structured physical activity on prevention of major mobility disability in older adults: the LIFE study randomized clinical trial", "authors": "Marco Pahor et al.; LIFE Study Investigators", "journal": "JAMA", "year": "2014", "url": "https://doi.org/10.1001/jama.2014.5616", "doi": "10.1001/jama.2014.5616", "pmid": "24866862" }, { "id": "molenaar-2023", "title": "Effect of Multimodal Prehabilitation on Reducing Postoperative Complications and Enhancing Functional Capacity Following Colorectal Cancer Surgery: The PREHAB Randomized Clinical Trial", "authors": "Molenaar CJL · Minnella EM · Coca-Martinez M · Ten Cate DWG · Regis M · Awasthi R · Martínez-Palli G · López-Baamonde M · Sebio-Garcia R · Feo CV · van Rooijen SJ · Schreinemakers JMJ · Bojesen RD · Gögenur I · van den Heuvel ER · Carli F · Slooter GD · PREHAB Study Group", "journal": "JAMA Surgery", "year": "2023", "url": "https://doi.org/10.1001/jamasurg.2023.0198", "doi": "10.1001/jamasurg.2023.0198", "pmid": "36988937" }, { "id": "carli-2020", "title": "Effect of Multimodal Prehabilitation vs Postoperative Rehabilitation on 30-Day Postoperative Complications for Frail Patients Undergoing Resection of Colorectal Cancer: A Randomized Clinical Trial", "authors": "Carli F · Bousquet-Dion G · Awasthi R · Elsherbini N · Liberman S · Boutros M · Stein B · Charlebois P · Ghitulescu G · Morin N · Jagoe T · Scheede-Bergdahl C · Minnella EM · Fiore JF", "journal": "JAMA Surgery", "year": "2020", "url": "https://doi.org/10.1001/jamasurg.2019.5474", "doi": "10.1001/jamasurg.2019.5474", "pmid": "31968063" } ], "claims": [] } }