Around 25% of surgical patients suffer preventable complications that prolong recovery and drive up NHS costs, and a new digital platform called Fit4Surgery aims to stop that before they ever reach the operating theatre. The problem is that existing prehabilitation programmes—exercise, nutrition, and behavioural coaching before major chest or abdominal surgery—work well but are largely in-person, making them inaccessible to rural, older, or digitally excluded patients. Fit4Surgery delivers the same support remotely via a smartphone app co-designed with patients and clinicians. In a feasibility study with lung cancer patients, those using the app completed more exercise sessions and showed greater improvements in exercise capacity than those receiving standard care. If this translational programme succeeds, Fit4Surgery will become a regulator-approved, NHS-compliant digital medical device ready for routine deployment. That could mean fewer complications, faster recoveries, and lower healthcare costs for thousands of surgical patients each year, while reducing the inequality that currently limits access to prehabilitation. The project will also secure UKCA certification, meet NHS Digital Technology Assessment Criteria, and test live integration at one NHS Trust—turning a promising research prototype into a deployable clinical tool.
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Scientific Summary FIT4SURGERY is a digital health innovation developed by a multidisciplinary clinical and academic team. It delivers remote, personalised prehabilitation — combining exercise training, nutritional optimisation, behavioural support, and health education — to patients preparing for major chest or abdominal surgery. This approach addresses a significant unmet clinical need: around 25% of surgical patients experience preventable complications, prolonging recovery and increasing healthcare costs. Traditional in-person prehabilitation programmes are effective but limited in accessibility, particularly for patients from rural, older, or underserved populations. The FIT4SURGERY platform was co-designed with patients and clinicians to maximise usability, accessibility, and clinical relevance. In a Health Foundation–funded feasibility study (ISRCTN00061628) in lung cancer patients, the app demonstrated high acceptability, feasibility, and clinical promise: patients using FIT4SURGERY achieved greater improvements in exercise capacity, performed more exercise sessions, and experienced low attrition rates compared to standard outpatient prehabilitation. The ongoing multicentre NIHR-funded FIT4SURGERY 2 trial (NIHR134214) will report in 2027 and is evaluating clinical and cost-effectiveness at scale. While FIT4SURGERY has shown strong potential, it is not yet ready for routine NHS deployment. To move beyond research trials into real-world impact, a focused translational programme is required to achieve regulatory approval, NHS compliance, operational readiness, and a clear commercialisation strategy. To address the final translational steps needed to prepare Fit4Surgery for NHS deployment we will: 1.Complete REGULATORY CERTIFICATION: the technical documentation and risk management required for UKCA marking as a Software as a Medical Device (SaMD), including conformity assessment as per Tier C classification (NICE) 2.Implement a QUALITY MANAGEMENT SYSTEM to support safe software maintenance and post-market surveillance. 3.Achieve full compliance with NHS DIGITAL TECHNOLOGY ASSESSMENT CRITERIA (DTAC) , covering clinical safety, data protection, cybersecurity, interoperability, and accessibility. 4.DEPLOY Fit4Surgery at one NHS Trust to test live clinical integration and workflow compatibility. 5 Secure INTELLECTUAL PROPERTY (IP) agreements, define the ROUTE TO MARKET (spin-out or licensing), and create NHS-facing BUISNESS DOCUMENTATION including a knowledge dissemination plan 6.Enhance the platform to meet ACCESSIBILITY STANDARDS, with additional multilingual support, inclusive design for users with lower digital literacy, and onboarding resources for those at risk of digital exclusion. Patients and the public have been involved throughout development and remain embedded in governance and co-design processes. To deliver these aims, we have partnered with Framework Genie, a specialist consultancy with deep expertise in regulatory affairs, clinical compliance, and digital health commercialisation. Their involvement ensures that the technical, regulatory, and commercialisation milestones are realistically achievable within the grant period. By the end of this project, FIT4SURGERY will be a regulator-compliant, NHS-ready, user-tested digital prehabilitation solution, positioned for wide-scale deployment to improve surgical outcomes and address health inequalities across the UK.
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