INTRODUCTION: The surgical regards, prehabilitation was determined as a process that prepares the patient in advance adjacent to inconvenience and indolence through physiotherapy to get better their efficient and vital competence and endurance.

OBJECTIVE: To evaluate the effect of prehabilitation programme on the quality of recovery in pre-infirmity and infirm (frail) patients undergoing heart valve surgery.

METHOD: The randomized control trial with single blinding method and non-probability convenient sampling technique was used to conduct this study. 68 control and interventional group patients were included from the twin city (Rawalpindi and Islamabad). Patients awaiting heart valve surgery for repair or replacement, both genders, Mild to moderate valvular diseases, New York Heart Association (NYHA) grade I and II, Pre-frail to moderately frail patients with a CFS of 4–6, Patients with an estimated 6-8 weeks of surgical waiting list time, Able to perform 6 minute walk test (6MWT) at baseline with Rating of Perceived Exertion (RPE) <13. The study population was assessed via 6MWT, Clinical FrailtyScore,15 item quality of recovery questionnaire, WHO disability assessment schedules 2.0 score, BORG RPE scale. Participants

randomized to the intervention arm were given prehabilitation (three times per week, supervised by a physiotherapist) in addition to current usual care. 6MWT was used as an estimation of individual peak oxygen uptake and hence oxygen uptake reserve (HRR) for exercise prescription.

RESULTS: The mean and standard deviation of Evidence of frailty score in interventional group is 4.05±0.91 and in control group is 4.0±1.25. For the variable of 6MWT (feet) results showed that there is no significant difference between control
and interventional group at preoperative with p-value (0.78) and postoperative 2^ndmonth with p-value (0.14), however there is a significant difference at postoperative4 week with p-value (0.001). For the Quality of Recovery 15 item questionnaire

results showed that their no significance at any stage baseline (p=0.77), preoperative (p=0.36), postoperative 1^st follow-up (p=0.28) and postoperative 2nd follow-up  (p=0.10).

CONCLUSION: These findings indicate that Prehabilitation has more positive impact at postoperative 8 week than post-operative 1st month. While prehabilitation alsoenhance the recovery phase and decreasing the risk of disability by improving the health of firm and infirm patients. The effect of prehabilitation increased from

preoperative level (prior to surgery) to post-operative 8 week follow up after surgery specifically in heart valvular patients.