{ "abstract": "Background: The impact of smoking, nutrition, alcohol, and physical inactivity (SNAP) on the outcome of ventral hernia repair remains underexplored. This trial aimed to evaluate the effect of targeted, intensive lifestyle prehabilitation on postoperative complications. Methods: The STRONG-Hernia trial (NCT06611462) was a multicenter, parallel-group, centrally randomized controlled trial at two Danish university hospitals. Adults scheduled for elective ventral hernia repair with ≥1 risky SNAP factor were randomized (1:1) to STRONG prehabilitation or standard care. Prehabilitation comprised six weekly in-hospital sessions of education, motivational, and pharmaceutical support tailored to each patient’s SNAP factors. The primary outcome was postoperative complications ≤30 days. Secondary outcomes included lifestyle changes and health-related quality of life (EQ-5D). Final primary outcome assessment and statistical analyses were blinded. Power calculation required inclusion of 2 × 199 patients. Results: Between March 2024 to May 2025, 43 patients were randomized with 21 to STRONG prehabilitation and 22 to standard care. Around 75% had one risky lifestyle factor, and 25% had ≥ 2; obesity was most common. Shortly after randomization, two prehabilitation participants were excluded due to no surgery. At end-of-intervention, 13/19 in the prehabilitation group had optimized all risky lifestyles versus 0/22 in the control group (p < 0.01). Three additional participants in each group did not undergo surgery. At 30 days, complications occurred in 3/16 prehabilitation and 4/19 control participants (p = 1.00). EQ-5D VAS remained unchanged in the prehabilitation group from baseline but decreased significantly in the control group (p = 0.03). EQ-5D-5L index changes were similar between groups (p = 0.92). Challenges encountered included outsourcing of patients, insufficient recruitment strategy, and a low inclusion rate. Conclusion: The trial was terminated early due to slow recruitment and was therefore not powered to assess the effect of the prehabilitation intervention on postoperative complications. The findings suggest that the STRONG program seems promising for optimizing risky lifestyles, although these lifestyle results should be considered preliminary. Insights from this trial may help address recruitment challenges essential for completing a future adequately powered trial on postoperative complications.", "abstract_shown": true, "affiliations": [ "WHO-CC, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark", "Center for Perioperative Optimization, Department of Surgery, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark", "Departement of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark", "Department of Surgery, Holbæk Hospital, part of Copenhagen University Hospitals, Holbæk, Denmark", "Center for Surgical Science, Department of Surgery, Zealand University Hospital, Køge, Denmark", "Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden" ], "article_type": "Research Article", "arxiv": null, "author_total": 7, "authors": [ { "affs": [ 0, 1 ], "name": "Sofie Anne-Marie Skovbo Jensen", "orcid": "0000-0003-1571-1385" }, { "affs": [ 0, 1, 2 ], "name": "Susanne Vahr Lauridsen", "orcid": "0000-0001-6045-4723" }, { "affs": [ 1 ], "name": "Siv Fonnes", "orcid": "0000-0002-8757-831X" }, { "affs": [ 1, 2 ], "name": "Jacob Rosenberg", "orcid": "0000-0002-0063-1086" }, { "affs": [ 2, 3 ], "name": "Birgitte Brandstrup", "orcid": "0000-0003-2659-1198" }, { "affs": [ 2, 4 ], "name": "Frederik Helgstrand", "orcid": "0000-0001-5702-8352" }, { "affs": [ 0, 5 ], "name": "Hanne Tønnesen", "orcid": "0000-0002-7161-3416" } ], "bibtex": "https://research.draconitic.com/paper/6e17ewb1m3eag.bib", "cited_by": 0, "doi": "10.1371/journal.pone.0360482", "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13712517/", "id": "6e17ewb1m3eag", "issns": [ "1932-6203" ], "landing_url": "https://doi.org/10.1371/journal.pone.0360482", "language": "en", "licence": "CC-BY-4.0", "licence_label": "CC BY 4.0", "licence_source": "article", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "heading", "Biology and Life Sciences" ], [ "heading", "Body Weight" ], [ "heading", "Clinical Medicine" ], [ "heading", "Clinical Trials" ], [ "heading", "Drug Research and Development" ], [ "heading", "Epidemiology" ], [ "heading", "Hernia" ], [ "heading", "Malnutrition" ], [ "heading", "Medical Risk Factors" ], [ "heading", "Medicine and Health Sciences" ], [ "heading", "Nutrition" ], [ "heading", "Obesity" ], [ "heading", "Pharmacology" ], [ "heading", "Physiological Parameters" ], [ "heading", "Physiology" ], [ "heading", "Randomized Controlled Trials" ], [ "heading", "Research Article" ], [ "heading", "Research and Analysis Methods" ], [ "heading", "Signs and Symptoms" ], [ "heading", "Surgical Repair" ], [ "heading", "Surgical and Invasive Medical Procedures" ], [ "heading", "Weight Loss" ], [ "openalex", "2746|Hernia repair and management" ], [ "plos", "/Biology and life sciences/Physiology/Physiological parameters/Body weight/Obesity" ], [ "plos", "/Biology and life sciences/Physiology/Physiological parameters/Body weight/Weight loss" ], [ "plos", "/Medicine and health sciences/Clinical medicine/Clinical trials/Randomized controlled trials" ], [ "plos", "/Medicine and health sciences/Clinical medicine/Signs and symptoms/Hernia" ], [ "plos", "/Medicine and health sciences/Epidemiology/Medical risk factors" ], [ "plos", "/Medicine and health sciences/Health care/Primary care" ], [ "plos", "/Medicine and health sciences/Pharmacology/Drug research and development/Clinical trials/Randomized controlled trials" ], [ "plos", "/Medicine and health sciences/Surgical and invasive medical procedures" ], [ "plos", "/Medicine and health sciences/Surgical and invasive medical procedures/Surgical repair" ], [ "plos", "/Research and analysis methods/Clinical trials/Randomized controlled trials" ] ], "openalex": "W7223998852", "pdf_url": "https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0360482&type=printable", "pmcid": "PMC13712517", "pmid": "42945164", "published": "2026-10-27", "publisher": "Public Library of Science", "ris": "https://research.draconitic.com/paper/6e17ewb1m3eag.ris", "sources": [ { "first_seen": "2026-10-30T12:17:17Z", "native_id": "10.1371/journal.pone.0360482", "source": "plos", "url": "https://doi.org/10.1371/journal.pone.0360482" }, { "first_seen": "2026-10-31T12:23:04Z", "native_id": "PMC13712517", "source": "pmc", "url": "https://doi.org/10.1371/journal.pone.0360482" } ], "subjects": [ { "field": "biology", "origin": "heading:Biology and Life Sciences", "subfield": "general" }, { "field": "medicine", "origin": "plos:clinical trials", "subfield": "clinical-trials" }, { "field": "medicine", "origin": "heading:Epidemiology", "subfield": "epidemiology-public-health" }, { "field": "medicine", "origin": "plos:physiology", "subfield": "physiology" }, { "field": "medicine", "origin": "plos:surgical and invasive medical procedures", "subfield": "surgery" } ], "title": "STRONG prehabilitation before elective ventral hernia repair: Learnings from recruitment challenges in a randomized controlled trial", "title_text": "STRONG prehabilitation before elective ventral hernia repair: Learnings from recruitment challenges in a randomized controlled trial", "type": "peer-reviewed", "updated_at": "2026-10-31T12:23:04Z", "url": "https://research.draconitic.com/paper/6e17ewb1m3eag", "venue": "PLOS One", "versions": [] }