Surgery is essential for treating various diseases but often leads to cognitive complications such as delirium and Postoperative Cognitive Dysfunction (POCD), particularly in older adults. These complications can negatively impact recovery, quality of life, and healthcare costs. While physical prehabilitation is widely recognized for improving surgical outcomes, the role of cognitive prehabilitation remains underexplored. This study compares the effectiveness of yoga-based prehabilitation and physical prehabilitation in enhancing cognitive function before surgery. It will assess key cognitive measures, including attention, processing speed, and memory, in elderly patients undergoing major surgery under general anesthesia.

A total of 200 patients aged 60ys and above will be recruited and randomized into two groups: Group A (Physical Prehabilitation) and Group B (Yoga). Group A will undergo supervised aerobic and resistance exercises, while Group B will participate in guided yoga sessions focusing on breathing techniques and relaxation. Both groups will follow Enhanced Recovery After Surgery (ERAS) guidelines, and cognitive function will be assessed using Depression, Anxiety, and Stress Scale (DASS-21) to evaluate mental states and the Montreal Cognitive Assessment (MoCA) to assess cognitive functions across six domains: memory, executive functioning, attention, language, visuospatial skills, and orientation. Additionally, blood biomarkers (BDNF, MDA, CRP, TNF-Alpha, Dopamine, and Noradrenaline) will be analyzed at multiple time points to evaluate physiological responses to each intervention.

By comparing these two approaches, this study aims to identify the most effective prehabilitation strategy for preserving cognitive health and improving surgical recovery in elderly patients.