Building on the article “Prehabilitation as Biological Preparation of the Patient” (Schek & Erbeldinger, sportärztezeitung online, 2025), this article aims to provide insight into the potential benefits that complementary measures (“co-therapies”) may offer in preparing patients for medical interventions.
Conservative therapy and its mechanisms of action can be understood in the context of prehabilitation as a kind of “open window” to rehabilitation. It can provide an initial impetus to activate the body’s own adaptation and regeneration processes while simultaneously strengthening the patient’s self-management. This perspective applies to both conservative and physical therapies as well as to interventional or surgical procedures.
Orthobiological therapies and patient-related influencing factors
Orthobiological therapies such as Platelet-Rich Plasma (PRP) / ACP, Blood Clot Secretome (BCS), ACS (IL-1RA), or cell-based procedures are increasingly being used to treat musculoskeletal disorders. At the same time, clinical studies show considerable variability in treatment outcomes in some cases (Filardo et al. 2023; Andia & Maffulli 2024).
An important reason for this could be that these therapies use autologous biological products. The quality of the injected material therefore potentially depends not only on technical manufacturing processes but also on the patient’s biological condition. A recent review by Montagnino et al. discusses that lifestyle factors such as exercise, diet, and certain supplements could influence platelet count and function as well as the quality of cell-based products (Montagnino et al., 2025).
However, the authors explicitly emphasize that these correlations currently appear primarily biologically plausible, while robust clinical evidence remains limited and further translational research is still needed.
Biopsychosocial Expansion of Prehabilitation
Against this backdrop, an expansion of the prehabilitation approach that takes psychological and social aspects into account alongside biological factors appears sensible. Such a biopsychosocial understanding of prehabilitation also aligns with newer concepts of so-called metabolic optimization prior to orthobiological therapies. In their review, Fernandes and Rodeo describe how systemic factors such as metabolic health, chronic inflammatory processes, sleep quality, or lifestyle behaviors can influence the organism’s regenerative environment (Fernandes & Rodeo 2026).
These systemic factors can influence both the quality of autologous biological products and the regenerative capacity of the target tissue. At the same time, the authors emphasize that many of these strategies are currently based primarily on preclinical or indirect evidence (Fernandes & Rodeo 2026).
Mind-Body Medicine as a Potential Co-Therapy
In this context, the field of mind-body medicine is also discussed. Programs such as Mindfulness-Based Stress Reduction (MBSR), developed by Jon Kabat-Zinn, or the Relaxation Response described by Herbert Benson are among the best-studied structured mind-body interventions.
- These programs aim to reduce stress responses
- improve autonomic regulatory processes
- and potentially influence immunological and neuroendocrine parameters.
A review on mind-body medicine in pain therapy describes that an eight-week MBSR program can lead to clinically relevant pain reductions in a significant proportion of participants (Paul 2023).
These findings primarily pertain to pain and stress modulation. The direct impact of such interventions on orthobiological therapies such as PRP has not yet been sufficiently investigated.
Diet and Potential Effects on PRP
In addition to psychosocial factors, the role of diet is increasingly being discussed. A recent clinical study by Platzer et al. examined the relationship between different dietary patterns and the composition of PRP. In this study, vegan, vegetarian, and omnivorous diets were compared. The results show that certain molecular components of PRP – particularly the pro-inflammatory cytokine interleukin-6 (IL-6 – may differ between dietary groups, while cell counts in the PRP remained largely comparable (Platzer et al. 2026). These data suggest that dietary habits may influence the molecular properties of PRP, although no direct clinical recommendations can currently be derived from this. Similar considerations are also found in other studies, which suggest that dietary and lifestyle factors could influence systemic inflammatory activity and thus potentially regenerative processes (Andia & Maffulli 2024; McLarnon et al. 2024).
Curcumin and Other Phytonutrients
Curcumin is frequently discussed in the context of inflammatory musculoskeletal disorders and has demonstrated anti-inflammatory and signal-modulating properties in experimental studies (Nguyen et al. 2025).
Furthermore, pharmacological and experimental studies show that curcumin may have platelet-modulating or antiplatelet effects by influencing various platelet activation signaling pathways (Liu et al. 2022).
In the context of PRP, this means:
An influence of curcumin on platelet-dependent processes appears biologically plausible; however, its specific significance for PRP collection or the clinical efficacy of PRP therapies has not yet been sufficiently investigated. Similar considerations apply to other polyphenols such as resveratrol, quercetin, or anthocyanins, which may also exhibit platelet-modulating properties.
The potential influence of such substances is therefore likely to depend significantly on dosage, formulation, and timing of administration, as well as on the individual metabolic context.
Nutrition, Metabolic Health, and Regeneration
Recent studies on metabolic optimization prior to orthobiological therapies indicate that systemic factors such as
- obesity
- insulin resistance
- chronic inflammatory processes
- physical inactivity
- sleep disorders
can influence tissue regenerative capacity and possibly also the efficacy of orthobiological therapies (Fernandes & Rodeo 2026). Diets with an anti-inflammatory profile – such as the Mediterranean or plant-based diets – are therefore discussed as potentially favorable conditions.
Here, too, most data are mechanistic or indirect, and clinical studies on the direct improvement of PRP outcomes are currently lacking (Montagnino et al. 2025; Fernandes & Rodeo 2026).
Conclusion
In summary, it can be stated that:
The preparation of patients prior to medical interventions can be viewed from a biopsychosocial perspective. Lifestyle factors such as exercise, diet, metabolic health, and stress regulation can influence the organism’s biological environment and thus potentially also modulate regenerative therapies. However, the current state of the literature shows that many of these relationships are so far primarily biologically plausible and cannot yet be considered established clinical recommendations.
Prehabilitation can therefore be understood as a potential “open window” in which patients can actively contribute to optimizing their baseline condition. In this sense, it can serve as a bridge between therapy, rehabilitation, and prevention – provided that the measures are implemented within the framework of a medically sound indication and patient-centered education.
Literature
- Andia I, Maffulli N. Platelet-rich plasma for musculoskeletal conditions. Int Orthop. 2024.
- Fernandes G, Rodeo SA. Metabolic Optimization Before Orthobiologic Therapies. Sports Health. 2026.
- Filardo G et al. Platelet-rich plasma in musculoskeletal medicine: variability and clinical outcomes. Knee Surg Sports Traumatol Arthrosc. 2023.
- Liu Z et al. Anti-platelet and antithrombotic effects of curcumin. Biomed Pharmacother. 2022.
- McLarnon J et al. Patient factors influencing PRP therapy outcomes. Orthop J Sports Med. 2024.
- Montagnino J et al. Optimizing orthobiologic therapies with exercise, diet, and supplements. PM&R. 2025.
- Paul A. Mind-body-Medizin in der Schmerztherapie. Schmerz. 2023.
- Platzer H et al. Dietary Patterns Are Associated with Blood Cell Profiles and the Molecular Composition of Platelet-Rich Plasma. Nutrients. 2026.
You can find further reading on this topic HERE
Editor’s Note
Supplement: PRP, protein, and soluble fiber
In the context of PRP injections, a targeted, personalized nutritional therapy appears biologically plausible and clinically beneficial. In addition, we would like to emphasize that an adequate supply of proteins, essential amino acids, and soluble dietary fiber in particular forms the structural and metabolic basis of regenerative processes. This is not considered problematic before, during, or after PRP interventions—nor before surgical procedures or physical therapies (see: Outcomes of Cancer Surgery and Malnutrition in Internal Medicine
Especially in the prehabilitation phase, this form of targeted nutrition, including cholesterol-lowering dietary strategies, can support the biological prerequisites for tissue adaptation and the healing response. It is suitable for any medical intervention when applied as targeted nutrition.
See also: CHOLESTERINSENKENDE WIRKUNG VON HAFER UND METABOLISCHES SYNDROM
and BALLASTSTOFFE REDUZIEREN RISIKO FÜR HERZ-KREISLAUFERKRANKUNGEN, PANKREASKREBS UND DIVERTIKULOSE
Autoren
ist Diplom-Sportwissenschaftler mit Professional Master’s Degree in Sports Medicine sowie postgradualen Weiterbildungen in Mind-Body-Medizin (Harvard Medical School), Psychoneuroimmunologie und Lifestyle Medicine (American College of Lifestyle Medicine); Verleger der sportärztezeitung.
is a certified sports scientist with a professional master's degree in sports medicine and postgraduate training in mind-body medicine (Harvard Medical School), psychoneuroimmunology, and lifestyle medicine (American College of Lifestyle Medicine); publisher of the sportärztezeitung.
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