[Prehabilitation for high-risk gastric cancer populations: challenges, countermeasures, and the integrated whole-course pathway].

Gastric cancer prehabilitation has evolved from a singular preoperative preparation into an integrated management strategy spanning the entire course from diagnosis to surgery. However, high-risk populations-characterized by advanced age, frailty, malnutrition, and those receiving neoadjuvant/conversion therapy-pose substantial challenges to conventional prehabilitation models due to their unique pathophysiological features. Treatment-related toxicities exacerbate the depletion of functional reserves, multidimensional vulnerability renders standardized protocols less effective, and adherence to home-based interventions with quality control remains the "last-mile" bottleneck. Drawing upon domestic and international evidence-based data, this article systematically dissects these challenges and proposes a response strategy centered on "whole-course integration, stratified precision, and technology empowerment"-namely, deeply binding prehabilitation with neoadjuvant/conversion therapy, establishing a tiered intervention system based on frailty stratification, and leveraging 5G, wearable devices, large-scale models, and AI agents to construct a digital closed-loop for home-based supervision. The future direction of prehabilitation lies in transitioning from experience-driven to data-driven paradigms, ultimately achieving a paradigm shift from "protocol-to-patient" to "protocol-adapts-to-patient".