The advancement of perioperative medicine is leading to greater diversity and creativity for pre-surgical interventions implemented to reduce patient surgical risk and enhance post-surgical recovery. Of these pre-surgical interventions, the prescription of preoperative exercise training is gathering momentum as a realistic means for enhancing patient surgical outcome. Indeed, the general benefits of exercise training have the potential to preoperatively optimise several pre-surgical risks factors, including cardiorespiratory function, frailty and cognitive function. Any exercise programme incorporated into the preoperative pathway of care needs to be effective and time-efficient, in that substantial fitness gains are possible in the often short period of time between the decision for surgery to operation (e.g. 4 weeks). Fortunately, there is a large volume of research describing effective and time-efficient exercise training programmes within the discipline of sports science. Accordingly, the objective of our commentary is to synthesise contemporary exercise training research, both from non-clinical and clinical populations, with an overarching aim of informing the development of effective and time-efficient pre-surgical exercise training programmes. The development of such exercise training programmes requires the careful consideration of several key principles, namely frequency, intensity, time, type and progression of exercise. Therefore, in light of the gathering evidence demonstrating the effectiveness and time-efficiency of high-intensity interval training - which involves brief bouts of intense exercise interspersed with longer recovery periods - the principles of exercise training programme design will be discussed in the context of high-intensity interval training programmes. Other issues pertinent to the development, implementation and evaluation of preoperative exercise training programmes, such as individual exercise prescription, training session monitoring and potential barriers and risks to high-intensity exercise are also discussed. The evidence presented suggests that individually prescribed and supervised high-intensity interval training programmes, encompassing a variety of exercise modes represent an effective and safe means of exercise therapy prior to surgery.