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Background Multimodality therapy (CROSS) or perioperative chemotherapy (FLOT) for locally advanced oesophageal cancer improves survival but may impair physical functioning. Cardiorespiratory fitness, measured by cardiopulmonary exercise testing (CPET), predicts post-operative mortality.Aim PRE-HIIT examined whether high-intensity interval training (HIIT) prehabilitation could restore fitness after neoadjuvant treatment.Methods Fourteen patients (mean 63.3±7.3 years; 64% male) scheduled for CROSS (n = 9) and FLOT (n = 5) were enrolled at diagnosis (T0). Physical parameters (CPET peak power; leg-press one-repetition maximum), function (Short Physical Performance Battery [SPPB]) and activity goals (International Physical Activity Questionnaire) were assessed at T0, after neoadjuvant therapy (T1) and after 2–4 weeks of prehabilitation (T2). Post-T1, patients were randomised to HIIT (five 30-min bicycle sessions/week at 100% peak power intervals) or standard moderate-intensity exercise. Within-cohort changes were analysed with repeated-measures ANOVA or Friedman tests; between-group differences with ANCOVA.Results Peak power declined from 153.6±44.4 W (T0) to 127.0±31.9 W (T1) and rebounded to 145.6±46.1 W (T2) (p = 0.004, ηp 2 = 0.547). Self-reported vigorous and total activity reduced post-neoadjuvant therapy (p=0.001, p = 0.037) but partially recovered with prehabilitation. The physical parameter muscle strength (leg press 1-RM) (p= 0.397, ηp 2= 0.143) and SPPB (p=0.273, W=0.163) remained stable. Significant changes in self-reported total leisure (p=0.045, W=0.388), vigorous (p=0.001, W=0.851), and physical activity were observed from T0 to T2. Posthoc testing demonstrated a significant difference between T0 and T1 for both total vigorous (p=0.001, effect size=1.28) and physical activity (p=0.037, effect size =0.89).Conclusion A supervised HIIT programme reversed neoadjuvant-associated fitness loss and revived vigorous activity. Structured prehabilitation shows promise for lowering surgical mortality risk by improving modifiable determinants of perioperative outcome. Larger randomised trials are required to confirm survival benefits and optimise intervention parameters.