Building strength before surgery may ease recovery

Building strength before surgery may ease recovery

Building strength before surgery may ease recovery

Rehabilitation can help get you up on your feet again after surgery or a physical setback. But some surgeons are increasingly turning to an innovative approach called prehabilitation in hopes of easing that recovery in the first place.

Prehabilitation, commonly called prehab, is an individualized medical program designed to help people, often those who are older or frail, better withstand and bounce back from an anticipated physically stressful event, such as surgery, says Dr. Julie K. Silver, an associate professor and associate chair of the Department of Physical Medicine and Rehabilitation at Harvard Medical School.

This program typically includes specific exercises designed to build strength in parts of the body that will be most affected by the event. For example, a woman undergoing surgery for breast cancer might focus on exercising the shoulders to increase strength and range of motion prior to the surgery. Prehab also may include other approaches to ensure a successful recovery, such as:

  • blood sugar control, to reduce postoperative infection rates.
  • smoking cessation for better healing.
  • nutritional strategies, including protein supplementation, to support an increase in muscle strength and activity before the procedure.

How far in advance prehabilitation begins really depends on why it's being used, says Dr. Silver. An elective surgical procedure, such as a knee replacement, would allow a longer time frame for preparation than a cancer surgery would. "It is possible to see positive changes in a short period of time," she says.

A well-established concept

Today, an increasing number of surgical plans for patients include prehabilitation, says Dr. Silver. However, while prehab may be on the upswing, it's not a new concept. Similar approaches have long been in use by the military, she says.

A study published in 1946 by The British Medical Journal (now The BMJ) described a comprehensive two-month program used to ready soldiers for war, she says. The program included nutritional, housing, recreational, physical training, and educational elements to boost readiness.

A subsequent analysis determined that the program was able to increase measures of the health of the 12,000 men who participated by some 85%, said Dr. Silver. Researchers reported that the results they saw from the program, which also included improvements in the participants' outlook on life, were "astonishingly easy" to accomplish.

Putting prehab to use

When it comes to the average person, this same concept can promote readiness for other physical stressors. A study published Nov. 13, 2019, in JAMA found that frail individuals had high death rates even after procedures that were considered low-risk, such as cystoscopy, a procedure to examine the bladder lining using a viewing device inserted into the urethra. Frail adults who underwent cystoscopy had a 1.5% 30-day mortality rate. Normally doctors characterize any procedure that has a 1% mortality rate or higher as high-risk.

Prehabilitation may reduce some of those elevated surgical risks in frail elders, says Dr. Silver. And, she adds, prehab can also be used to ready high-risk individuals for other health challenges. This could even extend to helping vulnerable people who might be exposed to infectious diseases, such as COVID-19, as she outlined in an opinion piece published in March by The BMJ.

Social distancing or sheltering in place may keep COVID-19 from spreading, says Dr. Silver, but it might also make people less likely to exercise, leading to declines in strength and heart and lung fitness. This could make them more susceptible to complications if they do become ill. While a prehabilitation approach in these instances is not yet backed by research, adopting a program to protect or even build strength in vulnerable individuals might help reduce complications from the virus, she says.

Prehabilitation should be overseen by a medical provider, but building strength and health before an elective surgery is never a bad idea. Provided your doctor approves, consider adopting a healthy diet, exercising regularly, and incorporating twice-weekly whole-body strength training into your routine.

You can keep fit even if you are stuck at home by doing upper-body strength exercises (use soup cans if you don't have weights), following Internet-based exercise classes, or walking on a treadmill or around your home.

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