Prehabilitation exercise, or “Prehab”, has become one of the biggest trends in physical therapy and fitness since “core stability” training.  It claims to reduce injuries and improve your physical function, particularly for active people.  Given its popularity in athlete conditioning programs, it would be understandable to believe that Prehab is intended for very active people who want to play their sports at a competitive level without risking an injury.

Using Prehabilitation to Make the Most of Your Surgical Delays

In fact, the best group to benefit from prehabilitation may not be athletes at all, but those waiting for surgical procedures and other medical therapies to restore their health.  The drastically reduced number of surgical procedures during the pandemic has created much longer wait times that are well-known to increase the risk of a poor outcome.

Surgery is a major metabolic stress that causes significant loss of muscle mass and strength, aerobic capacity, and an increase in fatigue.  Studies have shown how challenging it can be to recover.  For example, 50% of patients who had elective abdominal surgery still demonstrated a degree of disability, and patients with low cardiorespiratory fitness may not be able to tolerate many postoperative therapies.

For decades now, a significant amount of medical research has been studying the role of prehabilitation programs on patients’ recovery and health, and their results have been incredibly encouraging.  On average, presurgical prehabilitation programs are associated with a 30% risk reduction in postoperative complications.  Traditionally, prehabilitation approaches have focused on orthopaedic, cardiac, and cancer patients but ongoing studies show that it is has a positive impact on:

  • improved physical function and quality of life
  • more rapid return to normal physical activities
  • reduced postoperative complications
  • reduced length of hospital stays
  • improved outlook and mental health after surgery
  • being able to tolerate subsequent medical treatments, such as chemotherapy, radiotherapy, and hormonal treatment for cancer patients.

Doctors overwhelmingly support a rapid return to full safe physical function after major surgery.  Not only for the health benefits to the patient, but also for the shortened hospital stays.  This allows the medical system to care for more patients.

Understanding the Benefits of Prehabilitation Programs:

The graph below illustrates this situation.  The yellow horizontal line is describing a person waiting for their surgery date (the vertical dotted line).  Their recovery after surgery will look a lot like the red curve, dropping off sharply at the beginning and eventually resting at a lower level perhaps a few weeks or months later.  Unfortunately, their “new normal” is significantly lower than their presurgical fitness level, which will cause their bodies to have to work harder to get back to normal.

Effect of prehabilitation on postsurgical success

Effects of prehabilitation on improving postsurgical outcomes.

By comparison, a patient who follows a prehabilitation program will start their recovery at a much higher level.  This decreases the damaging effect of  postsurgical detraining because the drop-off in their physical capacity will not be as great.  Doctors are also showing that this period is much shorter for these patients, meaning that they can reverse the curve much sooner.  This all leads to a shorter rehabilitation or recovery phase and reduced complications and side effects.

Unfortunately, prehabilitation is not yet a part of routine clinical practice.  So, people have to proactively decide to engage to maximize their outcomes.  At the Orthopaedic Therapy Clinic, our clients tell us what a difference preparing for surgery has made in all aspects of their surgical experience.

It’s also important to note that engaging in activities to increase physical fitness promotes and facilitates health behavior changes, not only pre-operatively, but during the postoperative period and beyond.  In other words, participating in prehabilitation allows you time to develop positive habits that you can continue after the surgery and over the long term.

When You Should Start a Prehabilitation Program

Your improvement in your physical capacity will be dependent on many things, such as your diagnosis, age, and medical history.  Although every person’s prehabilitation program will be unique, it is important to start as soon as your surgery is confirmed, even if you do not have a date.  The longer you have to prepare, the better outcomes you can expect, which will make the postsurgical time far less difficult.  However, if your date is coming up soon, you can still get started with as little as a few weeks to a few months in advance, and still expect to receive a benefit.

Put our team on your side:

John Gray RKin, Registered Kinesiologist, has the skills and experience to design your individualized prehabilitation program to maximize your recovery.  Programs are targeted specifically for your surgical procedure and reflect your medical status and are designed to allow you the flexibility to be performed in your own home or gym, or with us at our clinic.

At the Orthopaedic Therapy Clinic, we help clients prior to surgery to become stronger and fitter, improve their mobility and return to life as soon as possible. We are committed to working with you to achieve optimal fitness before and after your procedure.

So, if you were one of the many people who think it is best to wait to work on your prehab until after your surgery, I hope this article has changed your mind. If you have further questions or would like to book an appointment to prepare for surgery or achieve any other training and conditioning goals, please contact John Gray at jgray@orthophysio.com or 416-925-4687.

References

  1. Multi-modal Prehabilitation: addressing the why, when, what, how, who and where next? Anaesthesia: Vol 74 (Suppl. 1), 20-26.