Prehabilitation: Preparing for Surgery to Improve Outcomes

Undergoing surgery is a significant event that can have a profound impact on your health and quality of life. While much emphasis is placed on post-operative recovery, prehabilitation—a proactive approach to preparing your body and mind before surgery—is gaining recognition for its role in improving surgical outcomes. Prehabilitation focuses on optimizing your physical, nutritional, and psychological status to enhance your recovery, reduce complications, and shorten your hospital stay.

This article explores the concept of prehabilitation, its key components, and practical steps you can take to prepare for surgery effectively.

What is Prehabilitation?

Prehabilitation, or “prehab,” is a comprehensive, multidisciplinary approach aimed at improving your health before surgery to enhance your post-operative recovery. The concept is rooted in the idea that a stronger, healthier body can better withstand the physiological stress of surgery. Prehab involves structured interventions around physical fitness, nutrition, mental well-being, and lifestyle modifications. Research has shown that patients who engage in prehabilitation experience fewer complications, experience less pain, and enjoy faster recoveries compared to those who do not.

Structuring Your Prehab Program

Improving your physical fitness before surgery can significantly enhance your ability to recover. The goal is to strengthen the cardiovascular system, improve muscle function, and increase overall endurance. You can take steps like:

• Boosting your aerobic exercise. Walking, swimming, or cycling help improve cardiovascular endurance, which can enhance oxygen delivery during and after surgery.
• Adding or continuing strength training. Resistance exercises like weightlifting or bodyweight exercises, build muscle strength, which is essential for post-surgical mobility and rehabilitation.
• Adding or continuing exercise that promotes flexibility and/or balance. Yoga, Pilates and targeted balance programs help prevent falls and improve mobility after surgery.
• Bringing your attention to your breath. Exercises, like diaphragmatic breathing and inspiratory muscle training, can reduce post-operative respiratory complications and enhance lung function.

Proper nutrition plays a crucial role in prehabilitation, as it helps your body heal faster. Consider working with a registered dietitian for a few sessions as part of your prehab preparation. Key nutritional strategies include:

• Including sources of protein in your diet, like lean meats, fish, eggs, dairy, legumes, and plant-based proteins, to support muscle repair. A nutrition supplement shake may be an appropriate way to boost protein intake as well.
• Staying well-hydrated. Hydration is essential for circulation, kidney function, and overall cellular health.
• Reducing consumption of ultra-processed foods, including excessive sugars and unhealthy fats, to help reduce inflammation and promote healing.

Your mental and emotional well-being are critical to a successful surgical outcome. Anxiety and stress can negatively impact recovery, so psychological preparation should be part of your prehabilitation program. Strategies include:

• Trying mindfulness, meditation and relaxation techniques like deep breathing and progressive muscle relaxation to help reduce anxiety and stress before surgery.
• Communicating with your physician about Cognitive Behavioral Therapy (CBT) or counseling for managing fears, expectations, and emotional challenges related to surgery.
• Asking your physician for evidence-based educational materials related to the procedure you are having. Learning more from trusted sources can help to reassure you around your upcoming procedure. Ask your physician about MGH-sponsored support groups if sharing your experience with others feels right for you.
• Factoring in family and friends. Family, friends, or support groups can provide encouragement and practical assistance during the surgical preparation and recovery period. Make connecting with others part of your prehabilitation planning.

Making positive lifestyle changes before surgery can significantly impact recovery. Important lifestyle adjustments include:

• Reducing/quitting smoking. Smoking impairs circulation, delays wound healing and increases the risk of post-surgical complications. If you smoke, consider quitting smoking at least a few weeks before surgery.
• Reducing/eliminating alcohol. Excessive alcohol intake can weaken the immune system and interfere with the efficacy of medications you are or will be taking. Limiting alcohol intake before surgery can improve healing and reduce complications.
• Managing chronic conditions like diabetes or hypertension. Work with your physician to build a pre-surgery strategy for post-surgery success.
• Get your rest. Ensuring proper rest and sleep before surgery can enhance your immune which promotes faster recovery.

Prehab is a proactive and holistic approach that empowers you to take charge of your health before undergoing surgery. By focusing on physical conditioning, proper nutrition, mental preparedness, and lifestyle modifications, you can significantly improve your surgical outcomes and overall well-being. Through proper preparation, you can face surgery with greater confidence, experience fewer complications, and enjoy a smoother and faster recovery.