Prehabilitation: The Art of Rehab Before Surgery

Despite advances in surgical techniques, anesthesia, and perioperative care, surgery remains physiologically stressful and tends to decrease one's functional capacity in the postoperative period.

If you are planning for surgery down the road, prehabilitation can help to enhance functional capacity pre-operatively for better toleration of surgery. Adding a "p" to rehabilitation improves outcomes pre- and post-op. By providing a stimulus to promote physical adaptation, you can mitigate acute deconditioning after surgery.

What is prehabilitation? [1]

Prehabilitation (preventive rehabilitation or prehab) helps patients build their strength prior to surgery and ease their recovery time postoperatively. Think of prehab as the preventive solution for further problems down the road.

Why go through prehabilitation? [2]

A "prehabilitation" program should increase functional capacity in anticipation of surgery, i.e. upcoming stress. It usually occurs after the surgical consultation and 6-8 weeks prior to surgery, and is based on three components:

a) physical care,

b) nutritional support and

c) psychological support.

The aims of prehabilitation are to improve both nutritional status, both pre- and postoperative fitness, and to reduce postoperative complications. Prehabilitation demonstrated benefit on postoperative complications in cardiovascular surgery but its benefit in digestive surgery is still unclear with contradictory results. The aim of this review was to summarize the results of prehabilitation on the pre- and postoperative periods and to determine its possible future in digestive surgery.

“An ounce of prevention is worth a pound of cure.”

What happens in the prehabilitation process?

#1. Diagnosis

This is the first step to any journey into the operation theatre, and could be made weeks to months before the planned surgery. The earlier prehabilitation can commence, the better the post-surgery outcomes.

#2. The Pre-Surgery Prep

This is where we come up with the game plan. This process consists of understanding your goals and aligning them with the medical plans. It is at this stage that you are empowered with the knowledge to know what needs to be added to your daily routine to attain the anticipated rehab milestones after surgery.

#3. Exercise Prescription

Your physiotherapists will meet with you to discuss a training programme that suits your needs. This will involve 2 to 3 times a week of a supervised and structured programme of warm-up and strength training, with some cardio exercises at the end.

#4. Early Mobility after Surgery

Regaining mobility is one of the most important aspects to kick start recovery. Getting back one's mobility will move you towards returning to performing activities of daily living without help. For example, it is imperative to start getting out of bed to walk as early as the first day after surgery!

#5. On-track to Recovery!

As time goes on, your exercise prescription will be constantly reevaluated according to how you are responding to treatment (see figure 1) to optimize your recovery. This is good news! You are now on track to the quickest path to recovery and optimal functional outcomes.