What Is Prehabilitation?
After surgery or another medical procedure, patients often take part in a rehabilitation program to help them achieve optimal healing and function. Rehab helps them build their muscles, regain function, and cope with the emotional and cognitive aspects of recovery.
But what about before surgery? Experts report that there’s a lot of beneficial preparation patients can do before they check into the hospital or clinic! “Generally, the more fit and active you are going into a surgical procedure, the more likely you are to retain a higher level of function after,” says the American College of Surgeons. “Prehabilitation is defined as a process of improving the functional capability of a patient prior to a surgical procedure so the patient can withstand any postoperative inactivity and associated decline. In other words, to get you to a better place physically before an operation.”
Of course, this isn’t possible before every surgery. An emergency appendectomy or heart surgery, a bowel obstruction, injuries from a car accident—some operations need to happen right away. But experts from the University of Michigan report that about 90% of surgeries are elective and scheduled. While a patient is waiting for a procedure such as heart valve replacement, organ transplant, joint replacement or chemotherapy and radiation, there’s usually a waiting period. What happens during that period can make a big difference in the patient’s recovery!
For example, experts from the University of Michigan Medical School developed a prehabilitation routine called the Michigan Surgical and Health Optimization Program (MSHOP), in which patients take part in coaching sessions before undergoing a variety of surgeries. In several studies, the researchers found that patients who had taken part in “prehab” had shorter hospital stays, fewer complications, and felt more in charge of their own care.
“Promoting healthful habits in advance of an operation is a measure that should be just as crucial as any other step in the admittance process,” said study author Dr. Stewart Wang. “The condition of the body is so important. It’s so much common sense that people often fail to recognize it.”
Prehabilitation might include:
- A regimen of appropriate physical activities
- Changing to a healthier diet
- Quitting smoking
- Stress reduction
- Breathing exercises to improve lung function
- Managing health conditions such as diabetes and hypertension
- Emotional support to help patients prepare
Walking is an especially important component of the MSHOP program. Participants are encouraged to take a stroll for about an hour each day. “The vast majority of the program benefits come from the walking,” says Dr. Wang.
Dr. Wang and his team also say doctors should evaluate patients’ readiness for surgeries—and in some cases, might delay a surgery until the patient had taken part in some prehabilitation activities.
Another study, published in the Canadian Journal of Cardiology, took a look at prehabilitation in a group of heart patients. The research team noted that in Canada, elective heart surgeries are typically scheduled a couple months in advance—and, reported lead researcher Dr. Rakesh C. Arora, patients typically spend those two months “in fear,” with minimal physical activity. How much better if patients were to receive the support they need to use those months productively!
Dr. Arora and his team applied the “NEW” approach, which stands for nutrition optimization, exercise training, and anxiety (worry) reduction. Said Dr. Arora, of the University of Manitoba College of Medicine, “Improving patients’ functional reserve before their procedure will improve postoperative outcomes that are important to older adults, including preserving mental and functional independence and enhancing postoperative recovery.”
And there’s one more big benefit: it saves money. “Prehabilitation is good for patients, providers, and payers,” Dr. Michael Englesbe, also a part of the University of Michigan study, told the American College of Surgeons. “Every time the prehab study has been studied, it’s found to increase the value of surgical care by improving care while reducing cost. This study cements the business case for hospitals to support it.”
Prehabilitation can take place in a group or one-on-one setting, via televisits or using an app. If your doctor recommends that you undergo a medical or surgical procedure, ask about prehabilitation. “The more you can do to manage your status preoperatively, the quicker you’ll be able to bounce back,” says Dr. Englesbe.