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PREhabilitation – Exercise Before Surgery

Get strong for surgery.
Get strong for surgery.

Doctors know all about what to do after you’ve been operated on. There’s the initial rest period, generally followed by some form of physical therapy and regular follow-ups to make sure there aren’t any complications. It’s all very routine.

However, nearly one-third of all operations in the United States are elective surgeries. They’re not an emergency, and the patient may have weeks or even months to prepare. That made a few researchers wonder, was there something patients could do before they go under the knife to improve their chances of a successful outcome?

The idea that we should do anything at all comes from a common medical observation. You might call it Better In, Better Out. That means people in better shape before surgery typically recover quicker and generally do better after surgery.

That doesn’t mean you’re doomed to a bad outcome if you’re not in peak physical condition. There’s a lot you can do, even if you’ve got as little as two weeks before an operation. An analysis of surgical outcomes done in 2012 concluded that a smart program before surgery could help “even the very old and frail.”

It’s called PREhab or PREhabilitation. For most patients, it starts with a customized workout. Exercise programs are tailored for an individual’s abilities and conditions. You might consider workouts to strengthen the supporting muscles for whatever areas you’re having worked on. For example, if you’re going to have surgery on an injured knee, you might try to strengthen your thigh muscles so they can compensate for that weakened knee after surgery.

When researchers followed up on patients who had a program, they concluded that “perioperative exercise in patients scheduled for cardiac surgery is well tolerated and effective. Moreover, there is circumstantial evidence suggesting the same for thorax, abdominal and major joint replacement surgery...”

Here’s where it got particularly surprising. Researchers suggested PREhab programs should consist of higher intensity training. They said, “High-intensity training is necessary to achieve improvements given the often short time available before surgery. Fortunately, frail and older patients can tolerate the programs.” A simple walk around the block probably isn’t going to help. Work with your doctor to build a specific, higher intensity program that addresses your areas of weakness.

There is a word of warning. If you’ve never exercised before, start slowly. You don’t want to pull or strain any major muscles. Just before surgery isn’t the time to make any conditions you’re dealing with worse.

Exercise wasn’t the only recommendation.

Sleep is critical because that’s when your body heals and recuperates. Skimp on sleep, and you weaken your immune system. Set your alarm to go to bed earlier. Try to get seven to eight hours of rest a night.

Quit smoking, at least temporarily until after the surgery. After surgery, smokers were more likely than others to need a ventilator to help them breathe. Smokers healed slower and were more prone to infection and pneumonia. Quitting reduced all those complications.

Eat a wide variety of fruits and vegetables while limiting the empty calories from sweets, fatty foods and highly processed foods. That includes possibly eating something up to six hours before surgery.

For decades doctors have told patients, don’t eat or drink anything after midnight if you’ve got surgery in the morning. The fear was that during surgery, the patient might regurgitate stomach contents into the lungs. Modern anesthesia and surgical techniques have dramatically lowered that risk. Today, researchers know that it impairs your ability to recover from complications when you don’t eat for extended periods.

The American Society of Anesthesiologists now says healthy people can eat up to six hours before surgery and drink clear liquids up to two hours before. Ask your doctor if that’s appropriate in your case.

Pledge to be strong for surgery. The more prepared you make your body, the faster you’ll get through whatever you’re about to face.

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CAUTION: Check with your doctor before
beginning any diet or exercise program.

Updated 7/16/2021