If you’re scheduled to have surgery, participating in prehab beforehand may boost your chances of a faster recovery and a better outcome.
If you have a surgery coming up, your doctor may have already told you what to expect afterwards. This will involve:
- How to care for yourself in the days after surgery
- Whether you will stay in a hospital or similar setting for care right after post-op
- Which signs and symptoms will require a call to the surgeon or urgent ER visit
- When your first follow up visit is
- Which home exercises you can do on your own
- When physical or occupational therapy should start, if appropriate
But has your doctor told you about the steps you can take before your surgery to help you get ready for it? More and more often, doctors are prescribing prehabilitation— or prehab— for surgeries such as total joint replacements, as prehab leads to better results for their patients. But if your doctor has not mentioned prehab, you may want to ask for those steps you can take prior to your surgery.
Preparing for surgery is very helpful, because surgery places a great deal of stress on both your body and your mind. And a growing body of research suggests that prehab may help you better cope with this stress. It may also help put you on the road to a faster, more complete recovery. The stronger and more mobile you are before surgery the better the outcome after surgery.
Prehab plans may call for an exercise program only—or they may also involve other steps, such as:
- Eating a diet high in nutrient-rich foods
- Losing or gaining weight, if needed
- Seeking mental health support to help ease presurgical stress and/or worry
- Using integrative medicine, such as acupuncture, massage, or mindfulness training
- Changing unhealthy habits, which might include reducing your alcohol, tobacco, and nicotine intake
- Making sure your sleep habits allow for proper rest and healing
- Making changes to help you better handle any underlying health issues such as high blood pressure or high blood sugar
- Changing any medications or supplements (e.g., blood thinners) that may increase the risk for certain surgical complications
Talk with your doctor or surgeon about tailoring a prehab plan that will help you get ready for your upcoming procedure. They can also help you decide how many weeks before surgery you should take part in your prehab program.
How prehab benefits you before, during, and after surgery
Research findings suggest that prehab may boost your overall health and immunity, along with your strength, endurance, and mobility. Studies also suggest that optimizing these areas of health and fitness before a surgery may help you:
- Feel less anxious about your surgery
- Lower the risk of surgical complications (bleeding, infections, clots, etc.)
- Shorten your hospital stay
- Lessen the risk of readmission
- Lessen post-op pain
- Enhance gains made during post-op rehab
- Cut your recovery and rehab time
- Support better mobility and overall functioning, so you can return to daily activities more quickly
- Feel better and stronger, which can help with healing
The goal of prehab is to send you to surgery in as physically fit and healthy a state as possible. Doing so stacks your odds of getting the most from your procedure. The stronger you are going into surgery, the stronger you’re more likely to be when you come out.
Exercise is often the cornerstone of prehab
Exercise—almost always a part of prehab programs— can help boost your overall health and physical fitness. It helps your body cope better with surgery by enhancing:
- Cardiorespiratory endurance
- Strength
- Mobility
- Balance
- Immunity
- The smooth functioning of your body’s organs and cells
- Your quality of life and overall well-being
Prehab exercises for orthopedic surgeries
Prehab exercises can be tailored to help you get more from a planned orthopedic surgery. These are typically for the joints and soft tissues of the body—like a hip or knee replacement, or back surgery, to name a few.
Say that you’re gearing up for knee surgery. Your surgeon may suggest you work with a physical therapist (PT). Your PT will likely give you prehab exercises to strengthen the leg and hip muscles that support the knee joint. These may involve the quadriceps muscle along the front of the thigh and the hamstring muscles along the back of the thigh, among others.
If you’re having hip surgery, your PT might give you exercises that focus on your core, hip, and leg muscles.
Your surgeon or PT may also suggest cardio, flexibility, and/or balance exercises along with strength-training exercises. Make sure to follow your prehab plan as prescribed by your doctor.
Prehab helps with other kinds of surgeries and treatments, too
Orthopedic surgeries aren’t the only kind that prehab can help you with. Research suggests that prehab may help when used before most kinds of cancer surgery. It can also be beneficial when used before other kinds of medical treatments, such as dialysis or radiation and chemotherapy. Prehab may also help with colon surgery, cardiovascular surgery, and reproductive surgeries, such as a Cesarian section or a hysterectomy.
Be proactive
If you have a surgery or another major medical treatment planned, ask your doctor how to get started with prehab. Many hospitals and surgical groups have dedicated prehab teams. These often have a wide range of specialists who can work together to assess all your needs. And they can suggest the best prehab steps for you—ones that will lead to a faster, easier, and more complete surgical recovery.
Not a Silver&Fit® member? Learn more about everything the program has to offer, including more helpful healthy living tips like this, here on our website.
This information is not intended to take the place of regular medical care or advice. Please check with your doctor before using this information or beginning any self-care program. Images used for this article do not depict any members of the Silver&Fit Program.
References
AllinaHealth. (2020, February 1). Before-surgery knee exercises. https://www.allinahealth.org/health-conditions-and-treatments/health-library/patient-education/total-knee-replacement/preparing-for-surgery/before-surgery-knee-exercises
American Academy of Orthopaedic Surgeons. (n.d.). Obesity, weight loss, and joint replacement surgery. https://orthoinfo.aaos.org/en/treatment/weight-loss-and-joint-replacement-surgery/
Anderson, A.M., Comer, C., Smith, T.O. Drew, B. T., Pandit, H., Antcliff, D., Redmond, A. C., McHugh, G. A. (2021, April 14). Consensus on pre-operative total knee replacement education and prehabilitation recommendations: A UK-based modified Delphi study. BMC Musculoskelet Disord 22(352). https://doi.org/10.1186/s12891-021-04160-5
Banugo, P., & Amoako, D. (2017, December). Prehabilitation. British Journal of Anesthesia, 17(12), 401-405. https://doi.org/10.1093/bjaed/mkx032
Cleveland Clinic. (2021, April 7). Exercise-related do’s and don’t’s before elective joint surgery: Make a proactive plan to prepare yourself for surgery. https://health.clevelandclinic.org/exercise-related-dos-and-donts-before-elective-joint-surgery/
Cunha, J., & Soloman, D. J. (2022, January). ACL prehabilitation improves postoperative strength and motion and return to sport in athletes. Arthroscopy, Sports Medicine, and Rehabilitation, 4(1): e65–e69. https://doi.org/10.1016/j.asmr.2021.11.001
Gillis, C., Buhler, K., Bresee, L., Carli, F., Bresee, L., Carli, F., Gramlich, L., Culos-Reed, N., Sajobi, T. T., Fenton, T. R. (2018, August). Effects of prehabilitation, with and without exercise, on outcomes of patients who undergo colorectal surgery: A systematic review and meta-analysis. Gastroenterology, 155(2), 391-410.e4. https://doi.org/10.1053/j.gastro.2018.05.012
Gränicher P, Mulder L, Lenssen T, Scherr J, Swanenburg J, de Bie R. Prehabilitation Improves Knee Functioning Before and Within the First Year After Total Knee Arthroplasty: A Systematic Review with Meta-analysis. J Orthop Sports Phys Ther. 2022;52(11):709-725. doi:10.2519/jospt.2022.11160
Konnyu KJ, Thoma LM, Cao W, et al. Prehabilitation for Total Knee or Total Hip Arthroplasty: A Systematic Review. Am J Phys Med Rehabil. 2023;102(1):1-10. doi:10.1097/PHM.0000000000002006
Medline Plus. (2022, August 22). Smoking and surgery. https://medlineplus.gov/ency/patientinstructions/000437.htm#
Mirapeix, E., Mancebo, G., Gayete, S., Gorcoy, M., Sole-Sedeno, J.-M. (2019, October). Role and impact of multimodal prehabilitation for gynecologic oncology patients in an Enhanced Recovery After Surgery (ERAS) program. International Journal of Gynecological Cancer, 29(8), 1235-1243. https://doi.org/10.1136/ijgc-2019-000597
Moyer, R., Ikert, K., Long, K., Marsh, J. (2017, December). The value of preoperative exercise and education for patients undergoing total hip and knee arthroplasty: A systematic review and meta-analysis. Journal of Bone and Joint Surgery, 5(12), e2. https://doi.org/10.2106/JBJS.RVW.17.00015
Ngo-Huang, A., Parker, N. H. Katz, M. H. G. (2019, December 20). Home-based exercise prehabilitation during preoperative treatment for pancreatic cancer Is associated with improvement in physical function and quality of life. Integrative Cancer Therapies, 18. https://journals.sagepub.com/doi/full/10.1177/1534735419894061
Punnoose, A., Claydon-Mueller, L. S., Weiss, O., Zhang, J., Rushton, A., Khanduja, V. (2023, April). Prehabilitation for patients undergoing orthopedic surgery: A systematic review and meta-analysis. JAMA Network Open, 6(4), e238050. https://doi.org/10.1001/jamanetworkopen.2023.8050
Riskowski, J., Dufour, A. B., & Hannan, M. T. (2011). Arthritis, Foot Pain and shoe wear: Current musculoskeletal research on feet. Current Opinion in Rheumatology, 23(2), 148–155. https://doi.org/10.1097/bor.0b013e3283422cf5
Sheshadri, A., & Johansen, K. L. (2017). Prehabilitation for the frail patient approaching ESRD. Seminars in Nephrology, 37(2), 159–172. https://doi.org/10.1016/j.semnephrol.2016.12.006
Soeters, R., White, P. B., Murray-Weir, M. Kolstove, J. C. B., Alexiades, M. M., Ranawal, A. S., Hip and Knee Surgeons Writing Committee. (2018, January). Preoperative physical therapy education reduces time to meet functional milestones after total joint arthroplasty. Clinical Orthopaedics and Related Research, 476(1), 40-48. https://doi.org/10.1007/s11999.0000000000000010
University of Rochester Medical Center. (n.d.). After surgery: Discomforts and complications: What are some common post-op discomforts? https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=85&ContentID=P01390
Yale School of Medicine. (2023, July 27). Building strength before surgery. https://medicine.yale.edu/news-article/building-strength-before-surgery/
This article was written by Gail Olson, edited by Kimberley Reynolds, and clinically reviewed by Jaynie Bjornaraa PhD, PT, MPH, SCS, LAT, ATC, CSCS.
