If you’ve suffered from chronic pain for months (or even years!) and you’ve finally got that surgery date booked in, it might seem a bit counter-intuitive to start ramping up your exercise training… You’ll just have to start from scratch again after the surgery anyway, right? Well, not quite!
Prehabilitation, or “prehab” for short, is a strategy that involves partaking in rehabilitative exercise prior to surgery, in order to improve outcomes after surgery. If you’ve been following our content for a while now, you know we are all about being proactive. And prehabilitation is proactivity at its finest!
One way we can look at fitness is our body’s ability to handle physical stress. And as far as physical stress goes, surgery is definitely up there! So the fitter you are going into surgery, the better equipped your body will be – during and after surgery – to cope with the recovery process. Sounds pretty good, right?
We know you trust us – but just to be extra convincing, we thought we would dive into the research to see what the science says… Is prehab worth the hype?
Prehab for Musculoskeletal Conditions
Perhaps the most widely studied group of conditions in the prehab world are musculoskeletal conditions/injuries. Prehab research has looked into joint replacements, fusions, soft tissue repair and more!
From a musculoskeletal perspective, prehab focuses on improving strength, stability and mobility around the surgery site, alongside other benefits like improved endurance and blood flow. In a study by Clode et al., (2018) the prehab group performed 45 minutes of exercise twice a week, right up until their knee or hip surgery. Compared to the control (no exercise) group, the prehab group achieved significantly better physical ability and quality of life outcomes. When asking the participants for feedback afterward, those who completed prehab felt ‘well prepared’ for their recovery process, compared to those who didn’t.
Another study by Huifen et al., (2018) also saw significant benefits – for knee replacements specifically. The prehab group in this study had significantly better mobility and lower body strength following surgery, and their hospital stays were also much shorter (can’t complain about that!).
Spinal surgeries are also popular in regards to prehab. Marchland et al., (2021) found that prehab in spinal surgeries impacts positively on many aspects of the recovery process, including functional ability, strength, endurance and pain. These differences in prehab vs. non-prehab were even more evident at the 3 month follow-up, showing that the benefits accumulate further over time!
Nielsen et al., (2010) suggests that prehab enables spinal patients to reach recovery milestones sooner. Most significantly, hospital stay was reduced in this study by up to 12 days in the prehab group when compared to controls!
Cancer Prehab
In recent years, prehab in the cancer space has also gained a lot of attention – this is no surprise given the great benefits we are observing in practice! Prehab in the cancer space refers to exercise prior to all types of treatment, including chemotherapy, radiation, and surgeries.
Research suggests that interventions prior to cancer treatment can reduce the likelihood of many complications and even the severity of some symptoms (like fatigue) – not to mention reducing the cost that comes with those complications (Silver, 2015).
A study in 2019 by Rooijen et al looked into prehab for colorectal cancer specifically, with some amazing results. Those patients who completed prehab had significantly better stamina and strength following surgery – at 4-weeks post surgery, only 40% of the control group had returned to their baseline capacity – whereas 86% of the prehab group had. Worth the extra effort, ya reckon!?
Are you convinced yet?
We would like to stress that we could go on and on in this space… But you probably get the idea!
So next time you have a client waiting for surgery, why not get ahead of the game and suggest a prehab program? You are well equipped for a convincing argument now!
References:
- Chen, H., Li, S., Ruan, T., Liu, L., & Fang, L. (2017). Is it necessary to perform prehabilitation exercise for patients undergoing total knee arthroplasty: meta-analysis of randomized controlled trials. The Physician and Sportsmedicine, 46(1), 36–43. https://doi.org/10.1080/00913847.2018.1403274
- Clode, N., Perry, M., & Wulff, L. (2018). Does physiotherapy prehabilitation improve pre-surgical outcomes and influence patient expectations prior to knee and hip joint arthroplasty?,. International Journal of Orthopaedic and Trauma Nursing, 30. https://doi.org/10.1016/j.ijotn.2018.05.004.
- Marchand, A., Houle, M., & O’Shaughnessy, J. (2021). Effectiveness of an exercise-based prehabilitation program for patients awaiting surgery for lumbar spinal stenosis: a randomized clinical trial. Scientific Reports, 11.
- Nielsen, P. R., Jørgensen, L. D., Dahl, B., Pedersen, T., & Tønnesen, H. (2010). Prehabilitation and early rehabilitation after spinal surgery: randomized clinical trial. Clinical Rehabilitation, 24(2), 137–148. https://doi.org/10.1177/0269215509347432
- Silver, J. (2015). Cancer prehabilitation and its role in improving health outcomes and reducing health care costs. Seminars in Oncology Nursing, 31(1), 13–30.
- van Rooijen, S., Molenaar, C., Schep, G., van Lieshout, R., Beijer, S., Dubbers, R., Rademakers, N., Papen-Botterhuis, N., & van Kempen, S. (2019). Making patients fit for surgery. American Journal of Physical Medicine & Rehabilitation, 98(10), 888–896.
Author: Tessa Nielsen
Editor: Yolanda van Vugt
Clinical Exercise Physiologists and Content Creators at Specialised Health
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