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Is "Prehab" exercise just another trend? Well, yes but not when done properly.

Prehabilitation, or “Prehab” as the influencers say, has become one of the biggest trends in physical therapy and fitness since “core stability” training to reduce injuries and improve your physical function, particularly in sports. The term has exploded across clinics and gyms, and of course Instagram, showcasing many unique and creative exercises that promise to keep your joints mobile, muscles prepared, and your movements pain-free.


Look online and it would be understandable to believe that prehab is meant for athletes focused on playing their sport at a competitive level, and its role is only to reduce the risks of getting hurt during play. Typical exercises may use resistance bands to target the “small muscles” such as the rotator cuff, or even tennis balls to massage muscle knots that restrict movement. Despite the very large industry this has created, the injury-prevention results are mostly anecdotal.

So you may find it surprising that a significant amount of medical research has been studying the role of prehabilitation programs on patients undergoing surgery, and their results have been incredibly encouraging.


Systematic reviews show a positive impact of pre-operative exercise therapy on improved physical function and quality of life, as well as reduced postoperative complications and length of hospital stay. On average, prehabilitation programs are associated with a 30% risk reduction in postoperative complications.


Additionally, prehab helps to improve your outlook and has been associated with improved mental health and nutrition practices as the patient becomes more aware of healthy practices that are essential to their ongoing recovery. It is also effective in preparing patients for subsequent cancer treatment, such as chemotherapy, and radiation and hormonal treatment.


Surgery is a major metabolic stress that causes significant loss of muscle mass and strength, aerobic capacity, and an increase in fatigue. Studies to date have shown how challenging it can be to recover. For example, 50% of patients who had elective abdominal surgery still demonstrated a degree of disability, and patients with low cardiorespiratory fitness may not be able to tolerate many postoperative therapies.


Traditionally prehabilitation approaches have focused on orthopaedic, cardiac, and cancer patients. Doctors overwhelmingly support a rapid return to full safe physical function after major surgery not only because of the health benefits to the patient, but also the shortened stay in the hospital allows the medical system to care for more patients.


This is particularly relevant today, when the stresses on the hospital system caused by the pandemic are still being felt. Those left waiting for longer periods of time are ultimately at an increased risk of a poor outcome because of the prolonged wait times.


The graph illustrates this situation. The yellow horizontal line describes a person waiting for their surgery date (the vertical dotted line). Their recovery after surgery will look a lot like the red curve, dropping off sharply at the beginning and eventually resting at a lower level perhaps a few weeks or months later. Unfortunately, their “new normal” is significantly lower than their presurgical fitness level, which will cause their bodies to have to work harder to get back to normal.





By comparison, a patient who follows a prehabilitation program will start their recovery at a much higher level, decreasing the damaging effect of the postsurgical detraining because the drop-off in their physical capacity will not be as great. Doctors are also showing that this period is much shorter for these patients, meaning that they are able to reverse the curve much sooner. This all leads to a shorter rehabilitation or recovery phase, as well as reduced complications and side effects.


Unfortunately, prehabilitation is not yet a part of routine clinical practice, so people have to proactively decide to engage to maximize their outcomes. Our clients tell us what a difference preparing for surgery has made in all aspects of their surgical experience.

It’s also important to note that engaging in activities to increase physical fitness promotes and facilitates health behavior changes, not only pre-operatively, but during the postoperative period and beyond. In other words, participating in prehabilitation allows you time to develop positive habits that you can continue after the surgery and over the long-term.


When You Should Start a Prehabilitation Program.

Your improvement in your physical capacity will be dependent on many things, such as your diagnosis, age, and medical history. Although every person’s prehabilitation program will be unique to themselves, it is important to start as soon as your surgery is confirmed, even if you do not have a date. The longer you have to prepare, the better outcomes you can expect, which will make the postsurgical time far less difficult. Where possible, you can start with as little as a few weeks to a few months in advance, and still expect to receive a benefit.


Put me on your team:

Over my 25+ year-long career, I've gained the skills and experience to design your individualized pre-habilitation program to maximize your recovery. Programs are targeted specifically for your surgical procedure and reflect your medical status and are designed to allow you the flexibility to be performed in your own home or gym, or with us at our clinic.

I help clients prior to surgery to become stronger and fitter, improve their mobility and get back to life. We are committed to working with you to achieve optimal fitness before and after your procedure.


So, if you were one of the many people who think it is best to wait to work on your rehab until after their surgery, I hope this article has changed your mind. If you have further questions or would like to book an appointment to prepare for surgery or achieve any other training and conditioning goals, please contact me at any time!


References

1. Multi-modal Prehabilitation: addressing the why, when, what, how, who and where next? Anaesthesia: Vol 74 (Suppl. 1), 20-26.

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