Anyone who has undergone major surgery understands that the invasive procedure can be tough on the body, with most patients undergoing rehabilitation to get back into shape.
But a bourgeoning field of science suggests that shifting rehab to prehab – that is, exercise before surgery — can make recovery smoother.
Pre-operative conditioning has caught the attention of Canadian researchers, who are exploring the benefits of the approach this fall in a first-of-its kind national study.
Already, prehab has shown promise. Marie Lapointe, 66, underwent her own regular exercise routine a month before surgery to remove half of her lung. She exercised six times per week at home, with a particular focus on strengthening her abdominal muscles and legs, and also went on regular walks.
“I just did them in my living room,” said the woman from Russell, Ontario. “If I can do them, just about anybody can do them.”
Two weeks after her surgery, Lapointe was back on her feet and walking more than two kilometres every day. Not long after, she was playing golf several times a week.
“It was amazing. I just bounced right back,” she said.
The majority of Canadians having a major surgery are 65 or older, and about 40 per cent of those patients live with frailty: a combination of chronic conditions and reduced physical and mental health that can make them more vulnerable after surgery.
By boosting those patients’ physical fitness levels before surgery, researchers believe they could be back up and walking sooner, and experience fewer complications.
That’s the sort of recovery that researchers at the Ottawa Hospital are striving for as they measure the benefits of prehab. Their study focuses on older patients who are about to undergo cancer surgery – a notoriously grueling process.
The program involves 30 minutes of exercise, stretching and strength training three times a week for four weeks before elective surgery. Patients receive training in hospital and also exercise at home, with a weekly check-in from health staff.
Dr. Daniel McIsaac, an anesthesiologist and scientist leading the study, said researchers learned that patients enjoyed the exercise and, after surgery, noticed obvious benefits.
“It’s a great idea to tell people to go home and increase their activity before surgery, but we know it’s not easy to do that. So we’re testing what kind of tools can we use to facilitate people doing this at home so they actually stick with it and actually realize the benefit,” said Dr. McIsaac.
The Ottawa study inspired a national study being launched this fall in 11 hospitals across Canada. With more than $1.2 million in funding, the study aims to measure the benefits of prehab by comparing the recoveries of patients who undergo a pre-surgery home-based exercise program to those who do not.
The preparatory approach is a shift in philosophy in medicine that recognizes that getting ready for surgery is akin to training for a marathon, said Celena Scheede-Bergdahl, a researcher in McGill University’s Department of Kinesiology and Physical Education.
The more physicians get on board with the prehab approach, the more it will grow, Scheede-Bergdahl said.
“It takes a lot of convincing at first. But then, for example, when the surgeons participate, then all of a sudden they’re like, ‘How come we didn’t know about this sooner? Why didn’t we participate earlier?” she said.