How Prehabilitation Prepares You for Surgery

Understanding the operation you are going to have and preparing for this by being as fit as you can be, is something called prehabilitation. Most people are familiar with the word rehabilitation which is a programme undertaken by a patient to recover to their maximum following surgery, but often patients are less familiar with the concept of prehabilitation. A good example is someone training for a 10k race or a skiing holiday. In both instances, to make the most of the experience, it would be normal to expect to do some preparation and appropriate training in good time beforehand.

Preparing for all types of surgery is much the same. Patients need to prepare in the best way possible so their surgery is as successful as it can be.

Your physiotherapist will help you tailor a programme to meet your individual needs, as no two patients are the same. You can set your own goals in the same way as you will following your surgery when you are recovering and returning to your normal activity.

Physiotherapists guide patients to think about their general fitness and lifestyle choices, so the areas you may wish to consider would include the following:

Physical activity

You need to try to do as much physical exercise as you can. This will vary depending upon your age, your level of existing fitness, any other medical issues that you may have or your social circumstances. Physical exercise can be anything that keeps you moving, such as regular walking, cycling or swimming. You may be a member of a gym or enjoy gardening or yoga. Keeping moving a little and often and varying your activity usually works best for your overall fitness for surgery. This will keep your bones and muscles strong and also work on your posture and balance.

Without physical exercise, our muscles become weaker and our bones less dense, and these issues may prove to be a problem and delay your speedy recovery from surgery.

You must be careful not to try unaccustomed exercise suddenly, so if you have a heart or lung condition or you know you are overweight, you should check with your GP or your physiotherapist before embarking on something new.

Targeted exercise

Depending upon the actual surgery that you are preparing for, there may be some specifically targeted exercises for you to consider. Your physiotherapist will explain and set a programme tailor-made for you. See Links https://www.nhs.uk/conditions/knee-replacement/

One of the main principles behind targeted exercise in orthopaedics is to ensure that your muscles are strong enough to cope with the extra workload following surgery. For example, for surgery on the knee, you will want to ensure that your leg muscles surrounding the knee are strong enough to walk and manage the physical therapy in your recovery.

Smoking

It is very important you try to stop smoking at least four to six weeks before the date of your operation, if possible. Smoking increases your risk of developing complications and may delay your discharge from the hospital. The carbon monoxide from tobacco smoke is proven to reduce the oxygen levels in your blood.

If you smoke regularly, your heart and lungs probably don't work as well as they should. You may have breathing problems during or after surgery, and then you will be at a greater risk of developing pneumonia.

Smoking decreases blood flow; therefore, surgical wounds may be less likely to close, less likely to heal well and more likely to become infected. Smoking also weakens the immune system, which may increase the chance of infection after surgery.

Weight management

Maintaining a healthy weight can be a difficult task for everyone, and this can be even harder for patients suffering from a medical condition or injury, especially if it affects their mobility. However, when you are preparing for any surgery, it becomes more important than ever to be a healthy weight.

If you are overweight or suffer from type 2 diabetes, then there can be a higher risk of complications which include wound infection, joint infection, and poor mobility.

Losing weight before your surgery can make you feel better both mentally and physically and in the right frame of mind to tackle your rehabilitation. Just a few kilos can make all the difference.

Alcohol consumption

Drinking alcohol before an operation is not advisable, and planning to stop should be part of your prehabilitation. You should plan to avoid drinking alcohol for at least 48 hours before your operation. Drinking alcohol can lead to serious complications and a longer hospital stay, and prolonged recovery time. This is primarily because of an increased risk of bleeding, and the effect alcohol can have on anaesthesia. If this is a concern for you, you should speak to your surgeon before your operation so they can provide you with extra support in your prehabilitation and make adjustments for your safety.

Nutrition

Part of your general fitness and weight management ahead of your surgery will be a well-balanced diet with plenty of fruit, vegetables and fibre and sparing amounts of saturated fats and sugars.

The better your nutritional status is before surgery, the better your body is able to heal after surgery, which means a shorter recovery time. Several weeks before surgery is a good time to consider your protein intake. This helps to build up both your strength and your tissues.

Healthy proteins sources include:

• Fish
• Chicken
• Lean red meat
• Eggs
• Beans
• Soy
• Tofu
• Nuts

It is good advice to eat three to five servings of fruits and vegetables every day, eat mostly whole grains and include protein at every meal. The NHS also recommends you make water your go-to beverage and aim to drink six to eight cups or glasses each day.

You should start to make changes to your diet as soon as your surgery is scheduled. The earlier you start, the healthier you can be for surgery.

Prehabilitation support

It is good to talk through your prehabilitation plans with your nurse or physiotherapist in the run-up to your surgery so you can be confident that you are in the best shape possible. Talking through not just the physical part of prehabilitation but also preparing mentally for surgery is important. It can often be overlooked during the run-up to the surgery day, but taking the time to think and talk through the changes and the stresses that may come during the recovery will help patients cope with the changes following their surgery.

Feeling good and in control, as well as understanding risks, both general and personal, is great preparation for surgery and following this overall advice will help you to do that.