Overview

Prehabilitation is the process of getting your mind and body ready for surgery. It involves a set of personalised steps to improve your endurance, strength, and general well-being to ease your recovery. This mainly aims to reduce the risk of complications, shorten recovery times, and improve long-term results. This article will explore the importance of prehabilitation, its benefits, key elements of effective programmes, and how you can get started on your journey towards a successful surgical experience.

What is Prehabilitation?

Prehabilitation involves a variety of strategies designed to address both the physical and mental aspects of preparing for surgery. Unlike rehabilitation, which happens after surgery to restore function and health, prehabilitation happens beforehand, allowing you to build a strong foundation for recovery. Essentially, prehabilitation aims to improve physical fitness, reduce anxiety and educate you on the upcoming surgery, empowering you to take an active role in your health journey. With a combination of tailored exercise programs, nutritional guidance, and mental health support, prehabilitation is intended to set you up for success before even entering the operating room. 

Why is prehabilitation important?

Recovering from surgery can be very physically and mentally demanding. Research shows that improving your health and fitness before surgery can have many benefits, including:

• Faster recovery. This means less time spent in the hospital and a quicker return to full function¹
• Optimised health. Surgery can be an opportunity to improve your long-term health and promote a healthier lifestyle
• Lower risk of complications. Improving general well-being can reduce the likelihood of being admitted into intensive care or being readmitted into the hospital after surgery²
• Reduced stress and anxiety. Feeling knowledgeable, supported and prepared for your upcoming surgery can help reduce feelings of anxiousness before surgery and help you focus on recovery and improve your quality of life³
• More personalised care. Prehabilitation is usually tailored to your needs, providing special insight into what you can do to improve your general well-being

Areas of prehabilitation

Activity and exercise

Physical activity is a key element of prehabilitation. Personalised exercise routines are designed to improve strength, flexibility and heart health—all of which can significantly improve surgical outcomes.⁴ Depending on the type of surgery, exercises might focus on specific muscle groups or overall conditioning. 

Common elements of these routines include:

• Flexibility and Mobility Work. Stretching and mobility exercises help maintain joint flexibility and range of motion, both of which can be beneficial when recovering from surgery. Techniques such as pilates and yoga can also be used to promote relaxation and reduce stress
• Strength Training. Incorporating resistance exercises to build muscle strength can help patients withstand the physical stress of surgery and improve recovery times. This might involve using your own body weight, resistance bands, or free weights. The exercises will often focus on areas directly affected by the surgery. For example, strengthening core muscles would be a priority before abdominal surgery⁵
• Aerobic Exercises. Incorporating aerobic exercise elements into your daily routine, such as walking, cycling, and swimming, can improve cardiovascular endurance, making the heart and lungs more efficient. This can help patients tolerate anaesthesia and reduce the risk of complications like pneumonia after surgery⁶
• Breathing Exercises. These exercises are designed to help improve lung function, increase oxygenation, and promote efficient breathing. This is especially important when preparing for surgeries that affect the lungs, diaphragm, and abdominal area. Common breathing exercises include diaphragmatic breathing, incentive spirometry and segmental breathing⁷

By including a variety of exercises in your prehabilitation routine, you can not only prepare your body for surgery but also foster an empowered mindset, leading to better long-term recovery outcomes.

Diet and nutrition

Paying attention to your diet and addressing any nutritional deficiencies is an important part of prehabilitation. A well-balanced diet rich in essential nutrients can help you maintain strength, muscle and a healthy body weight, improving your ability to tolerate surgery and recover faster.⁸

Some important areas of a healthy diet to focus on are:

• Protein intake. Protein is essential for tissue repair, wound healing, and maintaining muscle mass, which commonly declines during recovery from surgery. During prehabilitation, it’s important to increase protein intake through eating foods such as lean meats, fish, eggs, legumes, seeds and nuts. This helps the body maintain strength and rebuild tissue after surgery⁹
• Vitamins and Minerals. It is crucial to maintain sufficient levels of vitamins, especially vitamin C (for immune support) and vitamin D (bone health), throughout your life and particularly before and after surgery. Additionally, minerals like iron, zinc and calcium also contribute to healing and energy production. Prehabilitation nutrition plans will often include supplements or dietary adjustments to make sure patients have enough of these essential nutrients
• Carbohydrates and healthy fats. Carbohydrates are the body’s primary energy source, and this is especially important in the lead-up to surgery when the demand for energy increases. Healthy fats, such as those found in avocados, olive oil, coconut oil and fatty fish, support cellular function and inflammation control, helping the body cope with surgical stress
• Hydration. Staying hydrated is vital for maintaining organ function and tissue health. You will likely be advised to drink plenty of fluids, particularly water, to support metabolism and circulation during the recovery process

By following a structured and personalised nutritional plan during your prehabilitation, you can enhance your body’s resilience, improve immune function, and reduce the risk of complications, making your recovery smoother and faster.

Mental health support

Mental and emotional well-being can significantly impact how you cope with the stress of surgery and recovery. By addressing the mental challenges that can emerge before surgery, prehabilitation can reduce anxiety, enhance mental resilience, and improve overall outcomes.¹⁰

• Stress Management Techniques. Surgery can bring feelings of fear, uncertainty, and stress. Stress management techniques such as relaxation exercises, practising mindfulness, and breathing exercises are often included in the prehabilitation process. Mindfulness meditation and guided imagery could help you focus on positive outcomes and instill feelings of calmness before surgery, reducing anxiety levels. Controlled breathing techniques, like diaphragmatic breathing, not only promote relaxation but also improve lung function, leading to better operative outcomes⁷
• Counselling. After being informed about an upcoming surgery, it is common for a medical professional to recommend counselling to provide you with emotional support and equip you with coping mechanisms to handle the mental burden of surgery. Psychological counselling or cognitive behavioural therapy (CBT) sessions offer a space to address concerns about the surgery, fear of complications, or worries about recovery. For some people, discussing their fears openly can help reduce feelings of emotional overwhelm and isolation. Counselling also encourages a positive mental outlook, which has been shown to improve recovery states and satisfaction after surgery¹⁰

Overall, seeking mental health support during prehabilitation can help you enter the surgery with greater mental clarity and emotional stability, leading to a better surgical experience and faster recovery.

Who Should Consider Prehabilitation?

Through enhancing your physical and mental preparedness before surgery, prehabilitation can significantly improve surgical outcomes. While it can benefit a range of patients, there are specific situations where prehabilitation can be especially helpful. 

Types of surgeries that benefit from prehabilitation

Prehabilitation can be especially useful for patients undergoing major surgeries that place significant physical stress on the body. This includes procedures such as:

• Orthopaedic surgeries. Before surgeries such as joint replacements and spinal surgeries, prehabilitation can be used to improve muscle strength and mobility, leading to quicker recovery and better postoperative function¹¹
• Cardiac and thoracic surgeries. Because these surgeries can reduce lung and heart function, prehabilitation techniques such as breathing exercises can be particularly helpful to improve respiratory efficiency and strength¹²
• Abdominal surgeries. Strengthening the core and enhancing nutritional intake can reduce recovery times and complications for procedures like colorectal or bariatric surgeries^4,5,7
• Cancer surgeries. Cancer treatment and surgeries are often intensive and demanding. Prehabilitation can help by improving immune function, managing fatigue and speeding up recovery⁶

Types of patients that benefit from prehabilitation

Patients approaching surgery with certain risk factors are more likely to benefit from prehabilitation. These include:

• Older adults. Ageing can decrease muscle mass and mobility, which can make recovery more challenging. Prehabilitation can help with these issues by focusing on strength, flexibility, and heart health¹³
• Patients with chronic conditions. Those with conditions like heart disease, respiratory issues and diabetes can have a higher risk of complications. Here, prehabilitation can be used to improve physical resilience, reduce surgical risks, and optimise general well-being
• Patients with anxiety or mental health concerns. Emotional well-being is vital for successful recovery and positive surgical outcomes. Prehabilitation can provide psychological support, such as stress management and counselling, to reduce anxiety and improve mental health before surgery

Assessing the need for prehabilitation

After the need for surgery is established, a medical professional will assess your need for prehabilitation and highlight the areas they deem important specifically for you. This evaluation often includes:

• Physical assessment. A detailed examination of your current fitness level, strength, mobility, and cardiovascular health. This typically includes both physical tests and screening, depending on specific needs
• Nutritional assessment. Dietary habits and nutritional deficiencies are identified to tailor a prehabilitation diet plan
• Psychological evaluation. Assessing your mental health, stress levels, and emotional readiness for surgery helps identify the type of psychological support required
• Risk analysis. Surgeons and other medical professionals will consider specific risk factors, including age, comorbidities, and the type of surgery, to personalise the prehabilitation plan

By identifying the right candidates for prehabilitation and creating a tailored plan, healthcare providers can enhance recovery, reduce complications and improve overall surgical experience.

Summary

Prehabilitation is an important part of surgical care that improves both physical and psychological readiness, leading to improved recovery outcomes. By engaging in prehabilitation, you can strengthen your body, manage stress, and optimise nutritional health, reducing the risk of complications and speeding up recovery. Considering prehabilitation offers a proactive way to take control of your health and improve the overall surgical experience. Medical professionals are encouraged to include prehabilitation as part of their surgical care, ensuring personalised plans that address each patient’s unique needs.