Prehabilitation: How to Prep for Post-Op Success

UW Health general surgeon Dr. Jacob Greenberg explains how prehabilitation can help you recovery more quickly following surgery

Madison, Wisconsin - Two months before her knee replacement surgery at UW Hospital and Clinics, Lisa Zovar was already hard at work on her recovery. Every day, she spent at least 45 minutes doing knee-strengthening exercises as well as core exercises.


It paid off: Zovar’s physical therapist said he’d never seen a patient recover so quickly. She was doing stairs the day after the surgery and was off crutches completely by three weeks.


“I couldn’t walk much before the surgery, but afterward, I felt like I lost 15 years,” she says.


Although Zovar took a class at UW Hospital about what to expect with a knee surgery, it was mostly her husband who inspired her to get serious about what’s known as “prehabilitation.”


“I was totally motivated because he was so afraid that I was going to be a pain in the butt while I was recovering,” Zovar says. “I’m a pretty high-energy person, and I don’t sit still well.”


Prehabilitation can be helpful with any -planned surgery, says Jacob Greenberg, MD, a UW Health general surgeon who works in the Comprehensive Hernia Clinic, Surgical Weight Management Program.


“The benefits are likely in reduction of complications before surgery, perioperative and long term,” Greenberg says. “Getting people in shape before their body goes through surgery rather than after is much more effective.”


A recent study by McGill University in Montreal found that a prehabilitation routine benefited patients who were undergoing surgery for colorectal cancer. Patients who followed the prehab routine — which included aerobic exercises, strength training, nutritional counseling, whey protein supplements and relaxation exercises — were able to walk significantly farther than patients who waited until after the surgery to start the program.


Reducing anxiety about surgery


“I’m a big proponent of prehabilitation,” says Steve Hill, a UW Health physical therapist who often works with patients before and after knee replacement, hip replacement, ACL and cancer-related surgeries. “One of the greatest benefits of being able to provide patients with education on how to move and what they’ll be doing after surgery is to see the look of relief on their face and their reduced levels of worry once they learn what to expect from the experience.”


That can make a patient feel better physically, too, because anxiety can amplify pain, Hill says.


Greenberg advises patients to start a prehab routine at least four weeks prior to surgery, and Hill recommends beginning at least six weeks before an orthopedic procedure.


Consider including these elements in your pre-op plan:


Get your exercise


Regular cardiovascular exercise will strengthen your heart and lungs and boost your immune system, helping prevent complications after surgery. Walking and stationary bikes are great for patients with lower-body injuries.


Patients who go into surgery with significantly limited range of motion might have more pain and a longer recovery, Hill says. A prehab routine improves your circulation and motor patterns and desensitizes nerves in the area, which can lead to better outcomes after surgery.


“Nerves love to move, and when pain prevents them from doing so, it can seem like a bad idea to go for a long walk,” Hill says. “But over time, people discover they can improve if they start small and work up to 30 minutes of gentle exercise.”


Unfortunately, not all insurance plans cover physical therapy prior to surgery, but there are things you can do at home. With knee, hip and other orthopedic surgeries, Hill suggests moving the affected body part through typical motions, holding for at least a few seconds and repeating the motion multiple times.


“The main thing is just to move and to move within your comfort levels frequently,” Hill says. Your physical therapist or doctor can provide more specific guidance on the exercises that would work best for you.


Related resources to help you get your exercise:


Improve your diet


Make sure you’re getting enough protein. “A lot of perioperative outcomes are dependent on people’s nutrition,” Greenberg says. “When patients are protein-malnourished, it affects their body’s wound-healing ability.”


He recommends 60 grams of protein or more a day. For reference, a chicken breast has about 30 grams of protein.


Related resources to help you improve your diet:


Manage other conditions


If you have diabetes or another chronic condition, such as sleep apnea, make sure it’s under control before surgery, Greenberg advises.


Related resources to help manage chronic conditions:


Quit smoking


This is a must. Smoking depletes the oxygen in your blood and hinders the wound-healing process, plus it can cause other post-surgical complications. “


Patients who smoke and who are obese have significantly more hernia reoccurrences after surgery,” Greenberg says.


Related smoking cessation resources:




Stress can take a toll on your immune system, so do what you can to minimize it.


“Obviously surgery can be a stressful and anxiety-producing thing, so whatever you can do to make yourself feel more comfortable, whether that’s yoga or exercise, is probably a good thing,” Greenberg says.


For Zovar, the extra effort in preparing for her surgery was worth it.


“If you want to recover and get back on your feet, prepare,” she says. “It’s going to feel awesome if you do that work. The healing is so much faster.”


Related stress reduction resources:


Date Published: 07/22/2015

News tag(s):  wellness

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