Prehabilitation for Faster Physical Recovery Following Surgery

Current medical guidelines have clearly indicated the benefit of physical exercise and rehabilitation after undergoing many forms of cancer treatment. These physical benefits allow for restored physical function and fitness. However, could patients do more to ensure their independence and physical function?

Current research suggests that individuals who participated in a “prehabilitation” program prior to cancer surgery have improved functional outcomes. Prehabilitation is simply a rehabilitation program that is done prior to surgery. For the orthopedic community, current research has pointed to the benefits of prehabilitation for adult surgical cases (Santa Mina et. al), including reduced length of stay, reduced pain, and improved physical function. So, why not apply these findings to the cancer community?

In a study published in the journal Anesthesiology, researchers found that individuals who entered surgery at a higher fitness level were able to regain better exercise capacity after a colorectal resection surgical procedure. In this study, researchers (Gillis et. al) compared the results of a 6 Minute Walk Test (6MWT) in two groups of people with colorectal cancer. The 6MWT is a standardized outcome measurement tool that examines what distance an individual can walk in 6 minutes. The experimental group received a rehabilitation program of exercise, nutrition, and relaxation 4 weeks prior to resection surgery and for 8 weeks after. The control group only received the rehabilitation program for the 8 weeks after surgery.

The exercise program combined walking, jogging, swimming or cycling for aerobic endurance as well as resistance strength training. In addition, the participants were consulted on dietary needs and participated in stress reduction with a psychologist. Both groups started with similar baseline 6MWT scores. After 4 weeks of prehabilitation, the experimental group had improved their mean score by 25.2 meters of walking, while the control group continued to decline, resulting in a 41.7 meter walking gap between the groups.

Almost 50% of participants in both groups had 6MWT scores that were 20 meters below their baseline 4 weeks after surgery (showing the negative implications of surgery). The differences in baseline and 8 week 6MWT scores were significantly higher in the prehabilitation group. Eighty-four percent of prehabilitation participants recovered to or above baseline exercise capacity at 8 weeks, in comparison to only 64 percent in the rehabilitation group.

This trial demonstrated that prehabilitation provides a buffer for faster return to baseline walking ability. The preoperative period may be the most optimal time to implement a physical rehabilitation intervention. The impact of improved physical fitness and endurance prior to surgical treatment plays a large role in restoring function after surgery. Combining physical activity, nutritional optimization and stress reduction was an excellent program, as it addressed both physical and mental health.

Physical endurance and walking tolerance are not the only impairments that can be improved through prehabilitation. For example, individuals undergoing treatment for breast surgery will likely experience a loss in their shoulder range of motion. Improving shoulder range of motion and strength prior to surgery and radiation may improve arm function later. Individuals who will undergo prostate resection will likely experience a loss in pelvic floor strength and function. Beginning a prehabilitation program to improve pelvic floor muscle activation may improve continence and sexual function outcomes after surgery.

Finally, engaging in prehabilitation offers patients a chance to learn about their expected recovery and expected limitations prior to having surgery. This knowledge can reduce some anxiety and physically prepare for the rigorous recovery period.

References:

• Mina SD, et al. Effect of total-body prehabilitation on postoperative outcomes: a systematic review and meta-analysis. Physiotherapy. 2014 Sep; 100(3): 196-207.
• Gillis C, et al. Prehabiliatation versus rehabilitation: a randomized control trial in patients undergoing colorectal resection for cancer. Anesthesiology. 2014 Nov; 121(5):937-947.