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Prehabilitation (or ‘prehab’) is the practice of improving fitness and strength before having surgery with the aim to improve recovery after surgery. As opposed to rehabilitation (‘rehab’) which happens after surgery.

Prehab has been shown to reduce the length of stay in hospital, post-surgery pain and post-surgery complications [Reference 1]. Major surgeries, such as open-heart surgery, will require downtime and rest to recover initially, resulting in reduced strength and fitness. So, if you could minimise this reduction, would you?

 

What determines recovery from heart surgery?

There are 3 main factors that will influence how well you recover from heart surgery:

  1. Age
  2. Frailty
  3. Comorbidities

Older patients develop more post-operative complications and have longer stays in hospital after surgery [Reference 2]. While there isn’t much you can do about this risk factor, it is important to know and should encourage you to change and manage what you can.

People who are frail (that is, weaker and less active) are 5 times more likely to have major complications after surgery [Reference 3]. This will also impact how well you can move around after your surgery. For example, after open-heart surgery you are discouraged from using your arms to get up out of chairs. But what do you do if your legs aren’t strong enough for you to stand up from a chair without using your arms to help?

Having multiple chronic health conditions or comorbidities can increase the presence and severity of complications and draw out the recovery process from heart surgery. Comorbidities can be conditions such as diabetes, high blood pressure, lung or kidney disease. Even conditions such as arthritis or osteoporosis can impact your recovery by reducing and altering what you can physically achieve. For example, walking may be difficult if you have really bad arthritis in your knees or back.

 

What can you change?

There are a number of risk factors you can change or manage that will improve your recovery from and potentially reduce the complications associated with surgery [Reference 4]. These include:

  • Muscle mass and strength
  • Cardiovascular fitness
  • Balance
  • Lung muscle strength
  • Obesity
  • Nutrition
  • Diabetes
  • Mental health (depression, anxiety, social isolation)
  • Smoking status
  • Sleep

While these are similar to things you will work on after heart surgery, it is important to start the process as soon as possible for your own long-term health and well-being. They will also help you recover faster and with less complications so that you can return to your ‘normal’ life sooner.

 

What should you be doing before surgery?

Since we’re in the exercise industry, I’ll focus on the physical things you should be working on before your surgery.

The first is fitness. Whether you want to walk, cycle, swim or dance. Choose something you enjoy or can do relatively easily, then start small and build gradually.

The second is upper body (arm) strength. You will lose strength in your arms after surgery, especially open-heart surgery, because you’re not allowed to use them as much while recovering. In addition, if you’re arms are stronger, you will be able to do a lot more within your upper body restriction post-surgery.

The third is core strength. This will help you getting out of bed without using your hands.

The final one is lower body (leg) strength. If you can get out of a chair without using your hands, great! If not, this is something you will want to practice.

 

A note of mental health

While there is science to back this up, I have noticed that patients with a positive outlook on life do a lot better after major surgery. Instead of asking, “Why me?”, try asking, “What is this teaching me?” or “What can I learn from this?”

It can be hard, but making this conscious effort to ask yourself a different question will do wonders to your ability to take things in your stride and recover faster (build resilience and grit). Connecting with others who have been through the same process will also help ease your worries and feel more confident.

Remember

Any improvement now is better than doing nothing and will benefit you both in the short- and long-term.

Also, be careful. Some forms or intensities of exercise aren’t appropriate for all heart conditions. For example, high intensity and high dynamic (moving) exercise should be avoided if you have severe aortic stenosis.

If you’re unsure what exercise is safe and appropriate for you, whether you’re waiting for your surgery and have already had it, book in for a one-on-one consultation with us and we will be more than happy to help.

Can’t get to us? Read our Telehealth Blog to find out if this option suits you better.

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