Getting healthier before surgery gives patients a jump start on recovery

In the randomized controlled trial, patients assigned to a program of exercise, nutritional counseling with protein supplementation and relaxation exercises were able to walk significantly farther two months after surgery than those who did not participate in prehabilitation. Both groups were prescribed traditional rehabilitation after surgery.

"Prehabilitation prepares patients to withstand the stress of surgery so they are able to recover faster and function better after the procedure," said Francesco Carli, M.D., M.Phil., lead author of the study and professor of anesthesia at McGill University Health Centre, Montreal. "Pre-surgery conditioning helps patients take an active role in their own recovery. We believe instituting prehabilitation before surgery when possible could improve health and recovery and reduce costs."

In the study, 38 patients participated in the prehabilitation program, while 39 were assigned to the rehabilitation-only group. The prehabilitation prescription included:

• 50 minutes of home-based unsupervised exercise at least three days a week, including aerobic and resistance training,
• a dietitian-created individualized nutrition program and whey protein supplementation, and
• a visit with a psychologist to learn how to reduce anxiety through relaxation exercises based on imagery and visualization and breathing exercises.

The average length of prehabilitation was 24.5 days. After surgery, patients in both groups followed the same rehabilitation program.

Researchers measured how far patients could walk in six minutes at the start of the study (before any intervention) and there was no significant different between the groups: 421 meters on average in the prehabilitation group, and 425 meters on average in the rehabilitation-only group. Researchers had patients repeat the walking test right before surgery and at four and eight weeks after surgery. Those in the prehabilitation group improved significantly during the pre-surgery period, walking an average of 25.2 meters farther than they had at the start of the study, while those in the rehabilitation-only group declined, walking an average of 16.4 meters less. Eight weeks after surgery, prehabilitation patients walked an average of 23.2 meters farther than at the start of the study, while rehabilitation-only patients continued to lose ground, walking an average of 21.8 meters less.

Colorectal cancer is the third most common cancer and the second leading cause of cancer death in the United States. The primary treatment is surgical removal of the cancer.

"Even when there are no complications, colorectal cancer surgery patients suffer from a 20 to 40 percent reduction in functional capacity after surgery," he said. "That's especially true for elderly patients with other health conditions, who may not recover to the function levels they were at before surgery for several months, if at all. Getting these patients healthier before surgery would be of huge benefit."