Prehabilitation: Be Proactive; It Can Make a Difference

Many of us either have had experience with or at least have heard of rehabilitation. Rehabilitation, sometimes called “rehab,” is often prescribed post-surgery or after one has sustained mental, emotional, or physical injury. Recently, a program of “prehabilitation,” already employed for a number of years prior to surgery, has been implemented for people with a diagnosis of cancer. The basic definition of prehabilitation is “a form of strength training that aims to prevent injuries before they can occur.” Another type of prehab may include a diet high in nutrients and protein and training in stress reduction techniques.

It is well known among health professionals that poor baseline physical status and poor nutritional status increase the risk of complications after major surgery and can lead to a prolonged recovery. Prehab has been shown to prevent physical decline, improve healing, and decrease complications. Core strengthening for patients having abdominal surgery, for example, has been shown to result in faster recovery times. A study by researchers from New England based hospitals found that knee and hip replacement surgery patients who had participated in water and land based strength training as well as aerobic and flexibility exercises for six weeks prior to their surgeries reduced their odds of needing inpatient rehabilitation by 73 percent.

While prehabilitation for surgery, as noted, has been used for quite some time, prehab for the patient with cancer is a relatively new concept. The goal of prehab for cancer patients is to improve physical and mental health outcomes for when the patient undergoes treatment and beyond. Cancer prehabilitation uses a multidisciplinary approach, combining exercise, nutritional, and psychological strategies to prepare patients for the challenges of cancer treatment, such as surgery, chemotherapy, immunotherapy, and radiation therapy.

In addition to the physical challenges confronting someone who is ill, he or she often experiences the effects of stress and anxiety. These effects can be wide ranging and may have a subtle impact on recovery. Perceived stress and worry about an illness or surgery have been associated with poor recovery, postoperative complications, and impaired wound healing. Psycho-social status may influence recovery, and psychological preparation may therefore improve outcomes.

The benefits of prehab for people who are sick or have an injury are clear. What about the healthy population? Could they benefit from prehab? Definitely! One of the most physically demanding jobs a woman can have is pregnancy and delivery. A woman prior to becoming pregnant could benefit from prehab by learning to eat food that is high in nutrients, folic acid, and calcium and by maintaining a healthy weight. Core abdominal work and pelvic floor training, in addition to aerobic exercises, prior to pregnancy will help with fatigue, shortness of breath, and back pain, and can set the stage for an easier, safer delivery.

Prehabilitation should be offered to all newly diagnosed patients if there is a window of time, no matter how short, before they begin surgery or treatment, as patients seem to benefit. But if the benefits are indeed so clear, why do so few people participate in prehab? Primarily it is due to the cost; most insurance companies do not pay for prehab.  So what are the options for the educated consumer?  First, speak to your doctor about the benefits of prehab and whether it is the right approach for you. You may need to create your own prehab. It may be beneficial to pay for a session with a physical therapist so that he or she can give you suggestions that you can follow at home. Personal training or yoga may be beneficial. Meet with a dietician or health coach to devise a healthy eating plan. Do not ignore the psychological and emotional effects that an illness or upcoming surgery may have on you; schedule time with a qualified therapist. The time invested in prehab may help you feel better and heal faster.

By Beth S. Taubes, RN, OCN, CBCN, Certified Health Coach