Study Reveals Impact of Prehabilitation on Surgery Recovery

A recent study led by researchers at The Ottawa Hospital has highlighted the importance of prehabilitation in improving recovery outcomes for frail older adults undergoing surgery. The research indicates that patients who actively participate in a prehab program—comprising exercise and nutritional improvements—experience significantly better recovery results. This comprehensive study is recognized as the world’s largest trial focusing on prehabilitation.

Researchers found that participants completing at least 75 percent of their prescribed exercises reported lower levels of disability following surgery. The implications of reducing surgery-related complications are substantial, as more than 20 percent of patients undergoing major surgeries face complications, which can lead to extended hospital stays and increased time away from work or daily activities. This risk is particularly pronounced among older, frail individuals.

Dr. Daniel McIsaac, an anesthesiologist at The Ottawa Hospital and clinical research chair in perioperative innovation at the University of Ottawa, emphasized the challenges patients face in adhering to a prehab regimen. “Prehab isn’t like a pill. If it were a pill and people could take it, it would be a blockbuster,” he noted. The commitment required for prehabilitation can be daunting, particularly in adverse weather conditions.

Despite these challenges, the benefits are compelling. “This study shows that older adults with frailty who have enough time and support before surgery to fully engage in a prehab program are likely to experience a better recovery and less disability after surgery,” McIsaac added.

The clinical trial involved 847 frail older adults across 13 surgical centres in Canada. Half of the participants followed a structured home-based prehab program for a minimum of three weeks prior to surgery. The program included personalized exercise routines, instructional videos, an elastic band for strength training, a pedometer, and coupons for protein supplements. Research indicates that increased protein intake before surgery correlates with improved surgical outcomes. Participants also benefitted from weekly check-in calls with a prehab coach.

Among the participants was Christopher Wanczycki, who enrolled in the prehab trial before undergoing cancer surgery. After battling rectal cancer, Wanczycki found himself in poor physical condition, struggling with mobility. He took the prehab program seriously, demonstrating significant improvements in his physical fitness. His journey saw him progress from being unable to perform five pushups against a wall to completing 50 pushups. Remarkably, he was cross-country skiing the day he received the call informing him of his surgery date.

While Wanczycki’s results may not represent the average outcome, they underline the potential benefits of a dedicated prehabilitation program. The study confirmed that those who committed to prehab realized substantial improvements, including earlier discharge from hospital, quicker return to work, and enhanced independence.

Dr. McIsaac acknowledged the challenge researchers face in motivating individuals who may lack the time or drive to engage fully in prehabilitation. “There is a lot of benefit that could be there if researchers can figure out how to get that level of performance—getting everyone up to 75 percent at least,” he stated.

Wanczycki’s experience exemplifies the transformative effects of exercise and nutrition on surgical recovery. “Christopher is the poster child. He is what happens when you do 100 percent,” McIsaac concluded, underscoring the potential for prehabilitation to revolutionize patient outcomes in surgical care.

This study not only adds to the body of evidence supporting prehabilitation but also calls for further exploration into how to maximize participation and adherence among patients. With such promising findings, there is a clear path toward enhancing recovery processes for frail older adults undergoing significant surgical procedures.