[Note: When first confronted with the term prehabilitation the first thought is that it is a typographical error. It is not; I do indeed mean prehabilitation. Its meaning, should you not be familiar with the term, will become clear in what follows.]
Preparing for surgery should be like preparing for any physical challenge. If you are going to run a race you prepare with planned exercise and diet. The same should be true for planned surgery. When people are in better physical and emotional health the results of surgery are better. The process of preparing in advance is called prehabilitation (or prehab, to shorten it to less of a mouthful). Prehab includes any preparations, either physical or lifestyle, that are done before surgery to improve recovery time and effectiveness after surgery. In addition to the physical preparations, it is also possible to prepare for the emotional challenge of surgery as part of prehab.
Surgery of any kind is a trauma to the system. Even when everything goes well during surgery the body takes a long time to recover. Most older people will experience some loss of ability following surgery. Losses can range from slight to severe, and not all abilities are affected equally. Each patient will have a different post-surgery experience.
Post-surgery effects can include everyday things like dressing, bathing and other self care. Surgery can also cause general weakness and can sometimes even impact the ability to think clearly.
When an older person experiences a planned surgery there are often several weeks between the decision and the surgery. Using this time well, with prehab exercise and practice, it is possible to reduce the impact of this trauma.
Doctors have learned that people who prepare for surgery with prehab have fewer complications and return to normal functioning more quickly. Research has shown that when people actively participate in well-planned and appropriate prehab for at least a couple of weeks prior to surgery everything was more likely to turn out better. Patients were more likely to return home after being hospitalized and they returned home sooner. By working on strengthening, endurance and flexibility, individuals are better able to withstand the impact of the inactivity that typically follows surgery. We all know that inactivity leads to muscle loss, and it is startling just how quickly that can set in.
Prehab typically includes exercises for strength and endurance, changes in diet, relaxation, and even lifestyle changes like quitting smoking. Breathing exercises can go a long way towards an increase in health of lungs which will further reduce post-surgery complications.
The National Institutes for Health defines prehab as including:
- Warm-up exercises with easy movements and stretching.
- Endurance training to improve heart and lung function with walking, and more active movement.
- Strength training against resistance including use of weights and resistance bands.
- Flexibility exercises with stretching to get more limber joints.
- Practicing functional daily living tasks such as dressing, going up and down stairs, using adaptive equipment like canes or dressing aids.
- Muscle relaxation, sometimes referred to as deep muscle relaxation, or progressive relaxation. There are specific exercises for doing this.
- Diet changes.
Orthopedic surgeons are the ones who started this business of prehab but it is now a widely accepted mode of preparation for any kind of surgery.
When you or a loved one is planning a surgery, ask the surgeon for a prehab program. This might include going to a therapist or advisor to get instructions for exercise, guidance for functional activities, and a plan for diet improvement if that is necessary. Stress and anxiety – a natural accompaniment to any upcoming surgery – can also be reduced with a good prehab plan.
Working to increase strength and endurance before surgery means starting with increased strength and endurance. This means that the impact of trauma causes by the surgery, as well as any muscle strength and endurance lost during recovery, will be less severe and more manageable. Even when surgery is scheduled on short notice and there is not much time to prepare (maybe even just a day or two) it is still helpful to engage in as much prehab as possible.
There are good prehab programs available for almost every kind of surgery. As mentioned above you can usually get them from the medical provider, the one related to the upcoming surgery. But almost all of the prepared programs you might come across are incomplete; they are missing one of the most important aspects of pre-surgery preparation: the psychology of surgery. They inevitably fail to tell the patient how to psychologically prepare for the surgery and its aftermath.
There are three primary ingredients of the psychological preparation for surgery. These are de-avoidance, familiarity, and pre-surgery conditioning.
De-avoidance and Familiarity. Most people quite naturally try to avoid thinking about upcoming medical procedures. Yet think about them they must. It is a little bit like the symptoms of post traumatic stress disorder: thoughts of the upcoming event pop into the mind at odd times – altogether too often for most – and dampen their mood and hopes for the future. But even if one can completely shut out of mind any thoughts of the scheduled surgery, that is a mistake.
There are distinct psychological and emotional advantages to doing everything possible to make the surgery procedures familiar and thereby more comfortable. As a caregiver you can at some time every day talk about the surgery and what your loved one can expect. This familiarization process should include the events leading up to the surgery, the surgery, and the recovery period.
This does not have to be technically correct or even very detailed. The focus should be on the very common and non-threatening aspects of the anticipated experience. Like putting together the things that will be needed; how early to start preparing to leave; where to park or where the patient goes when arriving at the hospital or clinic; what the surgical preparation might entail; where the patient will be upon first awakening and where recovery will begin; and so on.
The purpose here is to go there the commonplace aspects of the upcoming experience numerous times so that the strangeness is removed and the experience is less terrifying. It is often said that familiarity breeds contempt, but in this case it breeds calm. Repetition and non-technical commonness of detail are important ingredients of the familiarity part of psychological preparation for surgery.
Pre-surgery conditioning. Research has amply demonstrated that medical procedures are easier to tolerate, cause less stress, and healing is faster and more complete when patients believe they are in control. Or at least, when they feel they have some control over what is happening to them during the procedure and afterward. And they will have this sense of enhanced control if they visualize themselves doing well and being relaxed throughout the medical process.
Each step of the anticipated procedure can be visualized by your parent and you can help them imagine themselves feeling strong and resilient. Tell them how confident they are and how well they will do before, during and after their surgery. If you tell someone something often enough they will come to believe it. And that is empowering.
Not many of us would consider surgery to be much fun at all, but by following a good prehab program you can help you parent come through it with the least difficulty and distress, and give them the best chance of success.