Exercise is widely associated with numerous benefits, including a lower incidence of chronic disease, slower disease progression, delayed declines in mental and physical functioning, and decreased all-cause mortality [1]. However, one realm in which the benefit of exercise is not entirely clear is preoperative habilitation. While a significant body of research has targeted ways to ensure maximally successful surgical outcomes, the effect of exercise before surgery remains an open question in many contexts [2]. Fortunately, studies over the last ten years have brought the medical community closer to understanding if and how exercise can help patients prepare for surgery.

The effect of surgery on postoperative function and recovery appears to depend on the type of operation that the patient undergoes. Lemanu et al. conducted a meta-analysis of eight randomized controlled trials, all of which centered on the effects of PREHAB, a preoperative physical conditioning program [3]. The researchers’ results varied highly. For instance, while cardiothoracic surgery patients experienced shorter hospital stays, total hip arthroplasty and colorectal surgical patients who underwent PREHAB had equally long hospital stays, compared to the control group [3]. Ultimately, Lemanu and colleagues concluded that there is “little evidence demonstrating physiologic improvement in parties who undergo a PREHAB intervention” [3]. While these results could be the function of inaccurately selected endpoints, elderly cohorts, or other experimental limitations, they indicate that exercise is not an ideal preparatory tool for all surgical patients. 

The choice of type of exercise may define the degree of success that a preoperative training program enjoys. Among cardiac surgery patients, research indicates that exercise therapy programs that include traditional cardiopulmonary rehabilitative techniques are highly preferable to standard care [4]. For these patients, along with any others for whom improved cardiorespiratory function is linked to better surgical outcomes or faster recovery, high-intensity interval training (HIIT) regimes can lead to quicker but comparable gains than moderate-intensity training programs [1]. Of course, other patients, such as joint replacement candidates, may not benefit as much from cardiovascular exercises, given that the major risk that they face during surgery is wound infection [4]. This demonstrates the importance of selecting exercises that would produce improvements directly related to the patient’s outcome of interest [4].

While exercise is beneficial for most populations, it is particularly advised for patients with certain risk factors, such as diabetes and obesity [4]. Additionally, patients who exhibit poor physical functioning before surgery would be well-advised to adopt an exercise regimen before surgery, although the success of the regimen would depend on how far in the future the operation is planned [4]. One way to assess the importance of physical activity among patients is by testing them with a valid risk model; this would allow physicians to identify at-risk individuals and plan for their operations accordingly [4].

Another special population for medical teams to keep in mind are elderly patients. Researchers have found that short-term preoperative inspiratory muscle training may reduce elderly patients’ likelihood of experiencing pulmonary complications following a coronary artery bypass [5]. Furthermore, in the context of major abdominal surgery, Dronkers et al. found that both structured, intensive therapeutic exercise routines and home-based programs could help elderly patients preserve or even improve their physical conditions before surgery [6]. As a result, the researchers concluded that such exercise programs are both safe and feasible for elderly populations [6]. While it remains unclear how these results may generalize across different forms of surgery, this conclusion was nevertheless promising.

When designing a preoperative exercise program for surgical patients, medical teams should adequately account for the age and risk profile of the patient, as well as the type of surgery they are undergoing. By creating a personalized plan and reaching out to patients to keep morale high, surgical outcomes could proactively be improved [2].

References 

[1] K. Richardson et al., “Fit for surgery? Perspectives on preoperative exercise testing and training,” British Journal of Anesthesia, vol. 119, p. i34-43, December 2017. [Online]. Available: https://doi.org/10.1093/bja/aex393. 

[2] V. Wynter-Blyth and K. Moorthy, “Prehabilitation: preparing patients for surgery,” BMJ, vol. 358, p. 1-2, August 2017. [Online]. Available: https://doi.org/10.1136/bmj.j3702. 

[3] D. P. Lemanu et al., “Effect of Preoperative Exercise on Cardiorespiratory Function and Recovery After Surgery: a Systematic Review,” World Journal of Surgery, vol. 37, p. 711-20, January 2013. [Online]. Available: https://doi.org/10.1007/s00268-012-1886-4. 

[4] K. Valkenet et al., “The effects of preoperative exercise therapy on postoperative outcome: a systematic review,” Clinical Rehabilitation, vol. 25, no. 2, p. 99-111, November 2010. [Online]. Available: https://doi.org/10.1177/0269215510380830. 

[5] E. H. Hulzebos et al., “Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery: a randomized clinical trial,” JAMA, vol. 296, no. 15, p. 1851-57, October 2006. [Online]. Available: https://doi.org/10.1001/jama.296.15.1851. 

[6] J. J. Dronkers et al., “Preoperative therapeutic programme for elderly patients scheduled for elective abdominal oncological surgery: a randomized controlled pilot study,” Clinical Rehabilitation, vol. 24, no. 7, p. 614-22, June 2010. [Online]. Available: https://doi.org/10.1177/0269215509358941.