Prehabilitation Explained

Preoperative rehabilitation, prehabilitation or prehab, is a form of healthcare intervention that takes place before a medical or surgical intervention with the aim to reduce side effects and complications, and enhance recovery.^[1] Multidisciplinary team involvement can range from physiotherapists, occupational therapists, respiratory therapists, doctors, pharmacologists, anesthesiologists, psychologists, psychiatrists and sports physiologists.^[2]

Prehab can be applied to surgical populations in oncology, cardiorespiratory, cardiovascular and orthopaedic settings. The intention is that increasing baseline fitness prior to surgery will allow for relatively higher fitness post-operatively. Prehabilitation interventions are tailored to the patient so that even those with high amounts of comorbidities can receive a positive outcome. Research evidence is mixed, but suggests that prehabilitation reduces hospital stays and therefore risk of hospital acquired infections such as pneumonia.

Prehab is also being considered for use in some cardiovascular interventions,^[3] and may also be of some benefit for preventing lung complications, such as pulmonary atelectasis, in general surgery.^[4]

Research

In 2013, a pilot study of prehabilitation in colorectal surgery found that it improved postoperative functional recovery, measured in terms of the walking capacity at 4 weeks and 8 weeks (although the time in hospital and post-operative complications were similar).^[5]

According to a 2020 study looking at men awaiting surgery for urological cancer, high-intensity interval training (HIIT) may improve heart and lung fitness within a month before their surgery.^{[6] [7]}

Notes and References

1. Wynter-Blyth . Venetia . Moorthy . Krishna . 2017-08-08 . Prehabilitation: preparing patients for surgery . BMJ . en . 358 . j3702 . 10.1136/bmj.j3702 . 0959-8138 . 28790033. 29658090 .
2. Web site: 30 Nov 2020 . Principles and guidance for prehabilitation within the management and support of people with cancer . Macmillan Cancer Support.
3. Alkarmi A, Thijssen DH, Albouaini K, etal . June 2010 . Arterial prehabilitation: can exercise induce changes in artery size and function that decrease complications of catheterization? . Sports Medicine . 40 . 6 . 481–92 . 10.2165/11531950-000000000-00000 . 20524713 . 24870534.
4. Jack S, West M, Grocott MP . September 2011 . Perioperative exercise training in elderly subjects . Best Practice & Research. Clinical Anaesthesiology . 25 . 3 . 461–72 . 10.1016/j.bpa.2011.07.003 . 21925410.
5. Li C, Carli F, Lee L, etal . Impact of a trimodal prehabilitation program on functional recovery after colorectal cancer surgery: a pilot study . Surgical Endoscopy . 27 . 4 . 1072–82 . April 2013 . 23052535 . 10.1007/s00464-012-2560-5. 9888085 .
6. 2020-06-05 . High-intensity interval training rapidly improves fitness in patients awaiting surgery for urological cancer . NIHR Evidence . Plain English summary . en . National Institute for Health and Care Research . 10.3310/alert_40363. 242684291 .
7. Blackwell . J. E. M. . Doleman . B. . Boereboom . C. L . Morton . A. . Williams . S. . Atherton . P. . Smith . K. . Williams . J. P. . Phillips . B. E. . Lund . J. N. . 10 March 2020 . High-intensity interval training produces a significant improvement in fitness in less than 31 days before surgery for urological cancer: a randomised control trial . Prostate Cancer and Prostatic Diseases . en . 23 . 4 . 696–704 . 10.1038/s41391-020-0219-1 . 1365-7852 . 7655502 . 32157250.