New research suggests pre-surgery exercise and rehabilitation may reduce complications and length of hospitalization after surgery as well as improving quality of life and physical recovery.
Christopher Wanczycki underwent multiple rounds of radiation and chemotherapy after being diagnosed with stage 3b rectal cancer in 2021. By the time those treatments were done, the retired project manager was in rough shape.
Wanczycki had lost 37 pounds, his blood tests warned of deficiencies, his legs and feet were swollen and he had trouble walking. He was due to undergo surgery in a matter of weeks.
Doctors pushed that surgery back to give him time to recover. As part of that recovery, Wanczycki agreed to take part in a research project looking at the impact of prehab — pre-surgery exercise and rehabilitation — on surgical outcomes.
When he began the monitored exercise program, Wanczycki, then 63, struggled to complete five pushups against a wall. After almost two months on the program, he was doing 50 pushups and much more. In addition to exercises, he was asked to walk, bike, or swim for at least 20 minutes three times a week and was given a pedometer to track his distance. When his surgeon called him the day before he was due in the operating room, Wanczycki was about to head out cross-country skiing.
He felt ready, thanks to prehab.
“It physically gets you ready for surgery,” he said. “It also helps with blood circulation and brain fog. It helps to clear your mind.”
Wanczycki continued with the program after surgery and within five weeks was back on his cross-country skis. He says he is in better shape now than he was before his diagnosis.
That is not typically the case, says Dr. Daniel McIsaac, anesthesiologist and senior scientist at The Ottawa Hospital. Often patients — especially those who have undergone cancer treatments — are in worse shape heading into surgery than they were when they were diagnosed. That can increase the risk of complications and slow recovery.
Evening Update
Wanczycki was taking part in one of the world’s largest prehab trials in November 2021, led by McIsaac and his team.
New research led by McIsaac and published in the BMJ medical journal suggests prehab might be able to reduce complications and length of hospitalization after surgery. It also suggests prehab can improve quality of life and physical recovery.
“What we found was really, really promising,” McIsaac said.
The research was a meta-analysis, the largest of its kind, looking at more than 15,000 patients who participated in 186 randomized controlled clinical trials around the world.
They looked at various forms of prehab; some included exercise and nutritional enhancement, others contained psychological support and cognitive training or combinations of them. The research found exercise was the most promising component of rehab, followed by nutrition enhancement.
McIsaac advises anyone going into surgery to ask about prehabilitation, saying it should pay dividends. “If you are willing and able to regularly increase your activity levels and protein intake for a few weeks before surgery, you are likely to experience a noticeably shorter recovery time after surgery.”
Surgical complications are both serious and, in many cases, relatively common. More than 300 million surgeries are performed around the world every year. Worldwide, more than 20 per cent of major surgery patients experience post-operative complications that can increase the length of stay in hospital and delay recovery.
McIsaac said the research offered hope that post-surgical complications could be reduced significantly with prehab.
“Prehab is a bit like training for a race, but instead you’re training for surgery,” he said. “It’s structured, sustained exercise and nutrition over time that makes the muscles, heart, and lungs stronger. A lot of the exercises focus on strengthening the legs and abdominal muscles, which you need to get out of bed after surgery.”
Still, he said, more research needs to be done to understand the best and most realistic way to run successful prehab programs. At The Ottawa Hospital, prehab patients, like Wanczycki, are people who are enrolled in clinical trials. There is not a hospital-wide prehab program, as is the case at most Canadian hospitals.
The goal of the research, McIsaac said, is to review what is being done and the results and try to translate that into a working model “where every surgical patient would have really good access to pre-surgical care, ideally at home.” He said he was hopeful that over the next decade most people coming in for surgery would have the opportunity to engage in prehab, adding it could empower patients, but they needed direction and support.
“Just telling people to do it isn’t enough. Our big focus is how do we help people do this at home,” McIsaac said.
Doing the rehab work can be hard, especially for patients who are unwell and stressed in advance of surgery, but the data shows results if people stick to their routines and know coach are calling to check on them.
That made a difference for Wanczycki.
“When you know someone is there (coaching you), you want to adhere to it and follow the plan,” he said.
Wanczycki said he was fortunate to get into the research program. Those walks and outdoor activities sparked more interest in being outside and exercising.
He recently spoke to someone with a similar cancer. He related to her his experience with surgery and recovery after prehab. “She was scared, but, after speaking with me, she said, ‘I can recover to almost better than before.’”
Wanczycki regularly skis, both cross country and downhill, walks, camps and spends time outdoors, along with caring for family members.
He continues to be tracked for any return of the cancer, but so far he is clear.
