Surgery is an Athletic Event: Much like Usain Bolt’s world record was won in the months of training before the race, your surgical outcome is determined by how you prepare your body in the weeks leading up to the procedure.
"Taking it Easy" is Dangerous: While rest seems intuitive, inactivity leads to muscle loss and reduced lung function; prehabilitation actively fights post-op complications like blood clots and chest infections by building your "physiological reserve."
The Three-Pillar Approach: Optimal recovery requires a holistic strategy that combines physical exercise for oxygen delivery, nutritional support for tissue healing, and psychological preparation to manage the immune-suppressing effects of surgical stress.
It’s Never Too Late: Even with only 2 to 4 weeks before an operation, structured "prehab" can significantly improve your body’s ability to consume oxygen and withstand the stress of anesthesia, making it a vital tool for patients of all fitness levels.
Introduction
You and Usain Bolt are more alike than you think. It’s August 16th, 2009. We’re in sunny Berlin, it’s 25 degrees out. Every sprint, every strength session, every meal and every meditation session has led to this moment. 9.58 seconds later, a new world record has been set. He knew this was coming.
In much the same way, going under the knife can constitute the single most important event of your life. You may have even heard that preparing for surgery is like preparing for a marathon. Like Usain Bolt, when the day comes, it is essential that you are ready. There are countless ways to prepare.
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Why Complications Happen After Surgery
There are many reasons we get complications after surgery and these can occur due to different aspects of the procedure.
Breathing complications
The general anaesthetic you get during an operation changes your breathing pattern, and makes it more difficult to move mucus out of your lungs. Once awake, pain from surgery may then make it more difficult for you to take deep breaths. Finally, you are likely to spend more time than usual lying flat after your operation. These combined factors help secretions build up, creating an ideal environment for bacteria to grow and cause a chest infection.
Blood clots
Next up, the stress of surgery makes your blood more prone to clotting. We also tend to move less after a big operation, leading to blood pooling in our legs. This makes surgical patients the ideal prey to a clot which may then travel throughout the body, and cut off essential blood flow carrying oxygen to vital organs.
Infection risk
Last, but not least, wound infections can take hold. Healing requires blood flow, oxygen, and protein. Inadequate breathing, and a reduced appetite mean that our bodies now don’t get their usual supply of oxygen and protein. With the healing process slowed way down, bacteria have a unique opportunity to multiply and cause infection.
Why Preparing Before Surgery Helps
None of these complications happen in a vacuum. They become more likely when the body goes into surgery underpowered rather than prepared. At Emerald, we often encounter patients who tell us they’ve been ‘taking it easy’ before their operation. And yet intuitively, we know inactivity is detrimental to our health. Science backs this up: bed rest is linked with loss of muscle mass and function, and with a reduction in heart lung function. In other words, time spent not moving is actually time spent moving back.
On the flip side, we know from decades of research that exercising, eating well, and practicing mindfulness prior to surgery all lead to better outcomes for you after your operation. This is particularly true when patients tackle all three pillars in their preparation. They tend to report less pain, suffer less complications and leave hospital quicker. They also report better overall quality of life, and day-to-day functioning after their operation.
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Why Frail Patients May Benefit the Most
To understand frailty, one must understand the concept of physiological reserve. Your body has an inherent ability to bounce back after a stressor - whether that be an infection, illness, or surgery. Frailty refers to individuals whose bodies are less able to withstand those stressors. Some of the tell-tale signs of frailty include weight loss, fatigue, lack of muscle strength and slow walking. In those patients, even a simple UTI may lead to loss of independence, and to an inability to return to their baseline of day-to-day functioning following a seemingly innocuous event. Surgery is a major stressor, putting extra strain on your heart, lungs, and energy production systems. It follows that frail patients are at highest risk from surgery, and data backs this up. Specifically, they are likely to stay in hospital longer, and to develop complications. Still, many fear the repercussions that physical activity may have on their health, and worry their bodies may not cope. In reality, not only is structured physical activity safe in frail patients, it actually yields a cascade of benefits including better function (for example, being able to walk faster), and improved overall quality of life. Through physical, nutritional, and psychological interventions, we help restore some of that in-built resilience system.
How to Get Started
Even if your operation is around the corner, science says it’s not too late to get started. 2 to 4 weeks of preparation is sufficient to yield significant improvements in your body’s ability to consume oxygen, and to cope with physical activity. As we explored earlier, oxygen is the currency of recovery, so this translates into a better ability to withstand the stress of anaesthesia and surgery, and therefore better outcomes.
Now that we’ve established why preparation matters, you may now ask yourself - how do where to start ?
Physical preparation: for your cardiovascular health, start walking, swimming, or cycling. This will improve your body’s ability to deliver oxygen to all your tissues, which in turn will reduce your risks of developing a chest, or wound infection. Try resistance training with bands, weights, or your own bodyweight. Try yoga, or a new stretching routine. Strength and flexibility will help you to get moving early after your operation, which will reduce the risk of blood clots, and muscle loss.
Nutrition: make sure to include sources of proteins in your meals, including lean meats or plant-based proteins. This will help you maintain, and build muscle mass. If you can, avoid ultraprocessed foods, as those may contribute to inflammation, which surgery inevitably exacerbates.
Psychological preparation: how are you, really? You may want to try mindfulness, or simple relaxation techniques. If you’re struggling, consider talking to your team about a referral for CBT (cognitive behavioural therapy).
If that sounds like a lot to tackle alone, that is exactly where a structured prehabilitation programme can help.
What Prehabilitation Involves
Prehabilitation is a structured, personalised programme designed to improve your physical, nutritional, and psychological fitness before treatment, so that you go into surgery in the best condition possible. Wherever you may be, the team - made up of doctors, nurses, physiotherapists, dieticians, and psychologists - assesses you when they meet you for the very first time. From there, an individualised plan is carefully crafted, centred around three key areas:
Moving: your physical training programme will consist of a combination of exercises devised typically by physiotherapists to improve your strength, cardiovascular health, and mobility. This can take place through group sessions, or in the comfort of your own home.
Eating: dieticians will then walk you through a comprehensive nutritional plan including better food choices and portion sizes. They may also consider prescribing nutritional supplements to increase your protein intake.
Mindfulness: the anxiety surrounding surgery -whether it be centred around the operation, anaesthetic, recovery, or something else entirely- produces wider effects on immunity and recovery. To counteract this, your clinical team will be there to provide emotional support, and to provide information about the process from A to Z. If necessary, you may also be referred to see a psychologist who will help equip you with behavioural tools to feel psychologically ready before your treatment.
How Emerald Personalises the Process
At Emerald, we extend these principles further. We know that patients feel especially empowered when programmes are tailored to their particular needs. Because of this, we create a comprehensive health profile for each of our patients. We incorporate data from wearables (for example your heart rate and sleep patterns from your Apple Watch or your Whoop) and blood tests, along with information we collect from you, about your lifestyle and past medical history. From there, we create a plan that’s unique to you, with the day of surgery as our finish line.
Conclusion
So now you know: surgery may not be a measly task, but you’re in control. On that sunny evening in Berlin, Bolt didn’t break the world record in 9.58 seconds. He broke it in the months prior, through preparation. Your surgery day is the same.
References
The Aging Muscle in Experimental Bed Rest: A Systematic Review and Meta-Analysis
Effects of strict prolonged bed rest on cardiorespiratory fitness: systematic review and meta-analysis
MacMillan - Prehabilitation for people with cancer
Frailty in Older People: evidence for a phenotype
Postoperative outcomes in older patients living with frailty and multimorbidity in the UK: SNAP-3, a snapshot observational study
Effectiveness of physical activity interventions in older adults with frailty or prefrailty: a systematic review and meta-analysis
Effects of multicomponent exercise on frailty status and physical function in frail older adults: A meta-analysis and systematic review
Effects of sprint interval training on VO2max and aerobic exercise performance: A systematic review and meta-analysis
Effects of different protocols of high intensity interval training for VO2max improvements in adults: A meta-analysis of randomised controlled trials
Prehabilitation - BJA (Prehabilitation)
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