If you’ve ever had surgery you know the routine. "Do not eat, drink (not even water) or chew gum after midnight." But what about exercise?

While it’s unlikely you’ll be exercising the morning before surgery, a recent study explored integrating movement and other prehabilitation techniques into a patient’s schedule before the operation.

It makes sense.

Athlete’s bodies endure a lot of stress during an event, game or race. They undergo extensive training regimens prior to their athletic events. In the same way, colorectal cancer patients’ bodies endure tremendous stress during surgery. A new study explored the idea of "training for surgery" to see if preparations made BEFORE surgery helped patients function better and experience fewer adverse effects after their operations.

About the Study

As you can imagine, or may have experienced, post-op recovery can be slow and difficult. Patients undergoing surgery can experience feeling tired and weak for a significant period of time. The idea to physically prepare patients before surgery is a growing trend that has gained interest with healthcare professionals across the globe. Research is underway to see if this could become a “new norm.”

A new study, published in the January 2017 edition of the Journal of Supportive Care of Cancer, looked at 116 colorectal cancer patients in Montreal who went through a prehabilitation program to improve their post-surgical outcomes. The program included exercise, nutritional supplements and counseling on relaxation techniques.

The study conducted at McGill University noted that,

“Typically, 6 months after surgery only 1 in 5 patients have regained their previous level of physical activity."

One determinant for this could be a poor state of physical fitness. A cancer diagnosis brings about stress, which can cause fatigue, and fatigue may cause an individual to refrain from any sort of physical activity. This causes loss of muscle mass, memory and strength prior to surgery.

In this study, just 4 weeks of prehabilitation consisting of physical activity, nutritional supplements and relaxation counseling improved the patients’ physical function and thus improved their post-surgical outcomes. The hours patients spent exercising doubled for 70% of the patients in the prehabilitation group after 4 weeks.

Prehabilitation showed to minimize complications from colorectal cancer surgery AND build their energy back quicker.

What To Do If You’re Interested In Prehabilitation Before Surgery?

If this interests you and you have an upcoming surgery, talk with your oncologist or surgeon about this study. Ask who can connect you with an evidence-based prehabilitation program like the STAR Program Prehab Model, the first of its kind.

This model program looks to support the reasons for making changes in clinical care delivery. Dr. Silver, Associate Professor at Harvard Medical School, comments,

“Prehabilitation is part of the cancer care continuum. Just before starting cancer treatment, including but not limited to having surgery, is a critical time. The surgeon or oncologist should be directing the care so that the patient has the best possible result.”

Getting Started

To get started, sit down with a physiotherapist to create a plan aligning with helpful tips such as:

• start slowly
• start at least six weeks before the surgery
• add in a mix of yoga and other relaxation techniques to ensure proper physical preparation for surgery

Important Note about Pre-Surgery Activity

It is important to note that an aggressive increase in exercise right before surgery could create more complications, especially if the bar is set too high and if your program does not include focus on movement, nutrition, smoking cessation, stress reduction, etc. Dr. Silver adds,

“Prehabilitation ideally should prevent or lessen the known side effects of various cancer treatments - it should be very targeted treatment - not just advice such as walk more.”

What about the cost?

Also, check with your insurer to confirm that they will cover prehabilitation. As the evidence base is being built, there are still many insurers that undervalue the physical and mental benefits of prehabilitation.

If your insurer does not cover prehabiliatation, talk to your doctor. You may discover the medical facility offers prehabiliation services as part of their pre-surgery education or you may have the option to work out a reduced payment plan for prehabiliation services. Your doctor can also recommend steps to take at home to prepare for your upcoming surgery, such as specific exercises, vitamins and relaxation techniques to incorporate in your daily routine.

Exercise, Movement and CRC Patients

Integrating exercise and movement into daily life is healthy for anyone. In the “Risk and Risk Reduction” webinar by Dr. Harvey Murff, he called physical activity the closest thing to a “wonder drug.” More and more studies show the many benefits of exercise, from prevention to metastatic colorectal cancer survival.

Many goals set in the new year are related to exercise. This year, make time to find small increments of time to move more throughout your day. This includes all of you going in for surgery.

Cite: Chen, B.P., Awasthi, R., Sweet, S.N. et al. Support Care Cancer (2017) 25: 33. doi:10.1007/s00520-016-3379-8

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