Prehabilitation

Having an operation challenges your body and mind, and prehabilitation is the process of getting physically and mentally ready for surgery.  
  
There is lots of evidence that shows that when people make an effort to improve their physical and mental health before an operation, it can really help them to recover faster, have fewer setbacks and can potentially improve their long-term health and wellbeing.   
  
The key parts of preparing your body and mind for surgery are:

• Physical fitness
• Nutrition
• Mental wellbeing
• Stopping smoking and
• Reducing or stopping alcohol  

 
The benefits of prehabilitation are: 

If you’re having surgery:

• Reduce post-operative complications
• Reduce the time you spend in hospital
• Quicker recovery 

If you’re having chemo/radiotherapy:  

• Better response to treatment 
   
  All patients:
• Reduce anxiety, depression and improved mood
• Improved general fitness/ cardiovascular fitness
• Improve nutritional status
• Improves ability to fulfil normal activities of daily living
• Greater sense of control and continuity of care 
• Enhance quality of life 

There is also some early scientific research that if you have cancer, improving your physical fitness can reduce the chance of the cancer spreading or coming back 

Whilst your body is healing, your heart and lungs need to work harder to provide the oxygen and nutrients it needs to recover.  

Improving your physical fitness trains and prepares your body for the extra work it will need to do after the operation, which means you’ll get over the surgery and back on with your life faster.  

It’s not just any activity (although any movement you do is good for you), the key is to do some exercise that gets you out of breath 3 times per week, because it is the getting out of breath that is trains your heart and lungs to work a bit harder.  

Getting more active has other benefits too; it helps reduce stress and anxiety, improves your mood and can even reduce tiredness.  

Being as well-nourished as possible before you start your treatment can help you deal with problems that might arise along the way. Enjoying what you eat is important too.  

A balanced diet needs to include food from all the food groups to make sure your body works well, these include beans, pulses, fish, eggs, meat and other proteins, starchy foods, fruit and vegetables and dairy foods such as milk, yoghurt and cheese or dairy alternatives.  

Ideally you should eat enough calories (energy) and enough protein to keep your weight steady and keep as strong as possible. If you are underweight or have lost weight unintentionally then you may be advised to try and gain a little weight. Even if you are overweight, losing weight at this time may not be recommended but instead ensure you avoid gaining more excess weight.  

A balanced diet includes:  

• Enough calories to give you the energy to perform your everyday activities  
• Enough protein to keep your muscles strong, your immune system working, and support wound healing. Foods high in protein should be included in 2 or 3 meals each day. If your appetite is poor, eating 3 smaller meals along with snacks or milky drinks in between may be easier to manage.  
• Good sources of protein include meat, fish, eggs, and dairy foods such as milk, yogurt and cheese. Plant-based sources of protein include soy and tofu, beans, pulses, nuts and seeds
• Five portions of fruit and vegetables each day which provide fibre and vitamins and minerals. One portion is:
  • 3 tablespoons of vegetables or  
  • 1 medium piece of fruit or  
  • 2 smaller pieces of fruit or
  • A handful of small fruits such as grapes or strawberries.  
  • A glass of fruit juice or smoothie can count as one of your five a day  
  • Starchy foods such as potatoes, rice, noodles, pasta, bread, cereals – these provide energy but also fibre, especially when wholegrain  
• Plenty of fluids to keep you hydrated – aim to drink between 1.5 and 2.5 litres of non-alcoholic fluids a day and enough to keep your urine pale straw colour.

You might have ‘off days’ during your treatment, when your appetite is poor or you are lacking energy. Consider stocking up your freezer and store cupboard with easy to prepare or easy to eat foods and snacks.  There are additional resources available with suggestions and snack ideas below.

If you have Diabetes, ensure you check your blood sugar regularly and speak to your diabetes nurse or GP about how you might best manage your condition during your treatment.

If you are having difficulty in maintaining your weight, have a reduced appetite, swallowing issues or other dietary issues or concerns that are preventing you from eating well contact a member of your healthcare team (e.g. nurse, doctor, pharmacist) as soon as possible. You may be referred to a dietitian for individual advice or you can ask to be referred to a dietitian yourself if you are concerned.

Find out more:

• Getting Ready for Treatment Leaflet
• Basic Store Cupboard Ideas Leaflet

Having an operation is a stressful time in anyone’s life and it is natural to feel worried.   Managing your anxiety, encouraging positive thinking and developing your coping skills may have a positive impact on your recovery and outcome after surgery.

Sleep is also an important component of your recovery, and so if it’s something you struggle with, it’s important to try to address it before your operation, so you can benefit from the recovery benefits of sleep after surgery.  

These are some resources you may find useful in the lead up to coming into hospital:

• Preparing your mind before surgery (Royal College of Anaesthetists)
• Insight Timer Meditation App
• Mental Wellbeing Audio Guides (NHS)
• Breathing exercises for stress (NHS)
• Five steps to mental wellbeing (NHS)
• Sleeping Well (Royal College of Psychiatrists)
• Onboarding Sleep Test (Sleepio)

Stopping smoking or vaping  

Stopping smoking is the best thing you can do to reduce your risk of problems after an operation.   
The world health organisation suggests that you can reduce the complications from surgery by up to 50% by stopping smoking.

If you stop smoking:

• you increase blood flow to the tissues that are healing, reducing the risk of infection,  
• you reduce the strain on your heart, reducing your risk of a heart attack and it also  
• you improve the efficiency of your lungs, reducing the chance of breathing problems after surgery.  

There are many support options available to you, located within our local stop smoking service: Stop Smoking Berkshire

Stopping or reducing alcohol  

The NHS suggest drinking 14 units or less per week  

Unit calculator (Alcohol Change UK)

Alcohol has many effects on the body, but the main importance around the time of surgery is that it can reduce the liver’s ability to make the proteins/building blocks required to heal after the operation.  

What is post-operation pulmonary complication?

General anaesthetic affects your lung, plus the pain from your wound can make taking a deep breath and coughing difficult and painful. This means that sputum (mucus) can collect in your lungs, which can lead to a chest infection, which is the commonest reason to stay in hospital longer than you’d expect to after abdominal surgery.  

We encourage you to complete deep breathing, coughing and mobilising after your surgery to help clear that sputum and prevent you from developing a chest infection.

It is important to start clearing any sputum as soon as possible straight after your surgery. Coughing will not damage any stitches or staples, or anything internally. 

What can you do to prevent it?

Pain relief: If you are in pain when you take a deep breath or cough, please ask your nurse for some extra pain relief as it is vital you can do these things.  

Early mobilisation: Getting moving is a crucial component of your recovery. Sit up or out in chair as soon as possible after your operation. You should expect to be walking the first day after your operation. Try to walk around the ward as much as possible after your surgery, little and often is the key. Drains, tubes, other attachments should not stop you getting out of bed.  Your nurse or Physiotherapist will assist you with this if you are struggling.  

Breathing exercises: Your Physiotherapist will practise the exercise below to help you get rid of any sputum or mucus from your lungs:

The Active Cycle of Breathing Technique (ACBT) is a technique taught by a Respiratory Physiotherapist to help people to clear mucus from their lungs more easily.  

The ACBT involves breathing control, deep breathing and huffing.  

Breathing control is gentle breathing with minimal effort.

• Breathe in through your nose where possible, and then breathe out through your mouth.
• If you cannot breathe through your nose, then breathe in through your mouth and out through your mouth. 
• Try to make your breathing slow.  

It is important to practise breathing control between the more active parts of ACBT to allow your airways to relax.  

Deep breathing exercises is self-explanatory - take a long, slow deep breath in through your nose if you can.

• Breathe in through your nose.  
• Hold this breath when your lungs a full for 2-3 seconds.  
• Breathe out gently and relaxed.
• You should do 3-5 deep breaths in a cycle.  

Huffing is an exhalation through an open mouth and throat instead of a cough. It helps to move mucus up your airways so that it can be cleared in a controlled way. To ‘huff’ you squeeze air quickly from your lungs, out through your open mouth and throat. The best comparison is as if you were trying to mist up or fog a mirror or your glasses. Use your tummy muscles to help you squeeze the air out, but do not force it so much that you cause wheezing or tightness in your chest. Huffing should always be followed by breathing control. There are two types of huff, which help to move mucus from different parts of the lungs. 

• The small-long huff
  • This targets the mucus in the lower areas of your chest. Take a small breath in and then huff the air out until your lungs for as long as you can until they feel quite empty using the technique above.  
• The big-short huff
  • This targets the mucus higher up in the chest, so use this when the mucus feels ready to be cleared to your throat and swallowed or spat out. Take a big breath in then complete a short huff out quickly.  
  • Your huff should move the mucus in your chest by making it ‘rattle’. This will mean you are moving the mucus up the airways, it should then clear easily.  
  • If you are wheezing with each huff, you may be huffing too hard or for too long. Make sure you do not huff too hard and always practise some breathing control after huffing to relax the airways.  
  • Ask your physiotherapists for further advice on this if you’re not sure. 

Should I cough?

Some people worry about coughing as it evokes pain but this is a good way to clearing your chest. As discussed huffing is better and more effective than coughing. To facilitate cough gently support your abdomen with a rolled up towel or pillow to make it more comfortable.