With the development of surgical techniques and increased safety thanks to modern sterilization methods and advances in medical intervention methods, operations have become more accurate and less risky, despite these advances, Prehabilitation before surgery is still an essential component of the treatment plan, as it contributes to preparing the body, improving the results of the operation and accelerating recovery.
Prehabilitation before surgery is a preventive treatment program that aims to prepare the patient physically and functionally before undergoing surgery, through customized physical exercises, breathing techniques, and health education, which helps enhance post-operative outcomes by improving the patient’s physical condition, reducing potential risks, and accelerating the recovery process.
What are the benefits of prehabilitation before surgery?
Prehabilitation before surgery aims to improve the physical and psychological condition of the patient before undergoing surgery, as its benefits are numerous and directly affect the operation, which increases the chances of success of the operation and accelerates recovery, the most prominent benefits include the following:
- Enhance physical fitness and muscle strength: Prehabilitation before surgery helps to strengthen the muscles, especially around the area to be operated on, to facilitate rehabilitation and accelerate the return to normal movement after surgery, and improving cardiorespiratory capacity increases the body’s endurance during and after surgery.
- Minimize the risk of complications after surgery: Prehabilitation before surgery helps prevent blood clots caused by lack of movement after surgery, reduces the chances of pulmonary infections thanks to breathing exercises that improve lung function, and prevents muscle atrophy and weakness due to prolonged bed rest.
- Accelerate recovery and return to daily activity: Patients who undergo rehabilitation therapy before surgery recover more quickly and can regain the ability to perform daily tasks such as walking and using stairs more quickly.
- Optimize function after surgery: Prehabilitation helps to effectively restore range of motion.
- Reduce pain after surgery: Prehabilitation before surgery helps improve circulation and tissue elasticity before surgery, reducing inflammation and pain later on.
- Improve the patient’s mental health: Understanding the patient’s post-operative process helps increase their confidence and reduces stress.
Which patients are recommended for prehabilitation before surgery?
Prehabilitation before surgery is recommended for a number of conditions, as it minimizes complications, speeds up recovery, and improves long-term functional outcomes, including:
- Orthopedic patients: Orthopedic patients, such as those undergoing joint replacements or suffering from ligament and tendon injuries, are the primary beneficiaries of this treatment, as it helps improve muscle strength around the joint and reduces the recovery period.
- Older patients (65 years and older): Older adults often suffer from muscle weakness, osteoporosis, and imbalance, so Prehabilitation before surgery helps improve independence in daily activities and reduces the risk of falls after surgery.
- Cardiothoracic surgery patients: For patients undergoing open-heart surgery and lung tumor resection, intensive respiratory exercise improves respiratory efficiency and reduces the likelihood of post-operative respiratory complications, such as fluid retention or pulmonary infections.
- Patients who suffer from chronic diseases, such as diabetes or hypertension, are more prone to surgical complications, so physical therapy is used to help them manage their condition.
- Physically inactive patients: Patients with muscular dystrophy, muscular weakness, or a history of physical inactivity require prehabilitation before surgery to improve their physical condition and help them withstand the physical demands of the operation.
- Patients who will be undergoing major or long surgeries: Such as gastrointestinal surgery or tumor removal, which helps them withstand the stress of the operation and improves body function.
What can patients expect during prehabilitation sessions before surgery?
During the sessions of prehabilitation before surgery, patients go through a series of planned professional interventions that include assessment, training, follow-up, monitoring, and psychological support.
Comprehensive initial assessment
The initial assessment is the cornerstone of prehabilitation before surgery, where a physical therapist performs a thorough analysis that includes:
- Objective assessment: It measures muscle strength, assesses joint range of motion, performs static and dynamic balance tests, and evaluates gait and respiratory function.
- Clinical examination: The specialist assesses posture for any movement restrictions or pain, analyzes functional movement patterns, and evaluates the condition of the skin and soft tissues.
- Review of medical history: Medical reports and examinations are reviewed, impactful comorbidities are identified, and current medications and their effects are evaluated.
- Individual Needs Identification: Analyzes post-operative functional requirements, evaluates the home and work environment, and identifies personal and psychological risk factors.
The results of this assessment are meticulously documented in the medical record and are used as the scientific basis for a personalized treatment plan.
Design a personalized treatment plan and determine the duration of treatment
After completing the comprehensive evaluation, the specialist begins to develop a customized treatment plan for each patient, taking into account age, general health status, and the type of surgery to be performed, where he first determines therapeutic exercise programs such as muscle strengthening exercises using progressive resistance methods, exercises to improve the range of motion of the joints, and identifying exercises that help improve cardiac and respiratory efficiency, he also determines the intensity of the exercises and the number of repetitions and determines the appropriate tools, he also includes health education sessions and individual and group education sessions in accordance with the patient’s condition, and the duration of the program varies according to the type of surgery.
Perform exercises under the supervision of a specialist
The physiotherapist follows a precise Prehabilitation before surgery system of follow-up, where he evaluates performance on a daily basis by recording the number of repetitions and achievements for each exercise. He measures the extent of improvement in muscle strength and assesses progress in the range of motion while monitoring the patient’s tolerance to exercises. Additionally, he tracks vital signs such as pulse and blood pressure, records any difficulties or obstacles faced by the patient, and modifies the treatment program by increasing the intensity by 5% to 10% per week and adding new exercises when the basics are mastered.
Furthermore, the physiotherapist adjusts the angles and range of motion as well as changes the exercise equipment as needed. He updates the treatment record after each session, ensuring that important clinical notes are documented and any changes in the treatment plan are recorded. This comprehensive approach ensures that the patient’s rehabilitation is tailored to their specific needs and progress is continuously monitored.
Health and mental health education
Through individual and group educational sessions, a scientific explanation of the nature and duration of the expected pain, the recovery time, and what to expect after surgery, correct sleeping positions, safe sitting and standing guidelines, correct movement techniques to prevent stress, and instructions for daily activities are provided. Support is also provided through a home program in which a written and illustrated exercise schedule, repetition and intensity guidelines, safety warnings, and contraindications are created, which helps in managing anxiety, building self-confidence, and solving expected issues.
Psychological support and motivation
The physiotherapist provides comprehensive psychological support to the patient by providing a simple scientific explanation of the operation and the stages of recovery and using positive language to enhance self-confidence. Having an open dialogue about surgery fears using active listening techniques and providing real-life examples of successful recoveries while encouraging the patient to record his daily achievements, as well as involving the family in the process of motivation and support, and allocating sufficient time to answer all inquiries, helps to enhance confidence and minimize fears.
Monitoring and adjusting the plan
Regular follow-up is part of the success of the Prehabilitation before surgery plan. During the sessions, the progress of the patient’s condition is carefully and systematically monitored, and based on this data, the specialist makes adjustments to the treatment program to ensure its continued suitability to the patient’s needs. When the patient shows a noticeable improvement in his abilities or tolerance level, the intensity of the exercises is gradually and thoughtfully increased to enhance progress, while if difficulties or a decline in performance occurs, the plan is reviewed and modified to reduce stress and provide alternatives more suitable to his current condition while maintaining the treatment goals, this process aims to
Types of exercises and techniques used in prehabilitation before surgery
Prehabilitation before surgery relies on a variety of exercises and techniques that aim to strengthen muscles, improve flexibility, raise the level of cardio-respiratory fitness, and train the patient to deal with the post-operative phase, including the following:
Muscle strengthening exercises
The practice of muscle strengthening exercises is an essential component of prehabilitation before surgery, as it aims to enhance muscle strength in the areas associated with the surgical procedure, and these exercises improve the patient’s functional performance and prepare the body to endure the operation and recover faster, these exercises include the following types of exercises:
- Resistance exercises: Simple equipment such as light weights or elastic bands that provide resistance appropriate to the patient’s level.
- Bodyweight exercises: Squats and leg lifts are safe and effective.
- Balance exercises: Particularly focused on improving balance and weight distribution, these are especially important for surgeries involving the lower extremities.
These exercises are safe, but the patient’s health condition and the type of upcoming surgery must be taken into account, and it is advisable to perform these exercises under the supervision of a specialist and avoid any unnecessary stress.
Flexibility exercises
Flexibility and stretching exercises are an essential component of the pre-surgical rehabilitation program, as they contribute to improving the range of motion of the joints, increasing the flexibility of muscles and tendons, reducing the risk of post-surgical joint stiffness, and facilitating the performance of other therapeutic exercises. These exercises include the following types:
- Stretches the posterior thigh muscles: Helps improve the flexibility of the hamstring muscles.
- Stretches the leg and hip muscles: This improves lower limb mobility, making it easier to walk after surgery.
- Exercises to improve joint range of motion: Such as shoulder rotation exercises or gentle knee mobilization, which maintain normal joint mobility.
It is recommended to perform them daily for 10-15 minutes, avoiding pain.
Aerobic exercise
It enhances the efficiency of the cardiorespiratory system, which helps to improve the body’s tolerance to anesthesia and surgery, reduce the risk of respiratory and cardiac complications, and speed up the recovery process after the operation:
- Fast walking: This is one of the simplest and safest exercises, with the ability to gradually increase the intensity.
- You will use a stationary bike: It provides an effective workout while minimizing the load on your joints.
- Water exercises: Such as swimming or walking in water, it is especially suitable for patients with joint pain or obesity.
- For group activities: Such as simple dance exercises or group exercises while avoiding any unnecessary strain.
Breathing exercises
It is considered an essential exercise, especially for patients who will undergo heart or chest operations, as it helps prevent respiratory complications by enhancing the efficiency of the respiratory system and improving blood oxygenation during and after the operation. These exercises include the following types of exercises:
- Abdominal (diaphragmatic) breathing: Perform a deep inhalation with an expanded abdomen, followed by a deep and controlled exhalation, repeat 5-10 times every hour.
- Prolonged exhalation: Deep inhalation followed by a longer exhalation of twice the duration helps to empty the lungs of trapped air, reducing the risk of secretion buildup.
- Use the Incentive Spirometer: It stimulates the expansion of the lungs and strengthens the breathing muscles, which preserves lung capacity.
It is best to start these exercises at least two weeks before surgery, and repeat the exercises 3-4 times a day.
Functional training
In the functional and motor training phase, the patient is prepared to perform the basic daily movements that he will need after the operation, where he begins to learn to stand and sit in a safe manner, focusing on using the muscles correctly to avoid pressure on the joint, the patient is trained to use crutches to provide support and balance, and learn to get in and out of bed in a way that minimizes stress, the training also includes walking on uneven floors to avoid falls and adapt to the challenges of daily life.
Manual therapy
Manual therapy is one of the adjunctive therapies in a Prehabilitation before surgery program that helps improve motor function of the joints, relieve muscle tension, and promote local circulation:
- Soft tissue massage: It lengthens contracted muscles, improves connective tissue elasticity, and reduces tissue adhesions.
- Mobilization of joints: Joint mobilization helps improve gliding of the articular surfaces, restores range of motion, and increases the fluidity of the synovial fluid.
- Relieve muscle tension: Compression and therapeutic massage help release trigger points and relax tight muscles.
This type of treatment is applied by a qualified physiotherapist, and it is advisable to perform it well in advance to achieve the best results, taking care to avoid any excessive pressure on the surgical area.
Health education and psychological training
It is an important aspect of Prehabilitation before surgery, in which the patient is informed about what to expect after surgery and given instructions to deal with complications and accelerate recovery, such as how to manage pain after surgery, training on safe sleeping and sitting positions and instructions on joint protection movements, and awareness sessions also help reduce anxiety about the operation.
What is the role of the physiotherapist in prehabilitation before surgery?
The physiotherapist plays an important and essential role in prehabilitation before surgery, working to:
- Assesses the patient’s physical condition: It assesses risk, optimizes general health factors, measures cardiorespiratory efficiency, and identifies potential risk factors.
- Collaborate with the medical team: They collaborate with the medical team to develop a treatment plan, ensure that the plan is implemented effectively and successfully, and modify the plan as needed.
- Teach the patient the necessary exercises: It teaches the patient proper breathing techniques to prevent lung congestion and provides guidance on safe movement mechanics.
- Psychologically prepare the patient: It explains what to expect during and after the procedure, which helps reduce anxiety and boosts self-confidence.
The results of this assessment are meticulously documented in the medical record and are used as the scientific basis for a personalized treatment plan.
Finally, Prehabilitation before surgery is not a luxury, but a key pillar in improving the patient’s health and the success of the operation. It improves fitness, reduces complications, accelerates recovery, and enhances self-confidence, making it a vital part of the treatment plan, especially in major surgeries such as orthopedic, cardiac, and abdominal surgeries. Patients are advised to start this program weeks before surgery to achieve the best results.
Sources:
- Valkenet, K., van de Port, I. G. L., Dronkers, J. J., de Vries, W. R., Lindeman, E., & Backx, F. J. G. (2018). The effects of preoperative exercise therapy on postoperative outcome: A systematic review. Clinical Rehabilitation, 32(5), 651-663.
- Carli, F., & Scheede-Bergdahl, C. (2013). Prehabilitation to enhance perioperative care. British Journal of Anaesthesia, 110(5), 679-691.
- Physiopedia contributors. (n.d.). Physical activity pre and post surgery. Physiopedia. Retrieved May 15, 2025
