Prehabilitation Coming of Age

Abstract

While cardiac and pulmonary rehabilitation programs traditionally involve exercise therapy and risk management following an event (eg, myocardial infarction and stroke), or an intervention (eg, coronary artery bypass surgery and percutaneous coronary intervention), prehabilitation involves enhancing functional capacity and optimizing risk profile prior to a scheduled intervention. The concept of prehabilitation is based on the principle that patients with higher functional capabilities will better tolerate an intervention, and will have better pre- and post-surgical outcomes. In addition to improving fitness, prehabilitation has been extended to include multifactorial risk intervention prior to surgery, including psychosocial counseling, smoking cessation, diabetes control, nutrition counseling, and alcohol abstinence. A growing number of studies have shown that patients enrolled in prehabilitation programs have reduced post-operative complications and demonstrate better functional, psychosocial, and surgery-related outcomes. These studies have included interventions such as hepatic transplantation, lung cancer resection, and abdominal aortic aneurysm (repair, upper gastrointestinal surgery, bariatric surgery, and coronary artery bypass grafting). Studies have also suggested that incorporation of prehabilitation before an intervention in addition to traditional rehabilitation following an intervention further enhances physical function, lowers risk for adverse events, and better prepares a patient to resume normal activities, including return to work. In this overview, we discuss prehabilitation coming of age, including key elements related to optimizing pre-surgical fitness, factors to consider in developing a prehabilitation program, and exercise training strategies to improve pre-surgical fitness.

Prehabilitation before elective coronary artery bypass grafting surgery: a scoping review

“…Patients may benefit from multimodal prehabilitation interventions because of the synergistic effect of several interventions. Compared with unimodal prehabilitation interventions, multimodal interventions that include exercises and increase a patient’s functional capacity, in combination with diabetes control, nutrition counseling, smoking cessation, and psychological counseling, improve perioperative outcomes associated with surgical interventions 25 and accelerate the return to preoperative functional capacity 115 …”

“…Preoperative interventions, or prehabilitation, is emerging as a growing field of research globally. Given the increasing body of data documenting benefits of prehabilitation, programs should be taken into consideration when developing future research on preoperative interventions in appropriate patients 25 …”

“…Prehabilitation before elective CABG includes a combination of exercise training, education, and social support that affects the physical and psychological readiness of patients for surgery and is intended to reduce postoperative complications and LOS 7,18,24 . Preoperative interventions or prehabilitation are emerging as a growing field of research globally and, given the growing body of data documenting the benefits of prehabilitation, such programs should be taken into consideration when developing future research on preoperative interventions 25 …”

Does Prehabilitation in colorectal cancer surgery improves functional capacity, quality of life and reduce postoperative complications? - A Cochrane Review summary with commentary

“…However, most of these services are provided after surgery and other cancer-related treatments. In this scenario, prehabilitation seems helpful in improving functional outcomes in patients who undergo abdominal aortic aneurysm repair, coronary artery bypass grafting, and bariatric surgery 9 . Therefore, rehabilitation professionals should consider prehabilitation also for patients undergoing surgery for tumor resection.…”

Pulmonary prehabilitation and smoking cessation

“…Traditionally, pulmonary prehabilitation has meant exercise in the form of respiratory training, controlled breathing training, chest expansion, endurance training, and smoking cessation. Recent literature has demonstrated the beneficial effects of adjunct prehabilitatory measures, such as glycemic control, nutritional improvement, alcohol abstinence, and psychosocial counseling [9,22,27] (Fig. 1).…”