Exercising and improving nutrition before surgery can have positive benefits for older adults, but only if they fully take part in a prehab program, according to a new study led by researchers at The Ottawa Hospital.
The study, which is the world’s largest prehab trial, found that participants who completed at least 75 per cent of exercises that were part of a prehabilitation program had lower levels of disability after surgery.
Reducing complications after surgery would have a significant impact on individuals and the health system. More than 20 per cent of major surgery patients suffer from complications after surgery, resulting in longer hospital stays and more time off work or away from activities. Older people who are frail are at greatest risk.
But participating fully in an exercise and nutrition program is not always easy for patients, said Dr. Daniel McIsaac, an anesthesiologist at The Ottawa Hospital and clinical research chair in perioperative innovation at the University of Ottawa. He led the study that was published in JAMA Surgery.
“Prehab isn’t like a pill. If it were a pill and people could take it, it would be a blockbuster,” he said. Prehab is more demanding.
“It is a lot easier to take a pill than go outside on a cold December day.”
Still, the benefits can be substantial.
“This study shows that older adults with frailty who have enough time and support before surgery to fully engage in a prehab program are likely to experience a better recovery and less disability after surgery,” McIsaac said.
The large clinical trial enrolled 847 frail older adults in Ottawa and 12 other surgical centres across Canada.
Half were randomized to take part in a structured home-based prehab program for at least three weeks before their surgery. The program included personalized, home-based exercises, instructional videos, an elastic band for strength training, a pedometer and coupons for protein supplements. Increasing protein intake before surgery as part of prehab is associated with better outcomes. Participants also received calls once a week from a prehab coach.
Dr. Daniel McIsaac, lead author of new research into the benefits of prehabilitation before surgery.
Ottawa’s Christopher Wanczycki was among those who participated in the prehab arm of the clinical trial, joining about two months before he was scheduled to undergo cancer surgery.
He underwent multiple rounds of radiation and chemotherapy after being diagnosed with rectal cancer in 2021, leaving him in rough shape and having trouble walking.
Doctors pushed his surgery back to give him time to recover and Wanczycki was enrolled in the prehab trial led by McIsaac. Wanczycki took the program seriously, demonstrating the benefits that are possible from prehabilitation.
He went from struggling to complete five pushups against a wall to doing 50 pushups and more. He was cross-country skiing the day he got a call to tell him his surgery would be the next day.
He continued the prehab work after surgery and was back on his skis in five weeks.
Wanczycki’s story is not typical, McIsaac conceded, but it illustrates the benefits of improving fitness before surgery.
The study found that people who put work into prehab saw benefits.
“If they did 75 per cent of the exercises, they had meaningful improvement after surgery,” McIsaac said. That includes getting home from the hospital sooner, going back to work sooner and remaining more independent.
The question for researchers, he said, is how to encourage people who don’t have much time or motivation to do the prehab work.
“There is a lot of benefit that could be there if researchers can figure out how to get that level of performance — getting everyone up to 75 per cent at least.”
McIsaac said Christopher Wanczycki’s outcome illustrated the difference exercise and nutrition could make to surgical outcomes.
“Christopher is the poster child. He is what happens when you do 100 per cent.”
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