I am officially recovering. A few days ago, I underwent keyhole surgery to have my gallbladder removed. All went according to plan and, as I write this, I’m propped up on the sofa, feeling almost back to normal. My appetite has returned, my wounds are healing nicely and soon I’ll be able to drive again. One thing, however, is not as it used to be: my fitness.
I’m not a natural gym-goer, but over the past few years, knowing the importance of strength training, I’ve focused on trying to build muscle mass as well as going for a run a few times a week. And I have felt better – stronger and, oddly, more capable – for it. But in the lead-up to my op, I relaxed my usual schedule. My son stole my dumbbells and I didn’t bother trying to find them. Seven days before surgery, we moved house. I lost my yoga mat and my resistance bands. Running, I felt, was beyond me – I needed to establish new routes and find a parkrun, but with the op in the pipeline, why bother? I could start again once I’d recovered.
All of this is, of course, completely reasonable. But what it meant was a serious drop-off in fitness before the operation – and now, 10 days after surgery, I’m still a way off re-establishing my exercise schedule. I’m too tired, out of my routine, sluggish. It could be another two to three weeks before I’m fit enough to lift and run again… and in that time, I’m watching my hard-earned muscles melt away. At my age, this is not good news.
You may feel that 55 is the new 35, but your muscles have different ideas
‘You may feel that 55 is the new 35, but your muscles have different ideas,’ counsels Dr Sarah Jarvis. ‘Unfortunately, the natural process of sarcopenia or muscle loss begins in your 30s but can accelerate in your 40s and 50s in the run-up to, and after, the menopause. This means you’re much more prone to losing muscle mass if you’re not keeping up with physical activity – and that makes it even more important to protect your muscles and get in the best possible shape before surgery.’
So, instead of taking my foot off the fitness pedal pre-surgery, I should have been doubling down? Exactly, says Dr Sarah. ‘Prehabilitation is a relatively new term, coined as healthcare teams have become more aware of the risks of becoming deconditioned after surgery. It’s a combination of physical, nutritional and psychological support to maximise your health to cope with surgery and its after-effects.’
You will probably lose about 5% of your muscle mass in that first week after surgery
And she’s not the only GP who thinks intentially building fitness before surgery is important. GP and TV presenter Dr Zoe Williams, who is currently recovering from back surgery, told her audience about the importance of getting fit for surgery. ‘I think of it a bit like a marathon. A surgery is a big traumatic event. You wouldn’t just do a marathon; you’d train for it. You can train your body for surgery.
‘Thinking about physical fitness is the most important bit, especially muscle strength. You will probably lose about 5% of your muscle mass in that first week after surgery because you’re not moving but also because of what your body’s going through. Preparing your body by trying to increase muscle mass beforehand is a really good idea. It doesn’t have to be a lot – if you’re someone who is very sedentary, very small amounts of muscle-strengthening activity can make a huge difference to your surgical outcomes.’
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And it’s not just about fitness before surgery. ‘In terms of diet, most of the healthy eating rules apply,’ says Dr Sarah. ‘However, it is extra important to incorporate at least two portions of meat, eggs, beans or lentils into your diet each day. Two portions of fish a week (one of them oily fish) also contribute to your protein intake.
‘Where exercise is concerned, you should be focusing on a combination of aerobic exercise (the kind that makes you mildly out of breath and gets your heart beating faster but not necessarily racing) and individual muscle group exercise exercises – gym work, lifting light weights or using resistance bands all count. How much you do will depend on your starting level of fitness. If you’re generally fairly sedentary, it will take longer to build up, so you should aim to begin at least a couple of months, rather than weeks, before your surgery.’
Commit to building your fitness before your operation, experts agree, and you can relax and focus on recovery afterwards. ‘Recovery from surgery isn’t just about rest,’ says Dr Zoe. It’s a metabolic event and often our appetites can be affected by the pain, the painkillers and the surgery itself.’ When mobility drops, she adds, nutrition matters even more. So, even if exercising is off the table for now, protein- and veg-packed salads can most certainly be on it.
‘Prehabilitation and rehabilitation are basically two halves of the same coin.’ says Kim Hawley, Good Housekeeping’s senior fitness expert. ‘Prehab focuses on getting the body into the best possible condition before surgery. This can include improving strength and mobility, prioritising sleep and generally, optimising overall health. The aim isn’t to avoid surgery, but to improve and hopefully speed recovery and reduce the risk of complications afterwards.
Rehab begins after the procedure and centres on restoring function, strength and also confidence. This should be done gradually, with small increases in movement, prescribed exercises, and adapting back into daily activities. Following your medical advice is key, particularly around wound care, activity levels, and any diet and recovery timelines vary, so consistency and patience are the key.’
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