Prehabilitation Proves Vital for Older Patients’ Surgical Recovery

Research from The Ottawa Hospital has revealed that prehabilitation—focused exercise and nutrition before surgery—can significantly improve recovery outcomes for frail older adults. The study, which is the largest of its kind globally, indicates that participants who completed at least 75 percent of a structured prehab program experienced lower disability levels following surgery.

Surgical complications are a major concern, particularly among older patients. More than 20 percent of individuals undergoing major surgery face complications, which can lead to extended hospital stays and prolonged recovery times. Dr. Daniel McIsaac, an anesthesiologist at The Ottawa Hospital and clinical research chair in perioperative innovation at the University of Ottawa, led this important study published in JAMA Surgery.

The clinical trial involved 847 frail older adults across Ottawa and twelve additional surgical centres in Canada. Half of the participants were assigned to a home-based prehabilitation program that lasted at least three weeks prior to their surgeries. This program consisted of personalized exercises, instructional videos, an elastic band for strength training, a pedometer, and coupons for protein supplements. Notably, increasing protein intake before surgery is linked to improved outcomes.

Participants received weekly calls from a prehab coach, providing guidance and support throughout the process. One participant, Christopher Wanczycki, joined the prehab program approximately two months before his scheduled cancer surgery. After being diagnosed with rectal cancer in 2021, Wanczycki underwent multiple rounds of radiation and chemotherapy, which left him physically weakened. Doctors delayed his surgery to allow recovery time, during which he enrolled in the prehab trial.

Wanczycki dedicated himself to the program, achieving remarkable improvements. He progressed from struggling to perform five push-ups against a wall to completing 50 push-ups and more. On the day he received a call confirming his surgery, he was out cross-country skiing. After his operation, he continued his prehab regimen and was back on the slopes just five weeks later.

While Wanczycki’s outcome is exceptional, Dr. McIsaac noted that it exemplifies the potential benefits of engaging fully in prehabilitation. The study concluded that those who completed the requisite exercises saw significant improvements, including quicker hospital discharges and a faster return to work.

Despite these findings, encouraging participation in prehab programs remains a challenge. Many patients struggle with motivation or time constraints necessary to engage fully in the prehab regimen. Dr. McIsaac emphasized the need for researchers to find ways to motivate more individuals to complete the prehab exercises. “If we can get everyone to achieve at least 75 percent participation, the potential benefits could be substantial,” he explained.

Wanczycki’s journey serves as a powerful testament to the importance of prehabilitation. Dr. McIsaac referred to him as “the poster child” for successful outcomes through dedicated exercise and nutrition. As this research illustrates, a proactive approach to pre-surgical health can lead to markedly better recovery experiences for older adults facing surgery.