Studies show that a contributor to successful rehabilitation is prehabilitation or prehab, an exercise program started prior to surgery. Formerly affiliated with orthopedic operations such as knee and hip replacements, prehab has become more mainstream in the treatment of cancer patients, as early research reveals that becoming fit prior to cancer surgery may reduce the risk of cancer recurrence and progression, improve the effectiveness of treatment, reduce the side effects of chemotherapy and improve energy, self-image, confidence, and quality of life.
As you may know, I am an integrative physician who has recently undergone two cancer-related surgeries. At the age of 50, following my first colonoscopy, I was diagnosed with early-stage colorectal cancer. I pursued genetic testing, which not only revealed a high-risk gene that predisposes to breast cancer, but led to my second early-stage diagnosis. In each of these instances, my medical team was a group of competent, trusted individuals who provided me with all that I needed for curative care, but I took it upon myself to put together a regimen that would better prepare me for the physical and mental rigors of the surgery and recovery processes. This is the first in a series.
I consider myself an active person and exercise up to five times per week, but when I learned of my diagnosis and subsequent surgery, I decided to look into a workout regimen that would prepare me to compensate for areas that would be weakened after surgery. For example, if I couldn’t use my arms to get out of bed, I’d have to strengthen my core. And if I couldn’t use my core, I’d have to strengthen my legs. So, I worked on cardio and resistance training and I did countless squats. I also anticipated shallow breathing following surgery, so I added deep belly breathing to my daily routine.
I thought about the process considering my family members, who are competitive runners. Would they approach the starting line without preparing? Instead they plot and prepare and practice, setting themselves up for the best possible outcome. I decided to do the same.
“Undergoing surgery is much like running a race in that both require proper training. Introducing a regimen of even moderate exercise stressors helps to fine tune the body’s natural systems for healing, resulting in lower incidences of surgical complications and shorter recovery times,” said Health Coach Dan Deckman, an endurance athlete and running coach. “ The prescription for pre-surgery exercise need not be overwhelming, but consistency is key. Starting with as little as 15 minutes per day of moderate cardiovascular activity (e.g. increased breathing rate and increased heart rate) can make a tremendous difference.”
Organizations such as the American Cancer Society, the American College of Sports Medicine, the American Institute for Cancer Research and the U.S. Department of Health and Human Services recommend that adults should do moderate-intensity aerobic exercise (such as brisk walking) along with strength training (weights and resistance exercises that include major muscle groups) and stretching.
So what’s the right amount of exercise for you? Of utmost importance is this: Prehab requires a personalized fitness prescription. Talk to your doctor. Some hospitals offer prehab as part of the pre-surgery education. Or, schedule an appointment with a physical therapist, who may provide a regimen for your surgery. You can also locate a fitness trainer, but only if he or she is willing to contact your cancer care team to understand that your specific cancer and treatment can affect numerous body systems that are required for and affected by exercise training, including the neurologic, musculoskeletal, immune, endocrine, metabolic, cardiopulmonary and gastrointestinal systems.
There are additional paths, as well. Evidence-based studies about fitness and cancer have grown to spark change from organizations such as Livestrong, the Lance Armstrong Foundation, which has partnered with YMCAs to help train their staff members to work with and meet the needs of adult cancer survivors by building muscle mass, increasing flexibility and endurance, improving functional ability, reducing the severity of treatment side effects and preventing unwanted weight changes.
We can’t delay surgery to get into shape, and many are dealing with debilitating health issues that preclude them from exercise, but I believe that whatever can be done to increase activity – even daily deep breathing – will help our recovery. In my experience, following my prehab regimen helped me to get up out of bed and walk the day of surgery, to return to normal daily functions earlier than expected and to bypass prescribed medications, limiting myself only to pain relievers such as Tylenol and Motrin.
This is my personal experience, based on my fitness level prior to surgery. As always, check with your physician before implementing changes to exercise routines and, most importantly, listen to your body. Facing an impending cancer surgery is an extremely stressful time, and while we can plan to implement positive changes we also must respect our current condition and steer clear of additional complications. Whichever challenges you’re contending with in your cancer journey, I hope that prehab is a healthy option.