'PREHABILITATION' - IMPROVING YOU OUTCOMES
Prehabilitaiton is defined as the process of enhancing a person’s functional capacity in preparation for a forthcoming stressor, such as a joint replacement or other major surgery.
In Australia over 1.5 million joint replacement surgeries have been recorded in the past 20 years and in the United States approximately 2.5 million individuals live with a total hip replacement and 4.7 million people live with a total knee replacement.
Fortunately, with improvements in health care and technology, these procedures are becoming more readily accessible to the public. People with advanced arthritis are becoming mobile for longer periods and seeing big improvements in their quality of life. Who doesn’t want to be able to remain active for longer and be in less pain?
However, before undertaking major surgery it is important to understand that these procedures are a major stress on the body and mind. An extensive medical history analysis will usually be undertaken before you get that shiny new knee. This process can lead to anxiety and stress and, for some people, may put them off having surgery all together. This is where prehabilitation, or prehab, starts.
The term prehabilitation is a broad concept, which can include a multiple faceted approach. Exercise, nutrition, education and psychosocial aspects can all be adjusted to improve pre-operative fitness and preparedness. The approach taken is dependant on the upcoming procedure and pre-existing health of the individual.
Prehab often includes resistance and cardiovascular training for weight loss, which eases stress on your system whilst under general anaesthetic. It can also be more specific strengthening of the muscles surrounding the affected organ or joint. Recent promising evidence suggests that prehabilitation may reduce the length of hospital stay, thus reducing the risk of infection as well as providing physical benefits post-surgery.
Here are our top 3 tips for best “prehabilitating” before your upcoming procedure:
1. Listen to Medical Staff.
This may seem obvious, but it is often very clear to staff in the operating theatre when a patient has not followed instructions. More often than not, the surgeon and hospital will have provided you with a detailed explanation of the procedure and how they would like you to prepare. This will also include the vital prehabilitation details.
2. Stay as Active as Possible.
This can often be difficult, as many people don’t know where to start or they are worried that they may do themselves more harm. These are both rational and sensible concerns, however they will not result in optimum post-surgery outcomes. This is where a health professional, such as an Accredited Exercise Physiologist, can help to provide information and guidance on moving your body in such a way as to not aggravate your pain or performing cardiovascular exercise at safe intensities so as not to damage cardiac tissue. Both will reduce the impact of sedentary behaviour on your health.
3. Rest Up and Plan Ahead.
If possible, plan your day well ahead of time. Arrive at the hospital with time to spare and a bag packed with all of your overnight essentials and comfort items. The smoother and less stressed the transition into hospital the better you will feel heading into the procedure.
The following links offer some tips for general exercises to help strengthen hips, knees and shoulders.
PLEASE NOTE - These are gentle exercises, but may not be suitable to every individual. We recommend speaking to an exercise physiologist for specific guidance on how to start preparing for any upcoming procedure. Contact us on 5456 1599 for more information.
PREHABILITATION EXERCISE IDEAS
This article was written by Wian van Heerden, one of our qualified Exercise Physiologists based on the Sunshine Coast.
Maradit Kremers, H., Larson, D., Crowson, C., Kremers, W., Washington, R., Steiner, C., Jiranek, W. and Berry, D. (2015). Prevalence of Total Hip and Knee Replacement in the United States. The Journal of Bone and Joint Surgery-American Volume, 97(17), pp.1386-1397.
Santa Mina, D., Clarke, H., Ritvo, P., Leung, Y., Matthew, A., Katz, J., Trachtenberg, J. and Alibhai, S. (2014). Effect of total-body prehabilitation on postoperative outcomes: a systematic review and meta-analysis. Physiotherapy, 100(3), pp.196-207.
Santa Mina, D., Scheede-Bergdahl, C., Gillis, C. and Carli, F. (2015). Optimization of surgical outcomes with prehabilitation. Applied Physiology, Nutrition, and Metabolism, 40(9), pp.966-969.
Australian Orthopaedic Association
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Sunshine and Cooloola Coasts
Wian van Heerden