Prehab helps in preparation for surgery

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Dear Doctor: A friend from work needs surgery for lung cancer. He was doing breathing exercises, which he said was part of prehab -- something I’ve never heard of. I don’t want to bother him with questions, but am curious: What’s prehab, and why would it be important?

Dear Reader: Prehab is shorthand for prehabilitation, similar to rehab and rehabilitation. It’s based on the idea that patients, by building up strength and stamina before their surgery, may be able to improve their post-surgical recovery.

Prehab first became common with orthopedic surgeries such as hip, knee or shoulder replacement; rotator cuff surgery; joint fusion; and ACL surgery. These are procedures that require sustained physical therapy for the patient to recover full function.

The thinking was that the enhanced fitness achieved through a program of prehab could help prepare orthopedic surgical patients for rehab, and thus ease and even speed their recovery process. The concept of prehab gradually began to be adapted to other types of surgeries and procedures, including cancer surgeries.

Some people with non-small cell lung cancer diagnosed at an early stage may be helped by surgery. It’s a complex procedure that can range from cutting out a small portion of the lung to the removal of the entire lung. Unfortunately, not all patients are suitable candidates.

Among the criteria that make a patient eligible is an assessment of the individual’s physical condition, and whether they are physically fit for surgery; this includes having certain levels of heart and lung function. In some cases, these levels can be improved with a program of physical exercise, breathing exercises and other types of therapy. Some lung cancer patients deemed unfit for surgery have, with a targeted program of prehab, been able to improve their heart and lung function enough to go ahead with their procedure.

Prehab has also been shown to improve a lung cancer patient’s recovery following surgery. In a study published in 2019, researchers followed two groups of patients undergoing surgery for non-small cell lung cancer. One group took part in a two-week prehab program. This included performing daily aerobic exercise, resistance training and breathing exercises, as well as following specific nutritional guidelines. They also received counseling and psychological support. The other group of patients had no special preparation prior to surgery. The study participants were evaluated one month after each of their surgeries. The group of patients who had participated in prehab was found to have better heart and lung function than the group that had no prehab.

So far, studies that quantify the benefits of prehab are limited. However hospitals that offer this type of approach say their patients feel supported by the programs. They report that the techniques they learn help them not only through the immediate aftermath of surgery, but into their long-term recovery.

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(Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health.)