Features July 2013 Issue

Getting Your Body and Mind in Top Shape for Surgery

Why a pre-habilitation exercise plan can help ensure surgical success and ease your mind.

Just as an athlete physically trains to maximize his or her performance for a big event, so should those who are preparing for joint replacement surgery. While the best surgeon and physical therapy are hallmarks of success, proactive exercise is proving an invaluable player in overall outcomes.

Strengthening muscles helps you prepare for a more successful surgery.

Joint-replacement patients expect physical therapy after surgery, but emphasis on a pre-exercise program, also known as “pre-hab,” along with education on what to expect from the procedure, can help prepare the patient both physically and mentally, according to Cleveland Clinic Florida orthopaedic surgeon Juan Suarez, MD.

“We want to make sure the patient is in the best physical shape as well as mentally prepared before the procedure. By beginning an exercise program and receiving in-depth information weeks prior to surgery, we help eliminate the mystery of how to regain mobility and alleviate anxiety about the procedure,” says Dr. Suarez.

Pre-hab proof
Research is showing that pre-habilitation before surgery–or “pre-hab”–is helping patients become mobile sooner and recover faster. A study published in Arthritis Care & Research (October 2006) examined whether exercising prior to hip or knee replacement would benefit patients with end-stage osteoarthritis in terms of function, pain and muscle strength before or after surgery. The research found that knee- and hip-replacement surgery patients who had participated in water- and land-based strength training, and aerobic and flexibility exercises just six weeks prior to surgery reduced their odds of inpatient rehabilitation by 73 percent.

“We’ve long known that patients who are deconditioned will have a more difficult recovery from surgery,” says Dr. Suarez. “Many arthritis patients are deconditioned due to limited mobility, causing us to possibly delay the procedure. It’s during this time that we recommend pre-hab to improve their condition.”

According to the research, pre-hab benefits patients most in the first 24 hours after surgery. The pre-hab exercisers in the study were also more likely to walk more than 50 feet at the time of hospital discharge. Those who exercised responded differently before surgery and immediately following surgery depending upon the joint replaced.

The strength a patient gains prior to surgery through pre-hab is the key to meeting physical goals, according to athletic trainer Anna Hale, MS, ATC/L, who practices in Cleveland Clinic Florida’s department of orthopaedics. “Many patients who have put off surgery for an extended period of time often make their pre-surgery condition more challenging. By restoring muscle strength, the faster they will recover afterwards.”
Beginning a pre-hab program for six weeks prior to surgery is the gold standard, but two weeks can be beneficial, says Hale. “We know that pre-hab can help decrease pain and increase strength, but it won’t prevent the need for surgery.”

Knowledge is power
As the muscles are strengthened for surgery, mental preparation can help the patient gain confidence and be realistic about setting and achieving postoperative goals. At Cleveland Clinic Florida, joint replacement surgery patients take part in pre-operative teaching classes given by the orthopaedic department’s nurses and physical therapists.

“Explaining what to expect from surgery and offering guidance on exercises, allows patients to be a part of the process and understand their limitations,” says Dr. Suarez, who performs 350 joint replacement surgeries each year. “Preparing the patient both physically and mentally helps improve the surgery’s success, which leads to overall satisfaction.”