Surgery in combination with risk factors such as poor physical and nutritional status have detrimental effects on short- and long-term aspects of recovery and quality of life, especially in elderly patients whose functional reserve is limited. Strategies to minimize these effects and accelerate return to baseline levels have focused on the intra- and post-operative period; however, this may not be the most opportune time to intervene. Instead, the preoperative period may be a more emotionally salient and physically enabling time to initiate an intervention aimed at attenuating surgical stress and enhancing recovery after surgery. The process of increasing patients’ functional reserve in anticipation for surgery is referred to as prehabilitation. Elements of surgical prehabilitation programs include a structured exercise program consisting of both resistance and aerobic training, supplemented by flexibility exercises and nutritional optimization through counselling and supplementation. In general, individuals who are the least fit and the most sedentary have shown the most improvement when they initiate an exercise program. Since their physiologic reserve is limited, even small amounts of physical training can yield significant improvements. The interaction of physical activity and nutrition promotes anabolism, thereby preparing patients to better withstand the stress of surgery and subsequently mitigating the impact on postoperative outcome.
This article speaks to the benefits of a collaborative effort amongst the medical specialties. One to optimize the health of a patient prior to embarking on a surgical procedure. To use nutrition and exercise to optimize the body’s ability to deal with the physical stress of surgery. It also reflects on identifying those patients at risk for postsurgical problems and ways to prevent them.
Prehabilitation: a new area of integration between geriatricians, anesthesiologists, and exercise therapists
Francesco Carli1 · Vanessa Ferreira1
Received: 27 October 2017 / Accepted: 29 November 2017 / Published online: 4 January 2018 © Springer International Publishing AG, part of Springer Nature 2018