Should you exercise before surgery? The answer, for many, is yes, provided it is done intentionally and with medical guidance. This preparation, termed “prehabilitation” or prehab, involves structured exercise and health optimization before an operation. The goal is to enhance the body’s physical and psychological readiness to endure the stress of a major surgical procedure. Physical preparation significantly influences how well a patient tolerates the operation, the likelihood of complications, and the speed of recovery. A stronger, fitter body has a physiological advantage when facing surgical trauma, though prehabilitation is not appropriate for all patients or procedures.
The Scientific Rationale for Prehabilitation
Surgery creates a substantial physiological demand on the body, often likened to the stress of running a marathon. Prehabilitation works by building a reserve capacity in the body’s major systems to better absorb this shock. A primary focus is improving cardiopulmonary reserve, which is the combined capacity of the heart and lungs to deliver oxygenated blood. Enhancing this reserve allows the body to maintain stable oxygen levels and function effectively despite the trauma, blood loss, and inflammation triggered by the operation.
Structured exercise, particularly aerobic activity, directly improves cardiorespiratory fitness by increasing the efficiency of oxygen uptake and utilization. This improved efficiency is associated with fewer postoperative complications, especially in higher-risk patients. Exercise also helps manage the catabolic state induced by surgery, where the body breaks down muscle tissue for energy and healing. By building muscle mass beforehand, patients create a larger reservoir of amino acids necessary for wound healing and immune function post-surgery.
A stronger musculoskeletal system translates to better post-operative mobility, which is important for preventing common complications like blood clots and pneumonia. Optimizing physical fitness through prehabilitation buffers the patient against the temporary decline in function that follows major operations, allowing for a faster return to baseline health. Patients who engage in multimodal prehabilitation programs often recover their functional capacity much faster than those who only receive post-operative rehabilitation.
Recommended Types of Pre-Surgery Exercise
The most effective prehabilitation programs integrate three distinct categories of exercise.
Aerobic Exercise
Aerobic exercise is fundamental, aimed at improving endurance and heart-lung efficiency. Low-impact activities such as brisk walking, cycling, or swimming are highly recommended. The goal is moderate intensity, where breathing is noticeably harder but conversational speech is still possible. A common recommendation is aiming for at least 150 minutes of moderate-intensity aerobic activity per week, often broken down into shorter, frequent sessions.
Strength Training
Strength training is an important component, focusing on functional movements that maintain or build muscle mass, which serves as a metabolic reserve for recovery. Exercises like “sit-to-stand” repetitions or using light resistance bands and weights for functional movements are particularly beneficial. Maintaining core and limb strength helps patients manage the physical demands of early mobilization, walking, and using assistive devices immediately after surgery.
Breathing Exercises
A specialized third category involves breathing exercises, which are important for preventing post-operative pulmonary complications like pneumonia. Deep diaphragmatic breathing, where the stomach expands upon inhalation, helps to fully inflate the lungs and mobilize secretions. Techniques like Inspiratory Muscle Training (IMT) strengthen the muscles used for breathing, and practicing the “huff” technique helps patients effectively clear mucous post-operatively.
Crucial Safety Measures and Medical Clearance
Any decision to start or modify an exercise regimen before surgery must begin with obtaining formal medical clearance from the surgeon or primary care physician. Pre-surgical clearance is a comprehensive assessment ensuring the patient is medically stable enough to undertake both the surgery and the preparation. The healthcare provider reviews the patient’s complete medical history, existing conditions, and all current medications, including supplements, to identify potential risks.
Conditions such as unstable angina, severe pain, or an unmanaged injury may make high-intensity exercise inappropriate or dangerous. Specific illnesses, including uncontrolled diabetes, heart disease, or severe pulmonary conditions, require careful management and may necessitate modifications to the exercise plan. The physician uses this evaluation to determine if additional diagnostic testing is needed and to create a tailored strategy that minimizes complications. Patients must avoid activities that carry a high risk of injury, such as contact sports or heavy weightlifting, which could delay the scheduled procedure.
Medical clearance also addresses lifestyle risk factors that compromise surgical outcomes. Counseling for smoking cessation and reduction of alcohol intake is a standard part of prehabilitation, as these factors severely impact wound healing and immune function. Self-guided, aggressive exercise without medical clearance is strongly discouraged due to the potential for harm or complication.
Optimizing Timing for Maximum Impact
The general recommendation is to begin the structured exercise and optimization regimen as soon as the surgery date is confirmed. While any duration of preparation is beneficial, the optimal window for prehabilitation to achieve measurable physiological gains is typically between four and eight weeks prior to the operation. Even a minimal period of two to four weeks of consistent, structured training yields positive effects on functional capacity.
Consistency is more important than extreme intensity, and patients should maintain the regimen throughout the entire preoperative period. As the surgery date approaches, the intensity of physical exercise should be gradually scaled back. Most general and strength-based exercises should be stopped approximately 24 to 48 hours before the procedure to allow the body to rest. However, low-impact activities like gentle walking and essential breathing exercises are often encouraged to continue right up until the day of surgery. This final period of rest ensures the body is not fatigued and has its full energy reserves available for the operation and immediate recovery.