Prehabilitation, often shortened to “prehab,” is a strategy focused on preparing a patient’s body and mind for a major planned physiological stressor, such as surgery or intensive medical treatment. It is a proactive intervention designed to optimize a person’s health status in the weeks leading up to a procedure. The goal is to build up a reserve of physical and psychological capacity, allowing the body to better withstand the trauma of the upcoming event and recover more quickly afterward. A patient’s condition before a procedure strongly influences their outcome after it.
Defining Prehabilitation
Prehabilitation is a comprehensive, multi-modal program that takes place between the decision for a procedure and the procedure itself. It involves targeted interventions to improve a patient’s baseline fitness, nutrition, and mental well-being before the scheduled medical event. Prehabilitation is distinct from rehabilitation, which is a restorative process occurring after an injury or surgery to help the patient regain lost function. Prehab works to prevent or minimize the loss of function, while rehab focuses on recovering function that has already been compromised.
Prehabilitation establishes a higher “physiological reserve,” which is the body’s ability to cope with severe stress. Since major surgery or cancer treatment consumes a large amount of the body’s reserves, proactively raising this level provides a larger buffer against complications and a smoother path back to normal activity.
Core Components of a Prehab Program
A comprehensive prehabilitation program generally addresses three main areas: physical conditioning, nutritional optimization, and psychological readiness. Physical exercise is a primary component, typically including a combination of aerobic training, like walking or cycling, and resistance training, which involves strengthening muscles with weights or bodyweight. This exercise is prescribed and monitored with the aim of increasing cardiorespiratory fitness and building lean muscle mass.
Nutritional optimization focuses on ensuring the body has the fuel and building blocks necessary for healing and recovery. For patients facing surgery or chemotherapy, a focus is placed on protein intake, with recommendations sometimes suggesting 1.5 to 2.0 grams of protein per kilogram of body weight daily. Addressing any pre-existing malnutrition or micronutrient deficiencies, such as low Vitamin D, is also a common step to support immune function and tissue repair.
Psychological preparation is the third area, recognizing that anxiety and stress can negatively impact surgical outcomes. This component often includes education about the upcoming procedure and recovery process to manage expectations and reduce uncertainty. Interventions may also involve specialized support to address conditions like anxiety or depression, helping patients build confidence and a positive outlook for their recovery.
The Mechanism of Action
Prehabilitation’s effectiveness stems from its ability to improve the body before trauma. By engaging in structured aerobic exercise, patients increase their cardiopulmonary reserve. A greater oxygen delivery capacity allows the body to better handle the metabolic demands and stress response triggered by surgery or intensive treatment.
The resistance training component helps to increase or preserve lean muscle mass, which is directly linked to functional capacity. Surgical trauma and some treatments cause an inflammatory state and muscle breakdown, but a higher baseline of muscle mass provides a reserve that mitigates this loss. Improved fitness levels can also reduce inflammation markers in the body and enhance immune function, lowering the risk of postoperative complications like infections. This leads to a smoother recovery trajectory and a shorter hospital stay.
When Prehabilitation is Recommended
Prehabilitation is recommended for procedures associated with significant physiological stress and recovery time. It is commonly utilized before major elective surgeries, such as total joint replacements for the hip or knee, where improved strength and range of motion affect post-surgical outcomes. Patients awaiting cardiac surgery, like coronary artery bypass grafting or valve replacement, also benefit from prehab to enhance their cardiorespiratory fitness and reduce the risk of respiratory complications.
Beyond surgery, prehabilitation programs are widely applied in oncology for patients preparing for cancer treatment. Improving physical health and nutritional status helps patients tolerate the intensity of the treatment itself. For example, prehab is used for patients with breast cancer to improve upper-body function before a mastectomy, or for those with colorectal cancer to improve fitness before abdominal surgery.