Prehab: 4 Things Every Older Adult Should Do Before Surgery

Follow these simple steps to prepare your body, ease your mind, and speed your recovery.

The weeks leading up to surgery can be a scary time. There are so many unknowns, plus a hospital stay isn’t exactly a luxury vacation.

The good news: A little prep work can not only ease anxiety and empower you, but it can also help you recover faster and get back to doing all the things you love. Known as prehabilitation, or prehab, this preparation is effectively training for a surgery.

“If you were going to run a 5K race, you wouldn’t just go do it—you’d train,” says Michael Englesbe, M.D., a professor of surgery and director of the Michigan Surgical Quality Collaborative. “A two-hour surgery is about as hard on someone as a 5K,” he says. “So patients ought to train physically and psychologically for it.”

The benefits of this training are clear: Studies associate prehab with many positive outcomes, including shorter hospital stays, reduced insurance costs, increased likelihood of being discharged to your home rather than a nursing home, fewer post-operation complications, and improved quality of life after the surgery.

“The goal of prehab is to get the patient as strong as possible before surgery so they recover faster after,” says Marcia Russell, M.D., an associate professor of surgery at UCLA Medical Center.

While it’s always best to talk with your surgeon for personalized advice, there are certain general prehab strategies that apply to most older adults. Ideally, you’d start four to six weeks before surgery, but anything is better than nothing. If you’re scheduled for surgery in two weeks, you can still benefit by starting now.

Here’s your four-step prehab plan.

Prehab Step #1: Move Your Body Every Day

“Patients who are able to get out of bed and move around more quickly after surgery are also the ones who leave the hospital sooner and return to their pre-surgery level of living sooner,” Dr. Russell says. The best way to boost your chances of being active soon after a procedure is to be active beforehand.

Walking—outside or on a treadmill—is a great option, since all you need is a pair of supportive shoes and comfortable clothes. Dr. Russell recommends aiming for 30 minutes of walking each day.

“If you can only do 10 minutes to start, then do that,” she says. Gradually build up to longer walks by adding a few more minutes each week. The goal is simply to move more than you do right now and to get your heart pumping every day. Once you’re comfortable with a 30-minute walk, keep it fun and effective with these simple tips for upgrading your walking routine.

If you don’t enjoy walking, other moderate-intensity activities like biking or swimming are also great options.

Doing some form of cardio every day not only builds strength and stamina, but it also gets you in the habit of exercising. So when you’re lying in the hospital bed post-surgery, you’ll be more likely to want to get back to moving—even if that’s just around the hospital ward to start—rather than stay in bed. And that’s the first step on the road to independence.

“If you can’t get out of bed and get to the bathroom, you can’t go home,” Dr. Englesbe says.

In addition to 30 minutes of cardio each day, Dr. Russell also recommends doing one simple exercise: the chair stand or sit-to-stand.

Here’s how to do the sit-to-stand: Simply sit down in a chair and stand up, ideally without the help of your arms. (Though if you need to use them for balance, by all means, do so!) Start by doing five or 10 reps, and gradually build up to 15 or 20 in a row. This will increase lower-body strength, which also helps with getting into and out of bed.

Prehab Step #2: Check Your Diet—and Adjust as Needed

The best prehabilitation diet is an overall healthy diet, Dr. Englesbe says. For older adults, that means the following basic guidelines from MyPlate for Older Adults:

• Half of your plate should be fruits and vegetables of various colors.
• A quarter of your plate should be grains—with an emphasis on whole grains (for example, whole wheat bread, brown rice, and oatmeal).
• The remainder should be protein (nuts, beans, fish, poultry, and lean meat) and a little bit of low-fat or fat-free dairy (milk, yogurt, and cheese).

In addition to eating a well-balanced diet, it’s smart to pay extra attention to your protein intake before a surgery, aiming for at least 0.8 grams of protein per kilogram of bodyweight daily. To see your recommended dietary allowance for protein, multiply your weight in pounds by 0.36, or use this online calculator.

Some hospitals will check blood levels of a protein called albumin as part your pre-op labs, Dr. Russell explains. Low levels of this protein indicate malnutrition, which may lead to more complications post-surgery.

If your pre-op labs reveal low protein levels in your blood, Dr. Russell suggests asking your doctor about adding a protein supplement drink like Ensure to each meal. In addition to increasing your likelihood of a smooth recovery, protein helps everyone maintain lean muscle mass, which supports the immune system and wound healing.

Prehab Step #3: Manage Stress

Research links pre-surgery anxiety, depression, and low self-confidence with worse physiological surgical outcomes and post-op quality of life. So addressing your mental health is just as important as taking care of your physical health.

“We always encourage stress management and give advice on meditation and mindfulness,” Dr. Englesbe says. His clinic also recently began giving patients gratitude journals to write in every day.

If you’re new to meditation, this five-minute follow-along meditation video is a great place to start. If you’d rather try alternative techniques, check out these prescription-free ways to cope with anxiety.

Prehab Step #4: Build Your Support System

Dr. Russell suggests talking to your surgeon ahead of time so you know exactly what to expect—particularly in terms of pain and how to manage it. This can help you build the support system that’s best for your needs and eases anxiety, she says.

For example, you may need someone to drive you around or prepare meals for you. Or if your bedroom is on the second story of your house, you may need to stay with a family member who has a bedroom on the ground floor for the first week after surgery.

Whatever the case, “it’s much easier to do this planning before you’re in the hospital and potentially facing a nursing home,” Dr. Russell says.

Making sure you have family, friends, or neighbors ready to help will put you on the fast track to the independent lifestyle you’re used to. And don’t worry about imposing on others.

“It’s central for recovery to burden your family and friends,” Dr. Englesbe says. But also, there’s a good chance they don’t consider it a burden at all.

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