Exercise before surgery improves outcomes and shortens recovery time—new research

by Kari Clifford, The Conversation

edited by Lisa Lock, reviewed by Andrew Zinin

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Globally, about two in three people will need major surgery at some point in their lives.

While preparing for a major operation, patients usually focus on the surgery itself. But recovery also places a substantial demand on the body.

Having enough cardiorespiratory reserve—the body's spare capacity to meet a sudden increase in demand for oxygen, whether from walking uphill or dealing with an infection—is important.

This also helps people cope with the stress of surgery, inflammation and the effort of getting moving again.

Using the time before surgery to improve a person's physical fitness and readiness for recovery is called "prehabilitation." This can include exercise, nutritional support, psychological preparation and making sure other medical conditions are under control.

Exercise is often the central component, but an important question remains: Does it matter whether patients exercise under supervision, or can they achieve similar benefits at home on their own?

Our new systematic review of research examined this question. We brought together evidence from 42 studies involving 4,825 adults, including people preparing for colorectal, lung, cardiac, vascular and other major operations.

The answer is encouraging, but not as simple as "supervised is better."

What the evidence shows

Thirty of the included studies used supervised exercise, while 12 used unsupervised exercise. Supervised exercise took place in a hospital or exercise facility, with health care or exercise professionals present.

Unsupervised exercise was usually home-based, supported by instructions, exercise diaries or other forms of monitoring.

None of the studies directly compared supervised and unsupervised exercise in the same trial. Instead, we compared the results of separate groups of studies. That means the findings show associations rather than a causal relationship.

Both types of programs were associated with improvements in the six-minute walk test, a practical measure of functional capacity. The difference between exercise and usual care (without an exercise program) was statistically significant, but there was no clear evidence that either type of program was superior.

This suggests many patients can improve their walking capacity through a structured exercise program, even one based at home.

However, the improvement in walking distance was small: less than 1 meter (3 feet) on average in the analyses. This change is unlikely to represent a meaningful improvement in everyday function for most patients.

Postoperative complications

A different pattern emerged for postoperative complications. Aerobic exercise before surgery was associated with lower odds of complications. But this association was seen only in the supervised studies.

Supervised exercise was associated with about 40% lower odds of a postoperative complication. The association was stronger in analyses of high-intensity exercise, where the odds of complications were approximately halved compared with usual care.

The studies included different patient groups and combinations of exercise, nutrition and psychological support. The supervised programs were more likely to include high-intensity exercise, while unsupervised studies mostly involved lower-intensity activity.

Because of these differences, we cannot say with certainty that supervision was the active ingredient. The result could partly reflect differences in exercise intensity, the patients recruited, the operations being undertaken or other components of the programs.

Why exercise intensity may matter

Cardiorespiratory fitness describes how effectively a person uses oxygen during exercise. One common measure is peak oxygen consumption (VO₂peak). In our review, improvements in VO₂peak occurred only among people in supervised studies. Most of these programs included intervals of intense exercise.

Supervision may help in several ways. A clinician or exercise professional can assess whether exercise is safe, monitor symptoms and progressively increase the intensity.

There is also a behavioral component. Attending a supervised session creates structure and accountability. It may be easier to do challenging exercise when someone else is present to offer encouragement.

For patients, the practical message is to ask their surgical or primary care team whether prehabilitation is available and what type of exercise is appropriate. A program should ideally include a clear exercise prescription, a way to monitor progress and advice about when to stop exercising.

Our findings suggest supervision may be particularly valuable when the goal is to deliver high-intensity exercise.

But any form of prehabilitation should be safe and accessible. Digital tools such as exercise apps may help, and support from family members or caregivers may also be useful with appropriate guidance.

What we still need to know

No study directly compared supervised and unsupervised exercise, so we don't know whether supervision is significantly better than home-based exercise. Future trials should compare clearly defined supervised and unsupervised programs and focus on reporting outcomes relevant to health care.

The most useful outcome is not whether a patient can walk a little farther on assessment. It is whether they experience fewer complications, recover more quickly and return to the activities that matter to them.

The evidence suggests exercise before surgery is worth taking seriously. Patients may improve fitness with either supervised or home-based programs.

But when the aim is to achieve higher exercise intensities that may reduce postoperative complications, professional supervision could be important because it may help patients exercise at a level that is difficult to achieve safely and consistently alone.

Journal information: British Journal of Anaesthesia

Key medical concepts

Postoperative ComplicationsPrehabilitation

Clinical categories

General surgeryFitness & Physical activityAllied healthFamily medicineCommon illnesses & Prevention Provided by The Conversation Who's behind this story?

Lisa Lock

BA art history, MA material culture. Former museum editor, paramedic, and transplant coordinator. Editing for Science X since 2021. Full profile →

Andrew Zinin

Master's in physics with research experience. Long-time science news enthusiast. Plays key role in Science X's editorial success. Full profile →

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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