In this blog for people waiting for an operation, Dr Rebecca Gould, Cochrane UK Fellow and Sport and Exercise Medicine Registrar, explores some of the lifestyle changes people can make prior to an operation and Brian Devlin, Cochrane UK Consumer‘Consumer’ is Cochrane’s preferred term for patients (or someone with personal experience of a health condition), care-givers or family members of someone with a health condition. (https://consumers.cochrane.org) Champion, shares his own experiences of getting ready for an operation.
Page updated 25 May 2023, to include the latest evidence on preparing for bowel cancer surgery.
Take-home points
For people who require an elective operation (an operation which is scheduled in advance), waiting for the appointment date can be a difficult time. However, it can also be an opportunity to prepare, by making lifestyle changes (sometimes called prehabilitation), with the aim of reducing the risks of the operation and improving recovery afterwards.
Changes include:
increasing exercise levels
having a healthy diet
stopping smoking (if applicable)
reducing alcohol consumption (if applicable)
losing weight (if applicable)
We will now look at some of the evidence, including reviews published by Cochrane, on the effects of increasing exercise, and reducing alcohol, before having an operation.
It is recommended that aerobic exercises (for example, brisk walking, wheeling a wheelchair, cycling, swimming, jogging, and circuit training) are prioritised, as aerobic fitness is specifically associated with improved outcomesOutcomes are measures of health (for example quality of life, pain, blood sugar levels) that can be used to assess the effectiveness and safety of a treatment or other intervention (for example a drug, surgery, or exercise). In research, the outcomes considered most important are ‘primary outcomes’ and those considered less important are ‘secondary outcomes’. after surgery. People should aim to gradually build up their activity to 150 minutes of moderate-intensity aerobic exercise a week (or 75 minutes of vigorous-intensity). However, this level of activity may not be achievable for everyone and it is worth noting that any increase in exercise will have some benefits. Moderate-intensity activity can be defined in various ways including the ‘talk test’ – you are not able to sing whilst doing the activity but can still talk.
Moderate-intensity activity can be defined in various ways including the ‘talk test’ – you are not able to sing whilst doing the activity but can still talk.
There have been several Cochrane ReviewsCochrane Reviews are systematic reviews. In systematic reviews we search for and summarize studies that answer a specific research question (e.g. is paracetamol effective and safe for treating back pain?). The studies are identified, assessed, and summarized by using a systematic and predefined approach. They inform recommendations for healthcare and research. published recently that look at prehabilitation prior to an operation, in several different conditions..
A recent Cochrane Review Preoperative exercise training for people with non-small cell lung cancer (published September 2022) investigated the effect of exercise programme in people due to have an operation for a particular type of lung cancer (non-small cell). Exercise programmes were short, lasting between one and four weeks, and all included aerobic exercise. Some studies also included different types of exercise such as strength exercises or exercises aimed to help breathing or strengthen the breathing muscles. The authors found, compared to usual care, exercise training resulted in a large reduction in the riskA way of expressing the chance of an event taking place, expressed as the number of events divided by the total number of observations or people. It can be stated as ‘the chance of falling were one in four’ (1/4 = 25%). This measure is good no matter the incidence of events i.e. common or infrequent. of developing lung complications after the operation. Exercise training probably reduced the length of stay in hospital after the operation, probably increased fitness level and was likely to be safe.
Prehabilitation exercise therapy before elective abdominal aortic aneurysm repair (published July 2021) looked at exercise programmes for people prior to elective operations to repair a swelling (aneurysm) in the major blood vessel in the abdomen (abdominal aorta). Exercise programmes included circuit training or training at moderate or high intensity and lasted between one and six weeks. In three out of the four included studies, exercise was done in a hospital outpatient setting under the supervision of a healthcare professional. The authors found, compared to usual care, exercise programmes may slightly reduce heart and kidney complications associated with the operation. The effect of exercise on death within 30 days of the operation, lung complications, need for further surgery, bleeding, and time spent in hospital or intensive care unit were uncertain.
Another Cochrane Review Prehabilitation versus no prehabilitation to improve functional capacity, reduce postoperative complications and improve quality of life in colorectal cancer surgery (published May 2023) looked at the effect of exercise programmes, combined with nutritional and mental health support, in people who were about to have an operation for bowel cancer. The interventions were started 4 weeks before the operation and the authors found that prehabilitation may improve functional capacity (ability to do daily tasks and activities). The effect on other outcomes, such as complications associated with the operation, visits to the emergency department after the operation, or readmission to hospital were uncertain.
Reducing alcohol consumption
A Cochrane Review Perioperative alcohol cessation intervention for postoperative complications (published November 2018) looked at the effect of treatmentSomething done with the aim of improving health or relieving suffering. For example, medicines, surgery, psychological and physical therapies, diet and exercise changes. programmes aiming to help people stop drinking alcohol completely (alcohol cessation) prior to surgery. The authors found 3 relevant studies. All studies were from Denmark, included medication to assist with stopping alcohol, and were performed in men who drank 3 or more units of alcohol a day. Alcohol cessation interventions probably increased the number of men who quit drinking (41 out of 70 participants in the treatment group quit, compared to 5 out of 70 in the control groups).
Alcohol cessation interventions probably reduce the number of complications after the operation needing additional treatment (for example, wound-related complications, need for further surgery, heart and lung complications and admission to intensive care). In the control group, 33 of 61 participants had a complication, compared to 20 out of 61 in the intervention groupA group of people in a study receiving a particular health care intervention (for example a drug, surgery, or exercise)..
Brian’s experience
Brian: I must say I was not aware of the word ‘prehabilitation’ until I was referred for stoma surgery (an operation to divert the end of the bowel through an opening in the tummy wall) in 2018. The main lifestyle advice I was given then was to lose weight and increase my exercise. However, there was nothing specific that I remember – no programme to follow. I muddled along as best I could.
Unfortunately, I went on to develop a parastomal hernia (when the contents of the tummy – usually a small section of the intestines – bulge outward near a stoma). This required another operation to repair but this time I knew I’d be better prepared for surgery.
Rebecca: What was different for you in the lead up to your most recent operation, the parastomal hernia repair?
Brian: I wanted the operation to go as smoothly as possible. I knew I had to lose weight and I was referred to a dietician. With their support I changed my diet and I found this really helpful.I am definitely NOT an exercise person, but I enrolled in a trialClinical trials are research studies involving people who use healthcare services. They often compare a new or different treatment with the best treatment currently available. This is to test whether the new or different treatment is safe, effective and any better than what is currently used. No matter how promising a new treatment may appear during tests in a laboratory, it must go through clinical trials before its benefits and risks can really be known., for people with hernias, looking at the effects of Pilates-based exercises.
Rebecca: Did you increase your exercise in any other way?
Brian: As I said, exercise isn’t really my gig. But dogs are! Totally coincidentally my cousin’s sheepdog had a litter of puppies and we took on one of the pups. One thing collie pups need is a LOT of attention and boy does she need walking! So she has been my key ‘pre-habilitator’.
Rebecca: How did you find doing these new exercises?
Brian: Exercise was difficult at times due to being in pain. However, the pilates was gentle and aimed at beginners – it was something I found I could do, and I loved it. The puppy has kept me going with walking. Overall, I think my mood has changed, I feel less anxious and definitely motivated to keep getting fitter.
Rebecca: Thank you Brian for sharing your experiences. It sounds like you made some big changes to your lifestyle and it’s good to hear you’ve noticed some benefits.
If you’re interested in making some lifestyle changes before an operation…
…You could speak to your pre-operative assessment team, surgeon or general practice team for further advice and support.
You can read their ‘Fitter Better Sooner’ leaflet for general information and advice. They also have several procedure-specific leaflets, such as preparing for cataract surgery, or preparing for a knee replacement operation, and more.
Please note, we cannot give specific medical advice and do not publish comments that link to individual pages requesting donations or to commercial sites, or appear to endorse commercial products. We welcome diverse views and encourage discussion but we ask that comments are respectful and reserve the right to not publish any we consider offensive. Cochrane UK does not fact check – or endorse – readers’ comments, including any treatments mentioned.
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