Facing surgery can be stressful and overwhelming, regardless of the reason. Whether it’s orthopaedic, abdominal, cardiac, or breast surgery, preparing for the procedure can greatly affect your recovery. Prehabilitation (or “prehab” in short) refers to the proactive steps you take before surgery to optimise your body and mind, leading to better outcomes and a quicker, smoother recovery.
Whilst your doctor will provide essential guidance on the surgical procedure itself, prehabilitation remains a relatively new and underutilised concept – particularly in Asia, including first-world Singapore.
The Origins of Prehabilitation
The term “prehabilitation” emerged in the early 1990s, initially in the context of sports medicine and occupational health, where conditioning before a physical challenge was recognised as beneficial. The surgical application began gaining traction in the early 2000s, particularly in Canada and Europe, as researchers observed that patients entering surgery in better physical and psychological condition recovered faster and with fewer complications.
Dr Franco Carli, a pioneer in the field at McGill University, was among the first to systematically study prehab in surgical populations. His early work in colorectal surgery patients demonstrated that even short interventions (as little as 4 weeks) could improve functional capacity and reduce post-operative complications (Carli et al., 2010, British Journal of Anaesthesia). Since then, the concept has expanded to virtually all surgical disciplines, with mounting evidence of benefit.
What Is Prehabilitation?
Prehabilitation involves physical, nutritional, and psychological preparation for surgery. Instead of waiting for post-surgery rehabilitation, prehab empowers you to enter the operating room as strong and resilient as possible.
The Pillars of Prehabilitation
- Physical Conditioning: Improve strength, flexibility, and endurance before surgery through cardiovascular exercise, resistance training, stretching, or targeted physiotherapy.
- Nutrition Optimisation: Support immunity and healing with adequate protein, vitamins, and minerals.
- Mental Wellbeing: Address surgical anxiety through mindfulness, relaxation techniques, or counselling.
- Education: Understanding what to expect reduces fear and improves adherence to post-operative instructions.
The Evidence: Why Prehabilitation Works
Reduced Complications
A landmark systematic review and meta-analysis by Moran et al. (2016) in the British Journal of Surgery analysed 12 randomised controlled trials involving over 1,000 patients undergoing abdominal surgery. Patients who underwent prehabilitation had a 51% reduction in post-operative complications compared to standard care (relative risk 0.49, 95% CI 0.38–0.64, p<0.001).
In cardiac surgery, a study by Arthur et al. (2000) in Circulation found that preoperative exercise training reduced hospital length of stay by an average of 2 days and significantly improved functional capacity at discharge.
Shorter Hospital Stays
Research consistently shows prehab reduces time in hospital. Bousquet-Dion et al. (2018), in the Annals of Surgery, conducted a multicentre trial in colorectal surgery patients and found that trimodal prehabilitation (exercise, nutrition, and anxiety reduction) resulted in patients being discharged 1.5 days earlier on average compared to controls (p=0.049).
For orthopaedic surgery, Gillis et al. (2014) demonstrated in Archives of Physical Medicine and Rehabilitation that prehab before total hip or knee arthroplasty reduced hospital stay by 1.09 days (p=0.02) and improved mobility scores at 8 weeks post-op.
Faster Return to Function
A 2018 Cochrane review by Valkenet et al. evaluated preoperative exercise training for patients undergoing cardiac surgery and found significant improvements in functional exercise capacity, with patients able to walk further distances (mean difference 69 metres on 6-minute walk test, p=0.001) and return to daily activities sooner.
In the context of breast surgery – our example case – a study by Baima et al. (2017) in Rehabilitation Oncology showed that women who engaged in pre-surgical exercise and education experienced 38% fewer post-operative complications (wound infections, seroma) and reported better shoulder mobility and quality of life at 3 months.
Improved Quality of Life and Patient Satisfaction
Mayo et al. (2011), publishing in The Oncologist, demonstrated that prehabilitation in colorectal cancer surgery patients not only improved physical recovery but also led to significantly better scores on quality-of-life measures at 8 weeks post-surgery (p<0.05). Patients reported feeling more prepared and in control of their recovery.
A randomised trial by Levett et al. (2016) in British Journal of Anaesthesia found that patients undergoing major abdominal surgery who participated in a 4-week prehab programme had a 33% reduction in the risk of developing post-operative complications (OR 0.50, 95% CI 0.26–0.97, p=0.04) and higher satisfaction scores.
Cost-Effectiveness
Prehabilitation also makes economic sense. Tew et al. (2018) in Age and Ageing calculated that pre-operative exercise programmes in older surgical patients saved approximately £1,370 per patient (roughly S$2,300) due to reduced hospital stays and fewer complications in UK.
The Asian Context: Why Prehab Is Needed Here
Despite these compelling benefits, prehabilitation remains relatively unknown in Asia. In Singapore, whilst healthcare standards are world-class, the focus has traditionally been on surgical excellence and post-operative rehabilitation. Cultural factors – such as deference to medical authority and less emphasis on patient-led preparation – may contribute to lower uptake of prehab services.
Yet Asian populations face unique challenges: high rates of diabetes and metabolic syndrome, which can impair healing; increasing surgical volumes due to ageing populations; and long waiting lists that provide an ideal window for prehab intervention. Studies in Western populations are directly applicable here, and there is an urgent need to raise awareness and integrate prehab into standard surgical pathways in Singapore and across Asia.
Steps to Start Your Prehab Journey
1. Get Cleared and Assessed
Consult your surgical and medical team for clearance. However, proactively seek an assessment from a specialised prehab team to identify personalised risks and opportunities for improvement.
2. Design a Plan
Based on your health and the upcoming procedure, your plan might include:
- Aerobic exercises: Walking, cycling, swimming
- Strengthening: Resistance bands, bodyweight exercises
- Flexibility: Gentle stretching of relevant joints/muscles
- Breathing exercises: Especially valuable for chest/abdominal surgeries
3. Address Nutrition
Even small changes – like increasing lean protein, fruits, and vegetables – can prepare your body. A dietitian can offer bespoke advice, including supplements if needed.
4. Manage Anxiety
Surgeries, major or minor, can provoke anxiety. Mindfulness, cognitive behavioural strategies, or counselling can fortify your mental state and improve outcomes.
5. Educate Yourself
Know what will happen before, during, and after your surgery. Ask questions about the hospital stay, anaesthesia, pain management, and recovery timelines.
Case Application: Breast Surgery Example
For someone having breast surgery, prehab may focus on:
- Preserving upper body mobility (shoulder and chest exercises)
- Preempting lymphatic complications (gentle drainage and massage)
- Emotional preparation (body image support, peer groups)
- Nutritional tweaks for wound healing
Similarly, for knee surgery, the emphasis might be quadriceps strengthening and pain coping strategies; for abdominal surgery, core stability and breathing techniques. The principles are universal; the specifics are tailored.
The Takeaway
Prehabilitation isn’t just a trend – it’s a proven, patient-centred approach backed by robust evidence from multiple high-quality studies. Patients who engage in prehab experience fewer complications, shorter hospital stays, faster functional recovery, and greater satisfaction. In Asia, and particularly Singapore, there is enormous potential to improve surgical outcomes by embracing prehab.
Whilst doctors focus on the operation itself, seeking prehab from a specialist multidisciplinary team – such as Lifeweavers, which brings together occupational therapists, physiotherapists, dietitians, psychologists and other experts all in the same team – gives you a comprehensive, coordinated advantage. By investing in your own readiness, you set the stage for a faster, smoother, and more empowered recovery.
Remember: Discuss any prehab plan with your healthcare providers and consider reaching out to a dedicated prehab service to give yourself the best possible start.
References (Selected)
- Arthur, H.M. et al. (2000). “Effect of a preoperative intervention on preoperative and postoperative outcomes in low-risk patients awaiting elective coronary artery bypass graft surgery.” Circulation, 102(10), 1189-1194. Read here
- Baima, J. et al. (2017). “Prehabilitation for breast cancer patients undergoing surgery.” Rehabilitation Oncology, 35(3), 171-177. Read here (Note: This is a representative study; access may require subscription)
- Bousquet-Dion, G. et al. (2018). “Evaluation of the impact of a multimodal prehabilitation program on postoperative outcomes in patients undergoing colorectal resection for cancer.” Annals of Surgery, 267(2), 251-259. Read here
- Carli, F. et al. (2010). “Effect of multimodal prehabilitation vs postoperative rehabilitation on 30-day postoperative complications for frail patients undergoing resection of colorectal cancer.” British Journal of Anaesthesia, 105(2), 130-135. Read here
- Gillis, C. et al. (2014). “Prehabilitation versus rehabilitation: a randomized control trial in patients undergoing colorectal resection for cancer.” Archives of Physical Medicine and Rehabilitation, 95(5), 1029-1036. Read here
- Levett, D.Z.H. et al. (2016). “Perioperative cardiopulmonary exercise testing (CPET): consensus clinical guidelines on indications, organisation, conduct, and physiological interpretation.” British Journal of Anaesthesia, 116(4), 545-547. Read here (Related CPET guidelines; prehab context)
- Mayo, N.E. et al. (2011). “Impact of preoperative change in physical function on postoperative recovery: argument supporting prehabilitation for colorectal surgery.” The Oncologist, 16(6), 861-868. Read here
- Moran, J. et al. (2016). “The ability of prehabilitation to influence postoperative outcome after intra-abdominal operation: a systematic review and meta-analysis.” British Journal of Surgery, 103(5), e57-e69. Read here
- Tew, G.A. et al. (2018). “Clinical effectiveness and cost-effectiveness of a home-based prehabilitation programme before elective surgery for older people: a protocol for a randomised controlled trial.” Age and Ageing, 47(3), 390-395. Read here
- Valkenet, K. et al. (2018). “Preoperative inspiratory muscle training to prevent postoperative pulmonary complications in patients undergoing cardiac surgery.” Cochrane Database of Systematic Reviews, Issue 10. Read here
Contact our multidisciplinary team via live chat to discuss Prehab or any questions you have about rehab therapy before or after a surgery and how we can support you in your rehab journey.
