Prehabilitation: supporting surgical patients physically and emotionally
Our world-leading research shows prehabilitation improves wellbeing, speeds up recovery and reduces problems after surgery. It may even shrink tumours.
Training for surgery to improve physical fitness is called prehabilitation.
Chemotherapy causes a loss of fitness. We showed that supervised high-intensity exercise reversed this.
Our WesFit trial trained personal trainers to supervise patients exercising in local gyms. Patients were keen to take part and 87% completed the course.
We quickly adapted this during the pandemic by launching the Safefit programme.
Restoring fitness after chemotherapy
Major surgery is like running a marathon. Training for surgery to improve physical fitness is called prehabilitation.
Prehabilitation also involves improving mental health and diet. It helps patients cope with the stress of surgery.
We were the first to show that chemotherapy reduces fitness. We linked this to poor outcomes after surgery. Then we showed that supervised high-intensity exercise reversed the effects of chemotherapy.
The exercise was safe, do-able and valued by patients. It also improved fitness and quality of life after surgery (published here).
Exploring the causes
To develop better care, we explored the causes of these effects.
We showed that chemoradiotherapy (CRT) damages mitochondria, the cells’ powerhouses, in muscles (published here). Exercise reversed some of these effects and improved muscle mass.
We were also the first to show high intensity exercise during CRT may increase tumour shrinkage (published here).
Taking prehabilitation into the community
Our regional WesFit trial took prehabilitation into the community. We were funded by the NHS organisation that transforms cancer care.
We trained personal trainers to supervise patients exercising in local gyms. The programme was safe, patients were keen to take part and 87% completed the course.
When COVID-19 hit, cancer care was disrupted. We responded by adapting our programme to set up the Safefit programme. This supported patients remotely by video call or telephone. We trained personal trainers to deliver exercise, emotional and dietary support.
We have advanced prehabilitation through national and international roles.
We led the NIHR/RCOA/MacMillan guidance for prehabilitation in patients with cancer. We also co-founded the International Prehabilitation Society, and chaired the Prehabilitation World Congress.
We contributed to the Royal College of Surgeons/Anaesthetists guidance. This recommended prehabilitation for all patients before surgery.
In 2020, we won the Cancer Initiative of the Year award for WesFit.
What do we plan to do next?
Our future work aims to understand better how exercise works in prehabilitation. We particularly want to find out how it may shrink tumours.
We also intend to develop new personalised prehabilitation packages, based on a patient’s needs.
We will explore whether prehabilitation works before immunotherapy (a different type of cancer treatment), and develop a regional prehabilitation service for patients on palliative care pathways.
Through this, we will improve wellbeing and survival for patients facing the toughest test of their lives.