'Prehab' before surgery means less time in hospital, better patient outcomes, P.E.I. researcher says
Getting better quickly after a surgery isn't just a matter of how well the procedure went. New research shows that patients, especially older adults, can significantly improve their recovery by preparing for surgery in advance.
This approach is called prehabilitation, or prehab — a program that includes exercise, better nutrition, psychological support, and cognitive training to help position patients to recover faster.
Dr. Daniel McIsaac, originally from Mermaid, P.E.I., is among the people leading a systematic review of prehab published last month. He works in the departments of anesthesiology and pain medicine at Ottawa Hospital.
For the review, McIsaac and his co-authors at Ottawa Hospital Research Institute, McGill University in Montreal and St. Michael's Hospital in Toronto analyzed data from 15,000 patients receiving planned surgeries, as opposed to operations needed on an emergency basis.
They have noticed many benefits for patients who participate in prehab programs, the University of Ottawa professor said.
"We're seeing people get out of hospital a day or two sooner, which is a pretty big impact, if you think about the number of surgeries and patients going through hospitals," he told CBC's Island Morning.
"Once people are getting home, they're having a better ability to walk and get around and be independent at home, and whenever we ask them about their overall quality of life, they're having really meaningful improvements in quality of life as well."
Why it matters
McIsaac said his interest in prehab comes from his experience as an anesthesiologist; he has seen many patients, especially older ones, struggle to recover from major surgery. He wanted to understand how more people could have successful outcomes.
Preparing for surgery starts with the most important decision, he said: whether or not to proceed with the operation. He stressed the need for a thorough discussion with a surgeon about the potential benefits, risks and alternatives, calling that especially crucial for older patients with multiple health conditions.
For those who choose to go ahead, the real work of prehab begins.
While it seems like common sense that exercising and eating better before an operation will help, McIsaac said the stress of preparing for surgery – including attending appointments, undergoing tests and dealing with anxiety – often makes it hard for patients to change their habits on their own.
This patient used 'prehab' before a surgery — and it helped keep him motivated through challenges
27 days ago
Duration 1:57
Christopher Wanczycki, who took part in a prehab program of exercises before colorectal cancer surgery in 2022, says the program started with gradual exercises and levelled up — with support from a professional — over time.
That's where structured prehab programs come in.
"How do we get them to start exercising and keep exercising when they haven't been already? How do we get them to change their diet and get a lot more protein into it?" he said.
"People need help to make these big changes as they get ready for surgery during that stressful time."
McIsaac said successful prehab usually requires at least three to four weeks. Given current wait times for surgery, this actually presents an opportunity for patients to engage in prehab, he added.
Integrating prehab into health-care system
McIsaac hopes prehabilitation can one day become a standard part of the health-care system.
Ideally, as soon as patients decide to have surgery and leave the surgeon's office, they would receive information about prehab and get enrolled in a program, he said.
"Once they're in that program, they're going to need support on a fairly regular basis to check in and make sure that they're doing their exercises… Some people may need to get sent into a gym for support. Some people can do that from home," he said.
"The other thing is just the nutrition, making sure they're getting about a gram to a gram and a half of protein per kilogram of body weight a day. That way, their body is going to be better set to heal after the big surgery that they're going to have."
McIsaac and his team are conducting large-scale, randomized trials across Canada to further explore the impact of prehab.
Their goal is to present this data to health ministers and hospital leaders to advocate for integrating prehab into standard surgical care.
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Dr. Henry Friesen stands among the most distinguished Canadian scientists — if not near the front. A trailblazer whose name echoes not only in the annals of medical science but also the halls of political leadership, the Morden-born doctor made history early in his career. In 1970, three decades before he transformed the medical science landscape by spearheading the Canadian Institutes of Health Research, the young endocrinologist at McGill University had a career-defining breakthrough: he discovered and isolated human prolactin after decades of frustrated attempts by others. Supplied Dr. Henry Friesen, born in Morden, had a long and satisfying career in Canadian health research and advocacy. This has made the difference for many thousands of aspiring mothers, allowing Friesen in collaboration with the pharmaceutical company Sandoz to develop bromocriptine, a drug still used to treat infertility. 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Before joining the Free Press full-time in 2024, he worked in the U.K. and Canadian cultural sectors, freelanced for outlets including The Walrus, VICE and Prairie Fire. Read more about Conrad. Our newsroom depends on a growing audience of readers to power our journalism. If you are not a paid reader, please consider becoming a subscriber. Our newsroom depends on its audience of readers to power our journalism. Thank you for your support.
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- CBC
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Victims of a former Ottawa doctor convicted of sexual assault and voyeurism against his patients at a University of Ottawa health clinic may soon be eligible to receive compensation as part of a settlement with the school. If approved, the proposed $21 million settlement would be disbursed among the members of the class-action lawsuit, including any patient of the University of Ottawa Health Services who was recorded without their consent or sexually assaulted by Vincent Nadon. The proposed settlement, obtained by CBC News, proposes that a team of trauma-informed, experienced psychologists will classify members into four categories "based on the severity of abuse experienced." As part of the fund, an estimated $1 million will be allocated for victims who suffered "past or future income loss or lost educational opportunities." It has been nearly seven years since the class action against Nadon and the university was initiated — "a long and difficult journey to seek justice for the more than 140 known victims," said Sean Brown, the lead lawyer for the firm representing the plaintiffs, in a news release. "We expect that additional survivors may come forward in the days ahead. We are proud of the dedication and perseverance our team showed in securing a just outcome." The university and its clinic admit no wrongdoing, according to the release and the court documents. Hearing set for September Nadon was arrested in January 2018 for secretly recording dozens of his patients over nearly 30 years. He was practising medicine at the university's family health clinic on Rideau Street when the assaults took place. The College of Physicians and Surgeons of Ontario stripped Nadon of his medical licence in 2020, more than a year after he pleaded guilty to 14 sexual assault and voyeurism charges. He was sentenced to eight years in prison, less one year for time already served, but was granted full parole in 2021. A hearing to decide whether to approve the settlement is scheduled for Sept. 8 in Ottawa's Ontario Superior Court of Justice.
