Major Surgery is Like Running a Marathon – Both Require Training

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Prehabilitation is the concept of increasing an individual’s exercise capacity to physically prepare them for their upcoming surgery. The OpFit prehabilitation programme is a pre-operative exercise programme for patients who are scheduled for cancer surgery in St. James’ Hospital. We have based our programme on the current research on pre-operative rehabilitation, and also the Macmillan “Principles and Guidance for Prehabilitation within the Management and Support of People with Cancer” (2019).

All patients scheduled for surgery in >2 weeks are referred to the programme by their medical teams and invited to attend a daily exercise class in the physiotherapy department. The physiotherapist carries out an assessment of physical fitness, muscle strength, BMI, frailty, quality of life and mood, and gives advice and information on lifestyle factors such as smoking, alcohol intake and sleep where appropriate.

Patients are then enrolled in the programme and provided with a class timetable and exercise advice and information. During the exercise classes, patients are guided through a structured programme of resistance, aerobic and chest clearance exercises in the gym in the physiotherapy department.

Patients who are unable to attend the programme are invited to attend a 1:1 physiotherapy out-patient appointment where their fitness is assessed and an individualised home-based exercise programme is prescribed, with follow-up weekly telephone calls from the physiotherapist.

During the first 6 months of the programme, 309 patients were referred to the service. A total of 118 patients attended the prehabilitation exercise classes, with the median number of classes attended being 3 (range 1-15).

An additional 63 patients attended the 1:1 physiotherapy appointment, and a further 49 patients were supplied with educational materials on increasing exercise capacity in the pre-operative period via post or email.

The largest amount of patients were referred from the thoracic service (n=168), followed by upper GI (n=60), colorectal (n=48), and head and neck (n=38) services. Preliminary data has shown that the prehabilitation programme can decrease hospital LOS for patients undergoing thoracic surgery by up to 5 days (mean 8.5 vs 13.5 days). A full statistical analysis of all patient groups will be carried out as numbers of referrals to the programme increase.

Patient feedback on the service to date has been very positive:

“I was amazed by the option to do physio before surgery. My God, it’s so good. Really gets you into the mind frame on how to progress your recovery without looking for a pill. Keep it up, it’s a great medicine.”

“I liked the intensity of the programme, and all the different types of exercises I had to do. It helped me a great deal after my surgery. Thank you so much.”

“I think the exercise programme is a great idea, I met with some other patients within the group, which was nice.”    

Since the outbreak of COVID-19 in Ireland, there has been a lot of change in the running of the programme. We are continuing to receive referrals for patients who are having elective cancer surgery, and now carry out all of our assessments and treatments virtually. The initial assessment is carried out both over the telephone and via BlueEye video consultations. We are also running a daily aerobic and strengthening class via Zoom.

Patients receive a weekly follow-up phone call to discuss the home based exercise programme and to update it as needed. Patients are also given advice on exercising safely during Covid-19, and are directed to resources such as the Marie Keating Foundation and the HSE website which offer support for people with cancer during Covid-19.

This Blog was written by Sarah Moore, Clinical Specialist Physiotherapist in the Prehabilitation Service, St. James’s Hospital.

Email: samoore@stjames.ie

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