Die Genesung nach einer Operation ist schwer. 'Prähabilitation' könnte es einfacher machen.

Rehabilitation is a big focus after surgery, but new research suggests that you can improve your odds of having an easier recovery by making changes before going under the knife. This tactic is called “prehabilitation,” and the recent study suggests it can make a big difference.

“With this information, we can now move forward in helping patients to know what strategies may be best for them to prepare for surgery, and for researchers what key areas need to be the focus of new studies,” lead study author Daniel McIsaac, MD, anesthesiologist, professor, and vice chair of Research & Innovation at the University of Ottawa, told Health.

While prehabilitation is a term that has swirled around medical circles for years, it’s not well-known to the general public. Here’s what you need to know.

Prehabilitation is a strategy used to help people prepare for a major surgery, Michael Sutherland, MD, a general surgeon and senior vice president of member services for the American College of Surgeons, told Health.

'It's very effective in circumstances when the procedure is scheduled at least one week in advance so that you have a little bit of time to take advantage of strategies that help prepare the body for the stress of surgery,' Sutherland said.

Prehabilitation is all about being proactive, not reactive, said Chelsia Gillis, PhD, researcher, assistant professor, and director of perioperative research at McGill University. “We have adopted a view that recovery begins before the surgical incision,” she told Health.

Gillis said the term is “widely accepted” in medicine, although it’s not necessarily widely used.  

For the study, which was published in The BMJ, researchers analyzed data from 186 clinical trials on the prehabilitation methods of nearly 15,700 patients.

The researchers found that people who exercised regularly before their surgery had a 50% lower risk of complications than non-exercisers, while those who followed a healthy diet had a 38% lower risk than those who didn’t. Patients who focused on a combination of diet, exercise, and social support had a 36% lower risk of complications.

People who did a mix of exercise and social support spent two fewer days in the hospital. Meanwhile, those who did diet and exercise prehabilitation had their hospital stay cut by more than a day.

According to researchers, a key limitation of the study is that many of the studies used focused on one hospital. As a result, it’s not clear how well the findings would translate to other settings.

Still, the findings are promising for prehabilitation. “Our review found that prehabilitation based on exercise, nutrition, and especially exercise combined with other approaches were the most promising types of prehabilitation,” McIsaac said.

These findings aren’t entirely surprising, McIsaac noted. “The idea that exercise, nutrition, and psychosocial support would lead to better outcomes after surgery is, on one hand, common sense,” he said. “Across almost all areas of healthcare, being more physically fit, having good nutrition, and feeling mentally well lead to better patient outcomes.”

Though the paper didn’t break down the results by patient age or surgery type, previous studies have focused on these more narrow topics.

A 2023 scientific review, for example, looked at 48 trials examining prehabilitation before orthopedic procedures. It found that of more than 3,500 patients, prehabilitation “significantly improved” function, quality of life, muscle strength, and back pain in patients compared to those who didn’t prep for the surgery. 

In one 2023 randomized clinical trial, researchers analyzed 251 adults with colorectal cancer who underwent surgery. They concluded that experiencing a four-week prehabilitation program led to a “significant reduction” of severe complications. Patients who did prehabilitation also recovered faster and better. 

But a 2024 study that looked solely at outcomes for older adults suggests that prehabilitation may not be as effective. Researchers had patients with a high risk of frailty or malnutrition who were scheduled for surgery undergo at least four weeks of prehabilitation two to three times a week before their operation.

They found that prehabilitation improved the patients’ exercise capacity, mobility, and nutrition but that improvements in muscle strength, cognitive function, and emotional resilience were “minimal.”

The best prehabilitation routine is one that’s tailored to your needs, Tracey Childs, MD, chief of surgery at Providence Saint John’s Health Center in Santa Monica, California, told Health.

„Patienten sollten sich sowohl mit ihrem Chirurgen als auch mit ihren medizinischen Fachleuten in Verbindung setzen und Ratschläge zur Vorbereitung auf die Operation einholen“, sagte sie. „Je früher man mit der Vorbereitung auf die Operation beginnt, desto effektiver wird die prähabilitative Maßnahme sein.“ Eine gesunde prähabilitative Routine kann das Anpassen Ihrer Ernährung beinhalten, um sich auf spezifische Lebensmittel oder Makronährstoffe zu konzentrieren, wie von Ihrem Arzt empfohlen, sagte Sutherland. Ihr Gesundheitsteam kann auch ein Übungsprogramm empfehlen. „Das bedeutet nicht, dass man ein intensives neues Training beginnt; Es kann einfach aerobe Aktivität beinhalten, regelmäßige Spaziergänge in der Woche vor dem Eingriff, Krafttraining und etwas Widerstandsarbeit“, sagte er. „All diese Dinge können zu Hause durchgeführt werden und können angepasst werden, um auf die jeweilige Operation Rücksicht zu nehmen, die Sie durchführen lassen.“ Im Allgemeinen dauert ein „typisches“ Programm vor der Operation laut McIsaac in der Regel vier bis fünf Wochen. Wenn Sie bereits gesund sind, empfiehlt McGillis, sich mit Ihrem Gesundheitsteam abzustimmen, um sicherzustellen, dass Ihre Definition von „gesund“ mit dem übereinstimmt, was Ihr Arzt im Sinn hat. Möglicherweise haben sie spezifische Empfehlungen, die sich von dem unterscheiden, was Sie bereits tun.