Working out before surgery leads to fewer complications afterwards

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Working out prior to colon surgery reduces the risk of complications by almost 50%.

This has been revealed by research carried out by Medisch Spectrum Twente (MST), Ziekenhuisgroep Twente (ZGT), the University Medical Center Groningen (UMCG) and Maastricht University (UM). ‘This is scientific proof of what we already suspected: prehabilitation works,’ says UMCG professor and surgeon Joost Klaase, initiator and principal researcher.  The research results have been published in the American journal Annals of Surgery.

Post-surgery complications are common among elderly patients who are not in good physical shape and they can lead, among other things, to longer hospital stays and a decrease in quality of life in both the short and long term. In addition, complications after surgery increase healthcare costs.

Working out with a physiotherapist helps

For many years now, the UMCG and the UM, in cooperation with other healthcare organizations, have been firm believers in the importance of prehabilitation. Whereas rehabilitation is all about getting fit after the operation, prehabilitation focuses on getting the patient as fit as possible before the operation. This research project, led by Annefleur Berkel, a research physician at the MST and a general practitioner in Twente, now shows that prehabilitation has a substantial impact. The researchers made non-fit patients with colorectal cancer work out with a primary care physiotherapist for three weeks before their surgery. Compared to the non-fit patients who hadn’t worked out, the number of complications in the non-fit patients who had worked out decreased by almost 50%. ‘In addition, the patients who worked out reported that they felt increasingly fitter as the work-out programme progressed and that they enjoyed it, despite the intense physical effort required,’ says Berkel.

Widespread roll-out of prehabilitation

Although such preparations before major surgery might seem an obvious step, prehabilitation is yet to be widely implemented in healthcare settings. The UMCG and the UM are pushing for this approach to be introduced at a national level under carefully monitored conditions, which is also increasingly being recommended by international experts. Joost Klaase: ‘Until now, there wasn’t enough scientific evidence to back it up. Now that it has been proven to work for non-fit people with colorectal cancer, we want to work with all parties involved on the national roll-out and evaluation of prehabilitation. For example, arranging reimbursement for physiotherapy prior to surgery and monitoring and evaluating the effects of prehabilitation on a national scale.’

The research was conducted at the hospitals Medisch Spectrum Twente and Ziekenhuisgroep Twente, in collaboration with the University Medical Center Groningen and Maastricht University. Several academic and peripheral hospitals have joined forces to research and implement prehabilitation, including Erasmus MC.

Prehabilitation clinic at the UMCG

‘If you rest, you rust, even prior to major surgery,’ says Klaase. Based on this rationale, the UMCG launched a prehabilitation clinic about a year and a half ago. Here, patients undergoing major surgery are screened before the operation regarding their fitness, nutrition, mental resilience, anaemia, comorbidity (such as diabetes), smoking and alcohol consumption. Klaase: ‘Two out of three patients score unsatisfactorily on one or more of those points. We help them by putting together tailor-made work-out programmes that they can follow in the weeks leading up to their surgery, either at home or at a primary care facility.’

The Groningen Active Living Model

The prehabilitation clinic is part of the Groningen Active Living Model (GALM), which was launched at the UMCG this year. The GALM project aims to integrate patients’ lifestyles into care pathways and comprises both prehabilitation and ongoing lifestyle guidance and advice during treatment and recovery. GALM forms the basis for research and teaching in lifestyle medicine. In 2021, four focus projects will be launched. In addition to the prehabilitation clinic, the departments of dental, oral and maxillo-facial surgery and plastic surgery and the Groningen Transplant Centre are also involved, in close collaboration with the Centre for Rehabilitation. GALM reflects the UMCG’s commitment to the Healthy Ageing priority area.

More information about the research is available here.