Preparing Your Body for Surgery: The Power of Prehabilitation
When facing major surgery, most people focus on the procedure itself and the recovery afterward. Few consider how they might prepare their bodies beforehand. Yet this preparation period—known as prehabilitation or “prehab”—could significantly impact surgical outcomes. Much like training for a marathon, conditioning your body before undergoing the physical trauma of surgery can lead to better recovery and fewer complications.
In a groundbreaking study published in JAMA Surgery, researchers have demonstrated that personalized prehabilitation programs can meaningfully alter patients’ immune responses in ways that may reduce post-surgical complications. The study followed 54 adult patients scheduled for major surgeries, primarily abdominal procedures requiring general anesthesia. Half received standard prehab instructions in booklet form covering exercise, nutrition, and cognitive training to follow independently for two to six weeks before surgery. The other half participated in a customized program with twice-weekly remote sessions with specialists who tailored exercises to individual preferences and created nutrition plans using ingredients already in patients’ kitchens—a personalized approach designed to increase adherence and effectiveness.
The findings were remarkable. Using artificial intelligence to map patients’ immune systems through blood samples, researchers discovered that prehabilitation produced two significant cellular changes: a reduction in overactive immune responses that typically cause excessive inflammation after surgery and a decrease in certain T cell responses associated with post-surgical cognitive decline. While these changes were present in both groups, they were substantially more pronounced in patients who received the personalized program. As Stanford University immunologist Brice Gaudillière explains, prehab essentially “tunes a patient’s immune system before surgery so they’re better equipped to mount an efficient response” to the trauma of the procedure.
These immune system improvements appeared to translate into meaningful clinical outcomes. Among participants who received standard prehabilitation, eleven experienced moderate-to-severe complications after surgery. In contrast, only four patients in the personalized prehab group faced similar complications. Though the researchers caution that the study’s small size limits definitive conclusions about the connection between immune system changes and clinical outcomes, the results are promising. Gaudillière notes that while prehab’s effects aren’t as dramatic as taking steroids, they’re comparable to what might be expected from a pharmaceutical intervention—without the accompanying side effects.
Perhaps most significantly, this research identifies specific biological markers that could help measure the effectiveness of different prehabilitation techniques. As Franco Carli, a leading prehabilitation researcher at McGill University points out, “This is a complex intervention. It’s not just a tablet.” Understanding which immune responses are most affected by prehabilitation could help researchers fine-tune programs to maximize benefits for future surgical patients. This targeted approach represents a significant advancement over current one-size-fits-all prehab regimens.
The study underscores a paradigm shift in surgical preparation: rather than entering surgery unprepared, patients can actively participate in optimizing their bodies for the challenge ahead. Just as no athlete would attempt a marathon without training, perhaps we shouldn’t undergo major surgery without similarly preparing our bodies for the stress and trauma to come. By tailoring prehabilitation programs to individual needs and preferences, medical professionals can potentially reduce complications, improve recovery times, and minimize cognitive impacts—transforming how we approach surgical preparation and potentially improving outcomes for millions of surgical patients worldwide.
