New research from The Ottawa Hospital delivers a powerful but conditional message about preparing for surgery: structured exercise and nutrition programs before an operation can dramatically improve recovery for frail older adults, but patients must commit to the work.
World's Largest Trial Reveals Key to Success
The study, published in the journal JAMA Surgery and led by Dr. Daniel McIsaac, is the world's largest clinical trial on prehabilitation, or "prehab." It involved 847 frail older adults across 13 surgical centres in Canada, including Ottawa. The key finding was clear: participants who completed at least 75 per cent of their prescribed exercises experienced measurably lower levels of disability after their surgeries.
Dr. McIsaac, an anesthesiologist at The Ottawa Hospital and a clinical research chair at the University of Ottawa, emphasized that prehab is not a passive treatment. "Prehab isn't like a pill. If it were a pill and people could take it, it would be a blockbuster," he said. "It is a lot easier to take a pill than go outside on a cold December day."
The Program and Its Impact on the Health System
Participants randomized to the prehab group followed a home-based program for at least three weeks before their operations. They received:
- Personalized exercise plans with instructional videos.
- An elastic band for strength training and a pedometer.
- Protein supplement coupons to improve nutrition.
- Weekly check-in calls from a prehab coach for support.
The potential benefits for the healthcare system are substantial. More than 20 per cent of major surgery patients suffer complications, leading to longer hospital stays and extended time away from normal life. Frail seniors are at the highest risk. Effective prehab that reduces these complications could ease significant strain on medical resources.
An Ottawa Success Story
Ottawa resident Christopher Wanczycki became a testament to the program's potential. He enrolled in the study about two months before scheduled cancer surgery. By diligently following the prehab regimen, which included activities like cross-country skiing, he significantly improved his fitness ahead of the procedure.
"This study shows that older adults with frailty who have enough time and support before surgery to fully engage in a prehab program are likely to experience a better recovery and less disability after surgery," Dr. McIsaac concluded. The research underscores that while the path to better surgical outcomes requires patient dedication, the rewards for individuals and the healthcare system can be profound.
