How Exercise Can Improve Surgical Outcomes

Dr. Mark Panigutti explains why prehabilitation before surgery is crucial in patient outcome and recovery.

We have all heard about the importance of exercise and health. Being an orthopedic surgeon and performing many hip and knee replacements, I've seen this first hand.

The rehab after hip or knee replacement is crucial in the outcome and recovery experience. Pain, fatigue, depression, and, even at times, post-traumatic stress in the postoperative period plays a role in how the patient perceives their recovery and my quality as a surgeon. The impact became evident approximately 15 years ago when I thought it would make sense to have my debilitated or deconditioned patients exercise before surgery.

Less Pain and Fewer Side Effects After Surgery

The results of exercising before surgery—or what is commonly now known as “prehab”—were remarkable. The fatigue, difficulty sleeping, and significant pain—frequently seen the first few weeks after surgery—were surprisingly improved. During postoperative visits, the patients would smile more, meet rehabilitation goals faster, and be impressed with their success at a much higher level than those not willing to participate in the preoperative exercise program.

As the years have gone on, and we have fine-tuned the process, I have even had physical therapists call to ask what I do that makes my patients recover faster/better than others.

I am fortunate to be surrounded by many skilled joint surgeons. I attribute the perception of better recovery to the preoperative exercise and the motivation I put towards this. Scientific studies prove that patients who exercise before joint replacements have less pain, require fewer narcotics, and have better outcomes.

We are lucky that our health system has a health club associated with it. We have built a program for surgical patients to strengthen, build endurance, and increase flexibility beforehand. This process can be done through physical therapy but can be quite costly and has frequency limitations.

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Prehabilitation Programs to Build Endurance and Core Strength

We created a program with our neighboring health club where patients can visit weekly, without an initiation fee, but still get some guidance from a trainer specializing in total joint prehabilitation. Most of these patients have too much pain with prolonged weight-bearing activities. Therefore, we use water walking to build endurance and core strength before surgery.

I have found this type of therapy to be a lot less pain-provoking as it allows patients to exercise for much longer periods without significantly raising pain levels. We focus on water walking 45 minutes to an hour, four to five days a week. Patients prefer warm water pools. And for those unable to or unwilling to use a pool, recumbent ellipticals and recumbent bicycles for 45 minutes to an hour can also be an option.

Over and over, patients will thank me for convincing them to do water walking and even other exercises. Many of these patients have not exercised at a higher level for years. That energetic, endorphin–like feeling associated with good exercising is invigorating to these more sedentary patients.

We are starting to use a similar approach that we have used with joint replacements to those patients recovering from different types of surgery and even cancer treatment. Cancer recovery, especially, is filled with fatigue, depression, and other physical side effects that—likely—can be reduced with exercise. I would encourage physicians, health systems, and exercise facilities to venture together to promote improved recoveries and decreased side effects and complications with a coordinated exercise program focused on improving outcomes.

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Mark Panigutti

Mark Panigutti, MD, has been a board-certified orthopedic surgeon for more than 20 years. He has a BS in biomedical engineering, and has held leadership roles at Southwest General Medical Center in Middleburg Heights, OH, including chief of orthopedic surgery, chief of surgery, and president of medical staff.