Exercise to improve surgical outcomes

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Hi, my name is Jess and I'm a senior physiotherapist. Today, I will be talking to you about exercise, why getting fit for surgery is so important, and how exercise helps you to prepare for surgery and get the best recovery possible.
 
So, you might be wondering, what does exercise have to do with my surgery. Well, one way to think about it is to compare your surgery to running a marathon. You wouldn't go into a marathon without any training and nor should you go into surgery without preparation. You don't need to be marathon-fit but surgery is stressful for the body and the better you prepare, the better you will recover.
 
Undertaking everyday physical activities, such as cleaning the home, are good forms of activity. However, exercise is different because it is planned, structured, and specifically tailored to make improvements to your fitness.
 
There are many benefits of exercise but the most relevant to you are: exercise reduces the chances of having complications, it speeds up your recovery time, and it assists you to go home earlier after surgery. Exercise is considered by many as a wonder drug. Doing any physical activity is better than none. If you are currently not doing any physical activity, start with a small amount and gradually build up. Aim to be active every day of the week. With exercise, we want to target two particular areas of your physical fitness: aerobic fitness and muscle strength.
 
Firstly, aerobic fitness. Aerobic fitness gets your heart beating faster and your breathing rate up such as walking, cycling, or swimming. Aerobic fitness makes your body systems work better, including your heart, lungs, and vessels. This is important as it helps your body to better cope with the stress of surgery and recovery. We recommend that you do 30 minutes of moderate aerobic exercise each day. This can also be broken down to three lots of 10-minute intervals to start with. 
 
Keep in mind that these guidelines are the optimal recommendations. Your health team will provide advice to you after surgery and before you discharge. It is also important to reduce periods of prolonged sitting and move regularly throughout the day. Even shorter amounts of lighter activity has health benefits. For example, gardening, standing up, or walking around the house. 
 
So, what do we mean by moderate intensity? Moderate intensity means you're breathing harder but you're not out of breath. For example, brisk walking or steady cycling on a bike. It is important that you're always moving your body at an intensity that you feel comfortable with. A simple tool can be used to measure your exercise intensity. It is called the rating of perceived exertion scale. It asks you to rate your exertion on a scale from zero to 10 with zero being rest, five being hard and 10 maximal. We want you to be a green to yellow sections.
 
Vigorous exercise is when you go above the yellow into the orange and beyond. If you can exercise at this level, it can magnify the benefits of exercise. Higher intensity bursts with rest intervals can help make this achievable. Your exercise clinician will advise you on how and when to exercise in orange and red zones. Anything in the blue section will not have as great a benefit for you but this is still a start, and better than doing nothing.
 
Choose a type of aerobic exercise that you enjoy and are more likely to be able to fit into your daily routine. You can do this with everyday activities such as parking further away from the shopping centre. This is important so that you can be more physically active in your daily life, even after your surgery.
 
Our second recommendation is doing muscle strength training two to three times a week. This exercise type assists in building up your muscle strength and size. Whenever anybody has surgery, they lose some muscle strength and mass. Having a good reserve of strength before your surgery will allow you to get up and move and be active in your recovery. Examples of strength training include sitting down and standing up repetitively, push ups against a wall, or leg squats.
 
The combination of aerobic and strength training will allow you to be in the best shape possible to recover from your surgery. Remember, any exercise is better than no exercise. You can exercise through your local hospital, community health centre, physio, commercial gym, at home or at a local park. Start small and with lower intensity, then gradually increase the time and intensity.
 
If you're unsure about how to get started, ask your doctor to refer you to the exercise team or speak to your GP about a referral to a physio or an exercise physiologist. Please note, in some situations, you should receive medical clearance before exercising, such as a recent heart attack, chest pain, high blood pressure, and other conditions. Sometimes, you might even need to stop exercising. For example, if you experience pain in your chest or down into your arm, dizziness or fainting, nausea or vomiting, severe shortness of breath, or extreme weakness or fatigue.
 
Exercise is really important to help you recover after surgery. As soon as you wake up from your surgery, you can start the ACOUGH breathing exercises. Either the physio or the nursing team will also help you sit up and get out of bed as soon as it's safe to do so.
 
So let's summarise. Any exercise is better than no exercise. Build up to 30 minutes of moderate to vigorous aerobic exercise at least five times a week. Do two to three strengthening exercise sessions per week and practice the ACOUGH breathing exercises. You have now learnt important strategies to help you prepare for your surgery and assist your recovery.
 
Take exercising seriously and start making an exercise plan to help you get fit for surgery.