Pre-Surgery Exercise: How Important Is It ?

As an Exercise Physiologist, my motto is always “Prevention over cure,” and at Optimum we always attempt to put this into practice.

However, sometimes undergoing surgery is necessary to get the best possible outcome for a patient, and this is often the case when an individual has suffered a ruptured Anterior Cruciate Ligament (ACL) and requires the dreaded “knee reconstruction.”

A study I recently came across has shown that a 6 week pre-surgery exercise program (“Prehabilitation program”) can be used to greatly improve the recovery of a patient once the surgery has been completed and get them back to the daily duties and even sport at a much faster rate.

The study used 20 patients with a rupture of the ACL, each of whom required knee reconstructive surgery.11 patients were assigned to the intervention group and underwent a 6-week exercise program prior to the surgery, while 9 patients were placed in the control group and did not undergo an exercise program prior to surgery.

The pre-surgery exercise program consisted of supervised resistance and balance training. This program was comprised of 4 exercise sessions per week, which included 2 supervised gym sessions and 2 supervised home sessions. The primary focus was lower limb strengthening with a quadriceps emphasis, as well as proprioceptive (balance and awareness) training. Each exercise consisted of 3 sets of 12 repetitions and the weights were increased weekly by 10-15%.

Immediately following the 6 week “prehabilitation” exercise program the intervention group showed the following significant improvements:

• Significantly improved single leg hop test (this is particularly encouraging, as it has been documented to be a problematic area for athletes following knee reconstruction as athletes need to have the proprioceptive (awareness) ability and confidence to perform single-leg stopping, cutting, and jumping activities without hesitation).

• Increased Quadriceps and Vastus Medialis (teardrop shaped inner thigh muscle known as the “VMO) cross sectional area (CSA). This is of significant importance as these muscle groups are the first to atrophy (reduce in size) following a knee reconstruction and play an important role in stabilizing the knee.

• Improved scores on a pain questionnaire known as the “Modified Cincinnati Rating System Questionnaire” (mCKRS) which measures how knee pain has affected your ability to manage in everyday life.

12 weeks after the surgery the rate of decline in the single leg hop test was less and the mCKRS was significantly improved in the exercise group compared with the control group. Of particular importance was that on average patients in the prehabilitation group returned to sport in 34.2 weeks versus 42.5 weeks in the control group.

So, exercise can be a powerful medicine, even when surgical intervention is unavoidable. This is significantly important, as I believe many individuals can become very reluctant and negative towards exercise when they know they will be undergoing surgery. I believe an exercise program pre surgery (be it a knee, shoulder, hip, spine) can not only have a positive affect physically on the individual but may also improve their mental attitude and positiveness towards the surgery, which could have just as important an outcome towards their recovery.

So if you or someone you know requires surgery, contact your nearest Optimum Studio and let our  Exercise Physiology team get you started with a pre-surgery exercise program.

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