How to prepare for surgery for a stronger recovery

Dr. Scott Ellner spent more than 20 years as a general surgeon. Now a leading healthcare executive and author (Wipe Out, Rise Up), he found himself on the other side of the operating table when we spoke, just six weeks post-op from bilateral hip replacements. Turns out, even surgeons need surgery!

He trained for it like he was running a marathon. In the weeks leading up to it, he even tracked his blood glucose levels using a continuous glucose monitor (CGM).

“You wouldn't just go run a marathon without training for it, would you?” Dr. Ellner asks. This philosophy might hold at the operating table.

No surgery is ever small, so how you approach (p)rehab—the preparation you do before surgery—could make a positive difference. Dr. Ellner shares key strategies for successful prehab, and how they may help you recover faster, stronger, and heal better.

Have you prehabbed to prepare your body or mind before surgery?

The mistake people make before surgery

The prevention-based mindset we apply to aging might also apply to how we prepare for an operation.

❝

“I think the mistake is not taking it [surgery] seriously,” Dr. Ellner says. People wait for post-op to heal without understanding that their current level of health shapes the outcome and recovery.

In a small but promising study, 80% of patients who prehabbed before undergoing colorectal cancer surgery regained all of their pre-surgery functional capacity within two months compared to 40% who did not.

Other research seems to suggest that prehab could also reduce the risk of complications during and after the surgery. Older adults may face a higher risk of complications tied to weak immune function, inflammation, or another underlying condition, which is why greater baseline health may increase the likelihood of having a quick and successful recovery.

Heavy Lifting Results, Without the Heavy Lifting

Blood flow restriction (BFR) training uses light weights and specialized bands to challenge your muscles the way heavy loads do. That means short workouts, less joint strain, and fast recovery. Our free plan builds strength for women in perimenopause, menopause, and beyond, with or without BFR. Download the plan.

Prehabbing strategies for ‘elite recovery’

Working with a physical therapy team can help, and Dr. Ellner also has recommendations for lifestyle-first strategies:

Control your blood sugar and blood pressure

“The biggest thing [patients] can do to reduce complications is controlling their blood sugar,” says Dr. Ellner.

This advice is normally aimed at people with diabetes to reduce complications, but data suggest that even without diabetes, hyperglycemia (high blood sugar) at the time of surgery has been linked to slower wound healing and a longer hospital stay.

He used a CGM and kept his diet ‘really tight’ before his surgery. A review of pre-surgery nutrition found that focusing on high-quality protein (1.2 - 2 g per kg of body weight a day), vegetables, fruits, and whole grains in the weeks leading up to surgery may reduce inflammation and the risk of insulin resistance, and improve muscle recovery.

Dr. Ellner also recommends getting high blood pressure under control, as uncontrolled hypertension has been linked to cardiovascular complications during surgery, among other negative outcomes. Some procedures can even be postponed due to high blood pressure!

Support blood pressure by being less sedentary in the weeks ahead, and work with your provider if medications are involved.

Build your reserves: Pulmonary and physical

Lung function is an underappreciated indicator of healthy aging, and Dr. Ellner says that building pulmonary reserve prior to surgery is almost as important as balancing blood sugar.

Research suggests that doing some form of respiratory training before surgery may lower the risk of pneumonia, respiratory failure, and other complications whose risk goes up as we age.

Breathing exercises may improve breathing efficiency, while preoperative inspiratory muscle training (IMT) acts like resistance training for the breathing muscles. Staying current on vaccinations can lower your risk of respiratory infection, and regular cardiovascular exercise supports lung and functional capacity.

Big surgery is a major stressor, like a marathon, Dr. Ellner says. You lose blood and become catabolic, meaning your body breaks down fat and muscle tissue for energy.

Studies have found that prehab reduces the risk of serious muscle and bone loss post-surgery, especially in adults who already have some level of sarcopenia or osteoporosis (it might also reduce the risk of breaking a bone during the procedure).

Prehab may help frail older adults regain function and recover faster, and may lower the risk of dying.

Consider prehab with mobility, resistance, aerobic activity (walking and cycling), flexibility, or balance training, which has been shown to optimize post-surgical outcomes.

Sleep and support

Sleep is one of our most critical recovery tools that we can harness for surgery. Better sleep has been linked to less post-op pain in older adults and shorter hospital stays, and it may improve insulin sensitivity.

Because surgery is a psychological stressor too, Dr. Ellner also puts mental preparation alongside the physical.

Pre-operative anxiety has been linked to worse postoperative outcomes, but meditation has been shown to reduce anxiety and the risk of post-op pain. Simply take a few minutes every day to center yourself.

“It’s just taking that 10 minutes in your day to just stop,” he says.

Dr. Ellner also recommends that patients identify early on who their family, friends, and personal support will be for recovery.

Having an encouraging and present support system can boost mindset before surgery, with the potential to influence stress, sleep, and habits, and even how fast you heal.

Many people feel guilty, like they’d be a burden, he says. But in his nearly 30 years in healthcare, Dr. Ellner has seen that people are willing to help.

❝

“People want to be there for you when you're at your most vulnerable moment.”

When luck meets preparation

Dr. Ellner’s advice makes me think of the saying ‘when luck meets preparation.’

Much of surgery is out of your control, and eating well, exercise, or having a family member say “I’ll be here for you” won’t erase every risk. But certain longevity-minded habits might help reduce it.

So next time you need surgery, do what you can to make it the best marathon you’ve ever run.

Poll response

This question comes from last week’s newsletter: Barefoot shoes are trending. Are they good for aging feet? We asked:

Have you ever tried barefoot shoes? 👣

The largest percentage of responses suggest openness to trying them (30%), but many of the write-ins provide strong testimonials to chew on!

“I am 63 years old and since switching from regular shoes to barefoot shoes, I have no foot pain or knee pain.”
“I have no more pins and needles or numbness from neuropathy in my feet.”
“Barefoot shoes helped a lot with my balance.”
“I have walked barefoot at home all my life. I only wear shoes when I go out… Doctors think it’s why I have good flexibility and balance in my 80s. I have never fallen.”

Have a great day!
Erin

How did you like today's newsletter?

The information provided about wellness and health is for general informational and educational purposes only. We are not licensed medical professionals, and the content here should not be considered medical advice. Talk to a doctor before trying any of these suggestions.