Exercise: The Surgery Secret Weapon More Doctors Recommend

3 min read

Nov. 9, 2023 – Need more motivation to hit your daily step count? You could save yourself from painful or even life-threatening complications after surgery. 

Evidence has been mounting that physical activity can lower the risk of complications after an operation. Thanks to new fitness tracker data, researchers from the Medical College of Wisconsin zeroed in on a number: People who walk at least 7,500 steps a day are much less likely than those who walk less to have such complications. 

This held true even for patients with a higher body mass index (BMI) or health conditions, as well as for those having more complex surgeries, said the researchers, who presented their findings, which are not yet published, at the recent American College of Surgeons Clinical Congress in Boston. 

“The remarkable thing about this study is that we are finally starting to quantify exactly how much optimization we can do in the domain of physical exercise,” said Thomas Varghese, MD, chief of general thoracic surgery at the University of Utah, in Salt Lake City. (Varghese was not involved in the study.) 

The researchers analyzed fitness tracker data from almost 500 people (average age 57) in the months or years before their surgeries. Those who took at least 7,500 steps a day were, on average, 51% less likely to have a complication, such as an infection or slow-healing wound, within 3 months after the procedure.

“There likely are multiple factors that explain our findings,” said senior study author Anai Kothari, MD, a professor of surgical oncology at the Medical College of Wisconsin. “We speculate that improved physical fitness can modify the stress response to surgery and lead to improved outcomes.”

Many of the surgeries were “low risk,” where the patient either spent just 1 night in the hospital to recover or went home the same day, Kothari noted. The most common procedures included hysterectomy, thyroidectomy, breast reconstruction, and orthopedic surgery. Overall, 13% of patients had some post-surgery complication, aligning with stats from previous studies

The Power of 'Prehab'

The study builds on a growing body of research linking the fitness of a patient's heart and lungs to surgical outcomes. A higher fitness level may make people more able to withstand complications and speed recovery, researchers have concluded. It may also help buffer a patient against inflammation due to pre-surgery anxiety and reduced oxygen intake from anesthesia. Fitness is also linked to better mood and emotional well-being, which has been shown to aid healing

Surgical complications can cause pain and suffering, more medical costs, and, in less than 1% of cases, even death. With that in mind, doctors are now more likely to recommend physical activity and exercise programs to lower surgical risks. 

Several randomized controlled trials have shown that including exercise in "prehab" programs significantly reduces complications after surgery. Prehab, which is short for "prehabilitation," involves fitness activities that put people in a better place, physically, before surgery. A meta-analysis from June found that high-intensity interval training before major surgery reduced the odds of complications by 56%. And a 2022 meta-analysis found that patients who received an exercise plan during prehab had 5% fewer complications and were 28% less likely to visit the emergency room 30 days after colorectal cancer surgery. (A meta-analysis uses data from several studies to come up with its result.)

Ideally, people should maintain a high baseline fitness level well before they need surgery. But starting a tailored fitness plan even 2 to 3 weeks out can make a difference, said Varghese, who helped create the ACS’s Strong for Surgery prehab program. 

“The goal of the surgical intervention is to perform a direct action to result in better function,” said Varghese. “If we add in optimizing health ahead of surgery, you essentially prime your body for the best outcomes.”