How much exercise you can manage will vary for each individual. Many hospitals can refer patients to classes designed for people living with osteoarthritis, such as ESCAPE-pain. Even short daily ‘strength snacks’ like wall sits for two or three minutes a day can begin to build strength, says Vaux, or stepping down the last few stairs slowly, prolonging the lowering phase, taking each step at the count of three.
“If you’re really debilitated by pain, start [exercising] in water,” he suggests. “Go to your local pool twice a week and walk the length of the shallow end. The resistance of the water against the body is a good way to start your body moving.”
The advice is also to get to a healthy weight if you’re not already. “For every lb you carry, four times that will go on your weight-bearing joints,” says Holden. “If you’re 10kg overweight, you’ve got 40 extra kgs loaded onto your knees and hips. Just losing five to 10kg makes a big difference. Most of us can lose 1kg a week if we try really hard.”
Eating protein-rich food is good for muscle mass, but check with your GP before adopting a high protein diet, especially if you have kidney issues. “In general, there is no wonder food or devil food,” says Holden. “Eat grains, vegetables, green stuff and a wide variety to build good gut health in case you need antibiotics post-op.”
How to prepare for cardiac surgery
Not many cardio units offer prehab, and none in any specialised form. “It’s partly because we don’t know whether it works but also because of safety,” says Prof Enoch Akowuah, a leading cardiac surgeon, and one of the few to have led research on prehab. “In many cases, patients are routinely told to avoid exercise as there’s a perceived risk of increasing your symptoms and, in some conditions, sudden death as well.”
However, there is some research that points towards benefits. In a Canadian study, for example, people awaiting bypass surgery exercised twice a week – a warm-up followed by 30 minutes of aerobic activity – and spent on average one day less in hospital, as well as reporting better quality of life six months after surgery. In another study, people over 65 awaiting bypass or valve surgery who did balance and strengthening exercises were fitter and less frail after surgery than the control group.
Prof Akowuah is hoping to run a larger trial but has recently completed a trial of 180 patients who attended supervised exercise sessions twice a week for eight weeks and were also prescribed 45 minutes a day of aerobic and resistance exercise at home for five days. This included patients with severe aortic stenosis, who are usually told not to exercise. In this study, they did so with no ill-effects.
“It does make sense to get yourself fitter for what is, in effect, a physiological marathon,” says Prof Akowuah. “I think that it is probably safe to exercise. It’s a really good question to ask your surgeon when you go in with your list of questions.”
The most promising aspect of the trial was strengthening the respiratory muscles through distributing devices that patients blow into and then gradually dial up the resistance. It made the breathing muscles much stronger and this could make a key difference post-surgery, lowering the risk of chest infections. Although the devices must be prescribed and monitored by specialists, they could play a cardio role in prehab in the future.
