From the Guidelines
The most effective approach to implement lifestyle medicine in preoperative orthopedic care is a multimodal prehabilitation program that includes physical exercise, nutrition interventions, and psychological support, as evidenced by a recent study 1.
Key Components of Prehabilitation
- A normocaloric diet with a protein intake of 1.2 g/kg is recommended, along with dietary counselling, fortified diets, and oral nutritional supplementation (ONS) to restore energy deficit and improve functional performance 1.
- Exercise is a crucial modality that can help modulate metabolic consequences of tumor, promoting protein synthesis, reducing systemic inflammation, and improving insulin resistance 1.
- Carbohydrate loading as metabolic conditioning has shown benefits in reducing postoperative insulin resistance and hyperglycemia, although its impact on postoperative morbidity is not yet clear 1.
- A 6-week preoperative bundle of physical exercise and endurance training, nutrition interventions, and psychological support can optimize patient's functional capacity throughout the perioperative period 1.
Implementation and Benefits
- Prehabilitation should be implemented at least 4-6 weeks before surgery to maximize benefits, including a significant reduction in hospital length of stay and postoperative complications 1.
- A multimodal intervention is associated with improved perioperative physiological parameters, functional outcomes, and quality of life measures, although its impact on postoperative complications may vary depending on the patient population 1.
- High-risk patients undergoing elective major abdominal surgery may benefit from prehabilitation in the form of a motivational interview, high-intensity endurance training, and promotion of physical activity, which has been shown to reduce the incidence of postoperative complications 1.
From the Research
Effective Strategies for Implementing Lifestyle Medicine
The implementation of lifestyle medicine in preoperative orthopedic care can be achieved through various strategies, including:
- Interprofessional lifestyle medicine programs that optimize whole-person health prior to orthopedic surgery 2
- Incorporating diet and lifestyle education into clinical practices and hospital systems 3
- Prehabilitation or preoperative exercise programs that combine aerobic exercises, strength training, and functional task training to suit individual needs 4
- Coaching patients with evidence-based behavior change strategies to make lasting habits in key areas such as physical activity, healthy eating, and stress management 5
Barriers and Facilitators to Implementation
Healthcare professionals perceive several barriers and facilitators to implementing lifestyle interventions in patients with osteoarthritis, including:
- Barriers: non-optimal interdisciplinary collaboration, patients' negative attitude towards lifestyle interventions, patients' low health literacy, and healthcare professionals' lack of knowledge and skills around lifestyle interventions or promoting behavioral change 6
- Facilitators: good interdisciplinary collaboration, a positive perception of healthcare professionals' own role in implementing lifestyle interventions, the content or structure of lifestyle interventions, and healthcare professionals' positive attitude towards lifestyle interventions 6
Key Components of Lifestyle Medicine Programs
Effective lifestyle medicine programs for preoperative orthopedic care should include: