What are the recommended preoperative workout routines for patients undergoing surgery?

Preoperative Exercise Recommendations for Surgical Patients

Patients undergoing elective surgery should participate in a structured preoperative exercise program lasting 4 weeks, combining aerobic exercise (150 minutes weekly) with resistance training (twice weekly) and inspiratory muscle training, as this significantly reduces postoperative complications, hospital length of stay, and improves functional capacity. 1

Core Program Components

Duration and Timing

• Minimum 4 weeks preoperatively is the evidence-based standard for cardiac and major abdominal surgeries 1
• Programs as short as 2 weeks show benefit for lung cancer surgery, though 4 weeks is optimal 1, 2
• For urgent cases where 4 weeks isn't feasible, even 5-7 days of respiratory training reduces complications 1

Aerobic Exercise Prescription

• 150-300 minutes per week of moderate-intensity aerobic activity (or 75-150 minutes of vigorous activity) 1
• Progressive intensity increases following the "10% rule" - increase duration/intensity by no more than 10% weekly 3
• Specific modalities: walking, cycling, or swimming based on patient capability 1

Resistance Training

• Twice weekly on non-consecutive days, targeting major muscle groups 1
• Focus on muscle-strengthening exercises adapted to individual capacity 1
• Include functional movements that prepare for postoperative mobility 1

Respiratory Muscle Training

• Progressive inspiratory muscle training using an adjustable pressure valve device 1
• Start at least 5 days preoperatively, ideally 2 weeks 1
• Practice twice daily 1
• This component is particularly critical as it reduces postoperative pneumonia risk by 56% (RR 0.44-0.45) and atelectasis by 47% (RR 0.53) 1

Surgery-Specific Evidence

Lung Cancer Surgery (Strongest Evidence)

• Preoperative exercise reduces hospital stay by 4.2 days (95% CI: -6.14 to -2.32) 1
• Cuts postoperative pulmonary complications by 50% (RR 0.50,95% CI: 0.39-0.66) 1
• Reduces pneumonia risk by 53% (OR 0.47,95% CI: 0.24-0.95) 1

Cardiac Surgery

• 4-8 week multimodal prehabilitation improves preoperative physical condition measured by 6-minute walk test 1
• Reduces overall pulmonary complications (OR 0.52,95% CI: 0.30-0.92) 1
• Decreases hospital stay by 1.3-3.2 days 1

Urologic Cancer Surgery

• Multimodal programs (exercise + nutrition + psychological support) show promise, though evidence is still emerging 1
• Programs must demonstrate therapeutic validity using the CONTENT scale to be effective 1

Abdominal/GI Surgery

• Modest reduction in hospital stay (1.08 days, 95% CI: -2.29 to -0.14) 1
• Effects on complications less pronounced than lung surgery but still beneficial 4

Measurable Outcomes to Track

Preoperative Improvements

• 6-minute walk test: expect 25-meter improvement after 4 weeks 4
• Peak oxygen uptake (VO2max): increase of +2 ml/kg/min 2
• Maximal inspiratory pressure: increase of +12.2 cm H2O 2

Postoperative Benefits

• Overall postoperative pulmonary complications reduced by 48% (RR 0.52,95% CI: 0.41-0.66) across all surgeries 2
• Hospital length of stay shortened by 2.3 days (99% CI: -3.82 to -0.75) 2
• No difference in mortality, but significant reduction in morbidity 2

Safety Profile

• Exercise-related adverse events are rare - only 11 events among 670 patients in meta-analysis 1
• Serious events included: 1 MI, 1 syncope, 1 hypotension, 4 musculoskeletal issues 1
• Supervised programs by exercise professionals minimize risk 1

Critical Implementation Points

Patient Selection

• Prioritize patients with advanced age, frailty, multimorbidity, or poor baseline fitness 1
• Screen for contraindications: unstable cardiac disease, severe symptomatic aortic stenosis 1
• Balance benefit-risk based on surgical urgency 1

Program Structure

• Supervised sessions are superior to home-based programs for compliance and safety 1
• Combine with nutritional optimization and psychological support for multimodal approach 1
• Include patient education tools (in-person, printed, or app-based) to enhance engagement 1

Common Pitfalls to Avoid

• Insufficient duration: Programs shorter than 2 weeks show inconsistent benefits 1, 2
• Lack of progressive overload: Static exercise prescriptions limit functional gains 1
• Omitting respiratory training: This component has the strongest evidence for reducing pulmonary complications 1
• Poor compliance monitoring: Average attendance should exceed 75% of sessions 5

Contraindications and Modifications

Absolute Contraindications

• Unstable angina or recent MI (within 2 weeks) 1
• Severe symptomatic aortic stenosis 1
• Uncontrolled arrhythmias 1

Relative Contraindications Requiring Modification

• Moderate aortic stenosis: limit to low-intensity exercise 1
• Severe pulmonary hypertension: avoid high-intensity aerobic work 1
• Orthopedic limitations: substitute non-weight-bearing exercises 1

Quality of Life Impact

• All self-reported quality-of-life domains improve, particularly symptoms, hygiene, and emotional well-being 5
• Reduces preoperative anxiety and improves psychological readiness 1
• Enhances transition from hospital to home 1