Prehabilitation – what is it, and when should you start it?

Prehabilitation is conscious preparation for a planned physical strain on the body – most often surgery, childbirth, or intense physical exertion.

The term “prehabilitation” originates from perioperative medicine and complements traditional rehabilitation. While rehabilitation restores function after an injury or surgery, prehabilitation prepares the tissues and neuromuscular system before the procedure, increasing their efficiency, blood supply, function, and ability to regenerate.

This field originally developed in oncological surgery and orthopedics. It arose when it was noticed that patients who were better prepared physically and respiratorily:

• experienced complications less often,
• returned to fitness faster,
• and stayed in the hospital for a shorter time.

In orthopedic prehabilitation, particular emphasis is placed on restoring musculoskeletal function and preparing the patient for specific postoperative stresses.

In the context of urogynecological and urological physical therapy, prehabilitation involves working on the pelvic floor muscles, breathing, posture, and habits. This is a preventive approach aimed at reducing the risk of complications and accelerating recovery.

Prehabilitation does not replace surgery, but it significantly influences its outcomes.

In orthopedics, it contributes to:

• increasing physiological reserve and muscle strength before surgery;
• reducing anxiety and improving well-being;
• shortening the length of hospital stay and reducing the risk of complications;
• achieving better functional results (e.g., reduction of pain and joint stiffness and greater efficiency in performing daily activities) during convalescence.

Urogynecological and urological prehabilitation, on the other hand, contributes to:

• reducing the risk of complications (e.g., urinary incontinence, pain, organ prolapse);
• shortening recovery time;
• improving tissue healing and function;
• improving quality of life and sexual comfort;
• increasing body awareness and the patient’s sense of control and safety.

For surgeries involving the lower pelvis (e.g., procedures for organ prolapse, hysterectomy, prostate surgery), pelvic floor muscle function and control of intra-abdominal pressure are critical. If these structures are strengthened beforehand and the patient knows how to activate them properly, the body copes better with the surgical stress.

In the field of orthopedics, we can distinguish several areas of focus:

1. targeted physical therapy – focusing on the limb to be operated on. In the case of anterior cruciate ligament (ACL) reconstruction, the goal is to reduce inflammation, alleviate pain, and restore full range of motion before surgery. Before knee or hip replacement surgery, strengthening exercises, gait training, balance training, and proprioception (deep sensation) exercises are recommended.
2. patient education – one of the most important elements. The patient learns how to use orthopedic aids (crutches, walkers) even before the procedure. Education also includes learning safe positions (e.g., avoiding excessive hip flexion or rotation) and planning the return home and adapting the living space for the post-operative period;
3. optimization of health – including smoking cessation (which is crucial for tissue and bone healing), reduction of excess weight, and management of comorbidities such as diabetes or anemia;
4. psychological support – aimed at reducing anxiety and building motivation to actively participate in the recovery process.

Patients with low fitness levels who tire quickly and become short of breath even with minimal exertion are at a much higher risk of complications. Therefore, endurance (aerobic) training, along with strength and respiratory training, is one of the key elements of physical preparation for surgery.

The primary goal is to increase cardiorespiratory reserve, enabling the body to better adapt to the increased oxygen demand during surgery and in the immediate postoperative period. Furthermore, it has been shown that endurance exercise effectively reduces preoperative pain and improves overall physical fitness while waiting for surgery.

Patients preparing for surgery should aim to follow the basic recommendations of the World Health Organization, which means 150–300 minutes of moderate-intensity aerobic physical activity per week or 75–150 minutes of high-intensity activity.

As part of prehabilitation, patients are encouraged to engage in physical activity for at least 30 minutes a day (preoperative minimum), though the type of activity must always be tailored to the patient’s capabilities and clinical condition. Planning such training for high-risk patients (the elderly, those with heart disease) should be handled by a physical therapist in collaboration with a cardiologist or anesthesiologist.

In orthopedic prehabilitation, forms of exercise are selected that are gentle on the joints while building endurance. These include, in particular:

• stationary cycling or ergometer use – e.g., 10-30 minutes at low or moderate intensity. This form of exercise is particularly recommended prior to anterior cruciate ligament reconstruction and knee replacement surgery;
• swimming and hydrotherapy – which provide a good variety in exercise therapy and build endurance while reducing stress on the joints;
• interval training – studies suggest that prolonged (even 12-week) high-intensity interval training involving both the upper and lower body may be particularly beneficial for older patients.

In urogynecological and urological physical therapy, prehabilitation includes, among other things:

• learning proper pelvic floor muscle activation;
• strengthening the pelvic floor muscles;
• treating current pain and functional issues that may affect the outcome of surgery or childbirth;
• breathing and postural training;
• education on proper urination and defecation;
• prevention measures to minimize the risk of urinary incontinence and pelvic organ prolapse;
• preparation for childbirth or gynecological/urological surgery.

Orthopedic prehabilitation is recommended for all patients awaiting scheduled surgery.

Such measures are particularly important for:

• older adults at risk of so-called frailty syndrome, a condition resulting from the depletion of the body’s physiological reserves;
• patients with multiple comorbidities (e.g., cardiovascular diseases, diabetes);
• athletes returning to competitive activity after ligament injuries.

This applies, among other things, to procedures for pelvic organ prolapse, hysterectomy, abdominal surgery (laparotomy/laparoscopy), or prostatectomy. Studies show that strengthening and learning to control the pelvic floor muscles beforehand reduces the risk of postoperative urinary incontinence, shortens recovery time, and supports the restoration of impaired pelvic floor function.

Preparing the pelvic floor for vaginal delivery or cesarean section allows you to:

• improve tissue elasticity,
• reduce the risk of perineal tears,
• increase body awareness and control over the urge to push,
• reduce the risk of postpartum stress urinary incontinence,
• increase body awareness and a sense of agency during childbirth.

This applies to both women after childbirth and individuals starting intense training (e.g., running, strength training, competing in sports) or returning to it after various surgical procedures. A functional pelvic floor is the foundation for proper deep muscle function and control of intra-abdominal pressure.

Preparation for abdominoplasty applies to both women and men. Properly conducted measures can help reduce diastasis recti and lower the risk of issues related to healing and the quality of the postoperative scar. A key element of preparation is learning proper control of the pelvic floor muscles and conscious management of intra-abdominal pressure, which promotes, among other things, better tissue healing.

The optimal duration of prehabilitation is usually 4-8 weeks.

For patients preparing for major lower limb surgeries, such as knee replacement, combining prehabilitation (including cardiovascular training) with education approximately 30 days before the procedure can reduce the need for postoperative care by 29 percent.

Patients choosing prehabilitation at the NAMI Medical Resort and Clinic are cared for by an interdisciplinary team of specialists, including orthopedic and urogynecological/urological physical therapists, physicians, dietitians, and psychologists. Guests at our center benefit from medical training, yoga classes, as well as access to the gym and swimming pool.

We actively utilize treatments and methods that help reduce pain and inflammation, including cryotherapy, radiofrequency therapy, acupuncture, and shockwave therapy. We also prioritize nutritional prehabilitation. We provide access to a dietitian who assesses the patient’s nutritional status, can detect and treat malnutrition, and provide personalized dietary recommendations. Meals are provided by NAMI Restaurant – Poland’s first restaurant dedicated to longevity.

We also support you in quitting addictions, as stopping smoking and drinking alcohol significantly reduces the risk of infections and circulatory complications – not only after surgery.

NAMI Medical Resort and Clinic exclusively offers medical programs.

1. Surma S., Zembala M. O., Prehabilitacja kardiologiczna: definicja, cele, komponenty, czas trwania, efekty i aktualne zalecenia (2022–2025), „Choroby Serca i Naczyń” 2025, t. 22, nr 4, s. 207–224, DOI: 10.5603/chsin.109731 [1-3];
2. Banasiewicz T., Kobiela J., Cwaliński J. i in., Rekomendacje w zakresie stosowania prehabilitacji, czyli kompleksowego przygotowania pacjenta do zabiegu operacyjnego, „Polski Przegląd Chirurgiczny” 2023, t. 95, nr 4, s. 61–91, DOI: 10.5604/01.3001.0053.8854 [4-8];
3. Karbowski M., Głowacka-Mrotek I., Nowacka K., Hagner W., Usprawnianie pacjentów po rekonstrukcji więzadła krzyżowego przedniego (Rehabilitation of Patients after Anterior Cruciate Ligament Reconstruction), „Journal of Education, Health and Sport” 2017, t. 7, nr 8, s. 1540–1549, DOI: 10.5281/zenodo.1098437 [9-11];
4. Agencja Oceny Technologii Medycznych i Taryfikacji, Rekomendacja nr 58/2019 Prezesa AOTMiT z dnia 30 grudnia 2019 r. w sprawie zmiany technologii medycznej w zakresie rehabilitacji ogólnoustrojowej, Warszawa 2019 [12, 13];
5. Agencja Oceny Technologii Medycznych i Taryfikacji, Raport nr AOTMiT-WT-553-14/2015: Endoprotezoplastyka stawu biodrowego – opieka kompleksowa, Wydział Taryfikacji, Warszawa 2016 [14-16].