What is prehabilitation?
Prehabilitation or prehab means getting ready for cancer treatment in whatever time you have before it starts. It is a programme of support and advice that some NHS hospitals are using. It covers three particular parts of your health:
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what you're eating and your weight
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physical activity or exercise
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mental wellbeing
Stopping smoking and cutting down on alcohol can also help. It helps while you're having treatment, with your recovery, as well as improving your overall health.
The video below is about the things you can do to improve your health and wellbeing before cancer treatment. It is for anyone affected by cancer. The video is around 6 minutes long.
Hello I'm Zoe
I expect you're here because you or perhaps a family member or friend have been diagnosed with cancer and are about to have surgery or start some other form of cancer treatment.
Understandably, you might be worried and feeling overwhelmed.
In this video, we would like to support you by showing what you can do to prepare yourself and explaining why preparation is so important.
The hospital or your healthcare team might also call this prehabilitation or prehab.
Research says that when preparing for cancer surgery or other cancer treatment, you should focus on three lifestyle changes.
One, eat a varied diet.
Two, be physically active.
And three, take care of your mental health.
Focusing on these three areas and whatever time you have before your surgery or treatment starts can help you to leave hospital earlier, reduce the risk of side effects and feel more in control of your health.
Also, if you stop smoking and cut down on alcohol, the benefits to your cancer treatment, recovery and overall health could be even greater.
What should I eat?
We understand that following a cancer diagnosis, you might go through a period of uncertainty and anxiety which can lead to a loss of appetite and weight.
Being underweight can affect how well you cope with and recover from your treatment. And if you feel like this, try to continue eating using the advice on eating a varied diet in this video.
A varied diet means eating a wide range of foods in the right proportions and drinking plenty of fluids to achieve and maintain a healthy body weight.
But this doesn't mean you can't allow yourself the occasional treat.
So, divide your plate at each meal like this. Each slice shows you how much of a food group should be on your plate.
The amount of protein in each meal should weigh the same number of grams as half your body weight in kilograms.
Protein is important to build muscle and in preparation for surgery. Also, eating a varied diet with lots of protein helps the body fight off infections and heal itself.
If you're already on a special diet because of other health conditions, such as diabetes speak to your doctor, your specialist nurse or your dietitian to get the diet advice that's specific to you.
Tips for a varied diet
Watch for changes in weight.
Keep an eye on portion size.
Choose healthier options.
How can I be more physically active?
Cancer and cancer treatments are often compared to running a marathon.
In the same way that it's advisable to train before running a marathon, it's important to increase your physical activity before you have surgery, radiotherapy or chemotherapy.
Research shows that you can improve your fitness and build muscle in as little as two weeks. So it's worth doing the prehab activities recommended, even if there's only a short time before your cancer treatment.
You might not have been physically active for a long time, and starting now might feel impossible, but many people who felt the same have managed to do it and feel the benefits.
How much physical activity you can do and at what level differs from person to person.
Aim for two and a half hours of moderate or one and a quarter hours of vigorous activity per week, as well as some strength building exercises like weight training or yoga twice a week.
While it is safe to exercise when you have cancer, you need to do physical activities that are right for you. So speak to your GP or healthcare team for advice on your situation.
Being physically active boosts your energy levels, helps with anxiety and depression and reduces your risk of heart disease and type 2 diabetes.
Tips for getting more active
Keep an activity diary.
Identify anything which stops you being active.
Choose a physical activity close to home.
How do I look after my mental health
Anxiety or depression often starts at the time of diagnosis or when you're finishing treatment.
You might be feeling overly worried or panicked which are symptoms of anxiety, or you might feel low in mood and not yourself, wanting to withdraw from the world around you, which are symptoms of depression.
Try to keep in mind that a big part of what you're feeling during this time is a normal response to a very stressful life experience and a way of coming to terms with it.
Getting ready for treatment will help you feel prepared and stop the feelings of anxiety or depression from getting worse.
If you're finding it hard to manage, make sure you get the support you need.
Taking care of your mental health will improve the quality of your life long term. And research shows that for people with some pre-existing mental health conditions, making the most of that support could better your chance of overcoming certain cancers.
Tips for looking after your mental health
Make use of available resources.
Use your regular coping mechanisms.
Reach out for support if you can't cope.
We understand you might be going through a lot and making these lifestyle changes might sound overwhelming. But remember, everyone will have different needs and abilities, so use this video as a guide.
Do what you can and be kind to yourself.
Don't hesitate to ask your healthcare team for advice. They will want to help you during this time. And once treatment is over, it's important to carry on looking after yourself.
So, stick with a varied diet, stay physically active and look after your mental health. This will all help you live better in the long term
We have more detailed information about the three parts of prehabilitation.
How does prehabilitation help?
At diagnosis, your medical team checks for any problems you might have in the three areas above. Research shows that if you get support early on and are as healthy as possible before treatment starts, you are more likely to:
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leave hospital sooner after cancer surgery
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cope better with the side effects of cancer treatment
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have fewer side effects
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have more treatment options
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have better long term health
Prehabilitation plays a role during your cancer care. That includes diagnosis, treatment and follow up. It then continues as rehabilitation as part of your personalised care and support planning (PCSP).
Feeling more in control
Following a prehabilitation programme can help you feel more in control of your physical and mental health. You can cope better during treatment if you feel more in control. By taking care of your diet, physical fitness and mental health, you can live well in the long term.
Is there prehabilitation in every hospital?
At the moment, not everyone having cancer treatment will have prehabilitation. Research shows that it is helpful for people having surgery. But researchers think it might also help people having other cancer treatments such as chemotherapy and radiotherapy.
You might have prehabilitation at your cancer hospital or a local leisure centre as part of a NHS programme. Your doctor may also ask you to join a clinical trial looking into prehabilitation.
Some hospitals only offer prehabilitation to people with certain types of cancers. This includes:
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upper gastrointestinal cancers such as oesophageal and stomach cancer
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lung cancer
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bowel cancer
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prostate cancer
What happens if I’m not offered prehabilitation?
Not having prehabilitation will not affect the type of treatment you have for your cancer. You will still have the best possible treatment.
You can talk to your doctor, specialist nurse or other members of your healthcare team before you start treatment. Tell them if you're worried about your diet, physical fitness or mental health. They can give advice or may refer you to a specialist.
You can also follow one of the prehab programmes available online. You can use the information and videos on these websites for free. Always check with your GP or healthcare team before starting.
How does prehabilitation work?
There are 4 stages to prehabilitation:
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screening
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assessment
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intervention
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monitoring
Screening
It’s important that the healthcare team looking after you finds out about any problems you might have as early as possible. This means that you might have screening at the same time as you are having tests to diagnose your cancer.
During screening, your team looks at:
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your weight, whether you have had any weight loss or weight gain recently, as well as your eating and drinking
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how physically active you are
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your mental well being
Your team usually uses questionnaires such as the Holistic Needs Assessment (HNA) as part of prehabilitation screening. The HNA is a simple questionnaire that shows what needs you might have.
Assessment
Depending on the results of your screening, your team may refer you to specific prehab teams. They can be in the hospital or community. The teams can include:
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exercise specialists
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physiotherapists
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occupational therapists
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dietitians
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other NHS staff
These teams might ask you more questions about your needs or do special tests if they want to know more. For example, if your screening shows that you might not be very fit, you may have a physical fitness assessment. This might be a 6 minute walk test or a test that looks at how far you can walk, with the pace increasing gradually every minute.
And if your screening shows that you have problems with your diet, you may have a nutritional assessment.
The results of these assessments will show your prehab team:
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what are your needs
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how much support you might need
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the best way to improve your physical, nutritional and mental health in the time before treatment
Intervention
Your prehab team looks at your needs and plans interventions. There are 3 types of interventions you might have:
- universal
- targeted
- specialist
You might need a mix of different types of interventions. Universal interventions might support some of your needs. But other problems might need targeted or specialist interventions. You may also move between interventions over time.
It is important that your prehab team knows how much you can do, as well as what your needs and wishes are. They will adapt your prehab activities accordingly.
Universal interventions
Universal interventions are for anyone with cancer and their families. It focuses on 3 lifestyle changes:
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diet
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physical activity
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mental health
Your team might give you information on how to make changes in these 3 areas. Or they might signpost you elsewhere such as a website, app or videos.
In addition to these 3 areas, your team may also talk to you about:
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stopping smoking
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reducing the amount of alcohol you drink so it’s within the suggested limits
Targeted interventions
A targeted intervention is planned support from an expert. They are for people with cancer who are at risk of having long term side effects of treatment or have other health conditions.
Examples of targeted interventions include:
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a referral to an exercise class if you need support with physical activity. This might be a group class or a one to one class
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seeing a dietitian that can help with diet problems caused by your cancer or other conditions such as diabetes
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seeing a healthcare professional that can help you deal with anxiety and low mood
Specialist interventions
Specialist interventions are for people with cancer who have complex needs, are going to have major treatment or have a disability.
Examples of specialist interventions include seeing a:
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physiotherapist at the hospital if you can’t do much physical activity
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dietitian who can prescribe food into a tube into your stomach if you have complex diet problems
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a psychologist or psychiatrist if you have had a mental health problem before your cancer diagnosis
Monitoring
Monitoring your progress when doing the prehab activities is important. It helps the prehab team understand how the activities have been helping you and if they need to change anything.
How much monitoring you need depends on the type of intervention you have.
More information
You might find it useful to look at the following sections:
