What is prehabilitation?

Prehabilitation (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:

what you're eating and your weight
physical activity or exercise
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 universal interventions of prehabilitation. This means it is for anyone affected by cancer.

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Transcript

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

How does prehabilitation help?

At diagnosis, your medical team should screen you for any problems in the three areas above. Research shows that if you get support early on and are as healthy as possible, you are more likely to:

leave hospital sooner after surgery
cope better with the side effects of cancer treatment
have fewer side effects
have more treatment choices
have better long-term health

Prehabilitation plays a role in all your cancer care. That includes diagnosis, treatment and follow up. It continues as rehabilitation as part of your recovery package.

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 and recover better if you are in control. By continuing to take 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. These are 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 or service
research trial

Some hospitals offer it to people with certain types of cancers. These cancers include:

upper GI (gastrointestinal)
lung
bowel
prostate

But it is not available in every hospital at the moment. And there are differences depending on which UK nation you live in.

What happens if I’m not offered prehabilitation?

Not having prehabilitation will not affect the treatment you have for your cancer. You will still have the best possible treatment. Knowing about it can help you see what you can do to be in the best health possible before starting treatment.

So, before you start treatment, talk to your doctor, specialist nurse or other members of your healthcare team. 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 take part in prehab activities independently should you prefer to do so. The following places have prehab programmes. You can use the information on their website. Always check with your GP or healthcare team before starting.

How does prehabilitation work?

There are 4 stages to prehabilitation:

screening
assessment
intervention
monitoring

Screening

Screening means the team caring for you will look at:

your weight, whether you have had any weight loss or weight gain recently, as well as your ability to eat and drink
how physically active and strong you are
your mental well being

Screening aims to find problems as early as possible and get you as fit as possible for treatment. This means that you might have screening for prehabilitation at the same time as you are having tests to diagnose your cancer.

Everyone with a cancer diagnosis has a Holistic Needs Assessment (HNA). The HNA is a questionnaire that looks at your needs as a whole person and not just your cancer. The HNA shows what needs you might have during your cancer treatment. Your medical team can use it as part of prehabilitation screening.

You will also have screening with several other questionnaires.

If your screening shows that you are fine, your team will ask you to focus on three lifestyle behaviours until you start cancer treatment. These are also called universal interventions (see below). They are:

eating a wide range of foods in the right proportions, also called a varied diet
being more physically active and doing exercises
looking after your mental wellbeing

Assessment

Depending on the results of your screening, your medical team will assess your needs. They might ask you more about your history, examine you or do other special tests if they want to know more.

They may refer you to specific 'prehab' teams. They can be in the hospital or community. They will do the assessments. The teams can include:

exercise specialists
physiotherapists
occupational therapists
dietitians
other NHS staff

So, if your screening shows that you might not be very fit, you will have a physical fitness assessment. This might be:

a 6 minute walk test
an incremental shuttle walk test - a test that looks at how far you can walk, with the pace increasing gradually every minute at the sound of a beep

And if it shows you could have problems to do with your diet, you will have a nutritional assessment. This is to make sure you are getting enough of the types of food necessary for good health.

The team will also want to know your weight and the amount of fat and muscle (body composition) in your body. This is so that your body is in the best condition possible before treatment.

You will have an assessment of your psychological needs if it shows that your mental health is at risk. Your HNA will give the team more information on these needs.

The results of these assessments will show your medical and prehab teams:

what your needs are
how much support you might need
what the best methods are for improving your physical, nutritional and mental health in the time before treatment

Intervention

An intervention means helping you to cope with and recover from treatment. Not everyone will have the same needs. And how much support you need might also differ from others. So, your team will look at your specific situation.

There are 3 types of interventions you might have:

universal
targeted
specialist

Universal interventions

Universal interventions are for anyone with cancer and their families. It focuses on three lifestyle changes, namely diet, physical activity and mental health. It also focuses on other areas of your health which you can change when living with cancer. Focusing on your behaviour in these areas can help you to live well in the long term.

The other areas of health are:

keeping to a healthy weight
stopping smoking
drinking alcohol within the suggested limits

This might include your team talking to you about a particular area of your health. They might give you information or signpost you elsewhere, such as a stop smoking service. Or they might ask you to look at websites, use apps or watch videos.

It might be that you only need universal interventions to support you.

Targeted interventions

A targeted intervention is planned support from an expert. They aim to help you make a change in a particular area of your health. They are for people with cancer who:

are at risk of long-term (late) effects of treatment
have other long-term health conditions
need extra support to successfully do their recommended prehab activities

Your team might refer you to an exercise class if you need support with physical activity. This might be a group class or a one to one class. The class might be at a local gym with a cancer exercise specialist. Or it might be doing exercises with someone through a video call.

For problems with diet, a dietitian can tell you what to do and guide you. They can help with diet problems because of your cancer or conditions such as diabetes.

Good muscle strength is important before you start treatment. The advice on diet and exercise will help with this.

Some people need support to help them deal with specific areas of mental health. This might include dealing with anxiety, a low mood or problem solving. A healthcare professional with training in one of these areas can support you.

Exercise and continuing your daily activities can help support your mental health when dealing with a cancer diagnosis.

Specialist interventions

Specialist interventions are for people with cancer whose assessment showed you:

have complex needs
are having major treatment
have severe changes because of treatment
have a disability
are at higher risk of having problems if they try to do the prehab activities

So, if you can't do much physical activity, you might need specialist support. A qualified cancer exercise professional and physiotherapist at the hospital or a local leisure centre can help you.

Some people might have more complex diet problems, such as:

difficulty swallowing
weight loss
changes to how their digestive system works

In these situations, a dietitian might prescribe you diet support. These can be:

food through a tube into their stomach (enteral nutrition)
intravenous (drip) feeds called parenteral nutrition (PN)

A counsellor or psychologist can offer help if you have problems to do with your mental health. Some people need specialist therapy or psychiatric support. Support from a specialist is important if you have been suffering from a mental health problem before your cancer diagnosis.

You might need a mix of different levels of support. Universal interventions might support some of your needs. But other problems might need targeted or specialist interventions. You might also move between interventions over time.

It is important that your prehab team know how much you can do, as well as what your needs and wishes are. They will adapt your prehab activities accordingly.

Monitoring

Monitoring your progress when doing the prehab activities is important. This is before and after treatment. It will help the prehab team to understand:

what changes (if any) are happening
how this relates to your cancer treatment
whether they need to change anything

How much monitoring you need will depend upon whether you are doing your prehab interventions:

independently (universal)
with regular support from your prehab team (targeted or specialist)

Prehab teams are interested to know how the activities have been helping you. This will help them to show the importance of it and that more people should have it.

So, monitoring not only helps to understand what is happening to you, but can help other people affected by cancer in the future.

More information

We have more detailed information about the three parts to prehab.

For information about eating well:

For information about how to be physically active and exercise:

We have detailed information about looking after your well being when you have cancer.