Getting more than 7,500 daily steps before surgery can reduce postoperative complications, according to new research.Exercising before surgery—known as “prehabilitation”—can help reduce the risk of post-surgical complications like infections and blood clots.In addition to exercise, eating well and managing stress can also help improve surgical outcomes.
Whether or not you have a surgery planned, walking more before going under the knife may lower your risk for complications, new research shows.
The news comes from findings presented last week at the American College of Surgeons (ACS) Clinical Congress, which showed that getting at least 7,500 steps a day before an operation can reduce a person's odds of complications by 51%.
Exercising before surgery—what experts call “prehabilitation”—can help people avoid complications like infections, blood clots, and reactions to anesthesia.
“One of the biggest things that predicts complication risk is how healthy people are at baseline,” Daniel McIsaac, MD, an anesthesiologist at The Ottawa Hospital in Canada, told Health after reviewing the research.“The healthier someone is, the less likely they are to experience a complication.”
There’s a big push for prehabilitation, which includes exercising, eating better, and managing stress before surgery.
“The evidence that this approach decreases complications is emerging but it is still early days,” McIsaac said. “The biggest challenge is that it can be hard to get people to make these health changes consistently before surgery.”
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Walking More Reduces Complications After Surgery
For the new study, researchers looked at FitBit data from 475 people before they went in for a wide range of operations like orthopedic surgeries and general procedures. The average person was 57 years old. The researchers didn’t limit their evaluation of data to a time period just before surgery; they looked as far back as they could—even a few years before surgery—to get an idea of a person’s health habits.
Of the people studied, about 12.6% of them had a complication in the 90 days following surgery.
The odds of having a complication in the 30 days after surgery were 45% less in people who took more than 7,500 steps per day before surgery compared to those who took less than 7,500 steps. In the 90 days after surgery, the risk was cut by 51%.
Carson Gehl, lead study author and medical student at the Medical College of Wisconsin in Milwaukee, said in a news release that integrating Fitbit data into electronic health records (EHRs) can help doctors better plan pre- and post-op care.
“If we find people who are at high risk, using these Fitbit tools, we could monitor them more closely following their procedure because that allows us to catch problems before they progress beyond control,” Gehl said in the news release. “Another goal of our research is to modify physical activity in the preoperative period and improve postoperative outcomes. We need more studies and evidence to answer that question.”
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There are a few theories about why being fit can be protective if it comes time for surgery. Some researchers think people who are sedentary—those who get less than 5,000 steps a day—have a hard time utilizing oxygen in their tissues, which makes recovery harder after surgery.
Other experts think people who aren’t as fit have weaker immune function allowing complications to occur, KariClifford, PhD, a surgery researcher at Otago Medical School in New Zealand, told Health.
Healthier people may be able to move around more and get steps in, enabling them to stay physically active. If they aren’t as active, comorbidities can predispose them to complications, Clifford said.
Researchers aren’t exactly sure how long you have to be active before surgery to lower complications.
“Even starting two weeks before surgery is enough,” Marc Licker, MD, a researcher from Switzerland who’s studied prehabilitation in lung cancer patients, told Health after reviewing the research. He said the duration of the exercise, intensity, and frequency of the session matters most.
Individuals who report being highly active have probably been so for a long time, Aron Onerup, MD, a researcher at the University of Gothenburg Institute of Clinical Sciences in Sweden, told Health.
The research on whether or not fitness before surgery can actually prevent complications is mixed, though it’s generally thought that being more active helps.
In two previous studies led by Onerup—published in 2019 and 2022—the research showed that physically active people had fewer complications following surgery for colon cancer.
Similarly, a 2018 study showed the same in people who took part in high-intensity endurance training before getting abdominal surgery. And a 2023 analysis led by Clifford found that high-intensity interval training (HIIT) before surgery improved cardiorespiratory fitness and lowered the risk for post-surgical problems.
Conversely, walking fewer than 4,300 steps a day was linked to more complications in people who had their pancreas removed, a 2023 study showed.
But not all efforts to work out before surgery have been shown to avert complications. Onerup’s 2022 study also assessed people who did home-based interventions two weeks before and four weeks after colon cancer surgery; it didn’t find a difference in recovery perceptions between those who did and didn’t exercise.
The way people look at physical activity, the populations studied, and the outcomes (severe complications versus all complications) can vary—so the results can differ as well, said Clifford.
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Despite the mixed results on whether or not exercise can thwart complications, experts say it’s better to stay active before a procedure.
“Surgery is hard on the body, and when a person’s systems have to work harder to heal, or to clear medicines and waste products, they may shut down if not up to the task,” Clifford explained. “This is why being fitter gives you a better chance at healing.”
Celena Scheede-Bergdahl, PhD, who works with the perioperative program at Montreal General Hospital, said exercise prepares your body for the stress of surgery.
“You would never run a marathon without prior training, nor should you undergo surgery without prior training,” she told Health.
By walking, you teach your body to handle physical stress and improve your ability to handle the respiratory, neurological, cardiovascular, or metabolic challenges that can arise from surgery, Scheede-Bergdahl said.
“Not doing anything prior to surgery is the worst thing that someone can do,” Scheede-Bergdahl said. “The ‘rest is best’ mentality needs to be revised to ‘whatever you can do is better than doing nothing at all.’”
There isn’t necessarily a “right” kind of activity, either—just make sure the exercise gets your heart and respiratory rate up. Shoot for 10 minutes of the high-intensity exercise, Clifford suggested, adding that anything that gets your heart pumping is good.
“People who are in better condition to face physical challenges,” Scheede-Bergdahl said, “usually have less surgical complications and recover faster.”