Prehabilitation: Our journey from bench to bedside
University Hospital Southampton (UHS) has invested in a Prehabilitation Medicine Service based on our world-leading research.
Key facts
Training for surgery to improve physical fitness is called prehabilitation.
UHS launched a Prehabilitation Medicine Service in 2023, following 15 years of research by NIHR Southampton BRC researchers.
Over 3,000 patients have already benefited from the innovation. It is now being adopted across the country.
Preparing for surgery
Major surgery is like running a marathon. Prehabilitation helps patients to prepare. It focuses on improving their fitness, mental health and diet.
Our research shows the approach improves wellbeing, speeds up recovery and reduces complications.
Restoring fitness after chemotherapy
We were the first to show that chemotherapy reduces fitness. We linked this to poor outcomes after surgery. Then we showed that supervised high-intensity exercise training (HIIT) reversed or prevented the side-effects of chemotherapy.
The exercise was safe, do-able and valued by patients. It also improved fitness and quality of life after surgery (published here).
Exploring the causes
To develop better care, we explored the causes of these effects.
We showed that chemoradiotherapy (CRT) damages mitochondria, the cells’ powerhouses, in muscles (published here). Exercise reversed some of these effects and improved muscle mass.
We were also the first to show high intensity exercise during CRT may increase tumour shrinkage (published here).
Taking prehabilitation into the community
Our regional WesFit trial, funded by NHS England, took prehabilitation into the community.
We trained personal trainers to support cancer patients in local gyms. The programme was safe, popular and 87% completed the course. It also reduced costs by over 30% (£1,463/patient).
In 2020, WesFit won the HSJ Journal Cancer Initiative of the Year award.
COVID-19 disrupted cancer care. In response, we quickly set up a virtual prehabilitation trial called SafeFit. It supported over 2,000 patients through video and phone calls. We trained personal trainers to deliver exercise, emotional and dietary support.
First of its kind service
An NHS-funded Prehabilitation Medicine Service was set up at UHS in 2023. This is the first of its kind in the country.
UHS has now partnered with over 50 community gyms in Wessex and beyond. This delivers the interventions near to patients’ homes.
Over 3,000 patients have benefited from this innovation. 96% of our service users say they would recommend prehabilitation to others preparing for surgery. Patient feedback includes:
“My physical abilities and emotional outlook were transformed prior to surgery. I was discharged on day four and made a full recovery. It changed my life.”
What’s next?
Prehabilitation is now being adopted across the country.
We are leading on international guidelines and supporting wider use across the NHS and beyond.
Our future work aims to deliver virtual prescribed HIIT training sessions using wearable devices working with our industry partner, refine the interventions and explore the mechanism of harm vs benefit of new therapies.