Profound changes
The patients took physical and cognitive tests before starting prehab and again before their surgery. Those in the personalized group improved significantly on every test of physical and cognitive fitness, whereas those in the standard group improved only on a test of walking distance.
Moreover, the researchers discovered immunological changes that parallelled these effects.
“When we started measuring how these interventions change a patient’s immune system, that’s when things got really exciting,” Gaudilliere said.
Using sophisticated techniques, the researchers surveyed the immune cells from a patient’s blood sample and evaluated the function of individual cells, even simulating the molecular conditions of surgery in a test tube to see their response. They observed profound changes in the personalized prehab group, including less over-reactivity in certain immune cells and a lower level of baseline inflammation.
“From prior studies, we know that people who get an infection after surgery are those who have an abnormally high innate immune response before surgery, so they’re in an overly inflammatory state,” Gaudilliere said. The heightened state can paradoxically result in a less efficient immune response to pathogens.
Personalized prehab also appeared to normalize adaptive immune responses in certain T cells that have been linked to post-surgical cognitive decline, which affects up to half of patients after major surgery, said Franck Verdonk, MD, PhD, a senior author of the paper and a former research fellow in Gaudilliere’s lab.
Such significant changes to the immune system were surprising, the researchers said, especially as they resulted from a low-cost, non-pharmacological intervention that patients can do at home and has no side effects.
“It’s a measurable effect that you would expect from a pharmacological intervention, honestly,” Gaudilliere said.
“I think it’s really impressive as a response,” Verdonk said. “It’s not so much work, and it has a huge impact.”
A teaching moment
The researchers hope personalized prehab will become more widely available, but that will take time and resources. For now, the next step is to identify patients who would benefit the most from such intensive support, Kin said.
For those preparing for surgery on their own, she suggests starting with one tiny habit — any behavior that improves nutrition, exercise or sleep. “If I had to choose one thing, it would probably be exercise,” she said.
When delivered effectively, prehab can transform a period of anxious waiting into an opportunity to inspire long-term change.
“It’s a very powerful teaching moment when patients are facing an operation and they’re fearful,” Kin said. “To have something they can do at home to prepare and then have it actually work, I think that contributes to their ability to continue those healthy habits after surgery.”
The lead authors of the study are Amelie Cambriel, MD, a postdoctoral scholar in anesthesiology, perioperative and pain medicine; Amy Tsai, MD, a resident in general surgery; and Benjamin Choisy, MD, a former visiting medical resident in the Gaudilliere lab.
A researcher from the Centre Hospitalier Universitaire de Brest in France contributed to the work.
The study received funding from the National Institutes of Health (grant 1R35GM137936); the Fondation des Gueules Cassées; the Philippe Foundation; the Société Française d’Anesthésie-Réanimation; the Stanford Department of Anesthesiology, Perioperative and Pain Medicine; the Stanford Center for Human Systems Immunology; and the Stanford Department of Surgery.
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