You train for a 5K run.
You run, swim, and bicycle for months before a triathlon.
You even study for a math or history test.
So, why shouldn’t you get in shape for surgery?
That’s the thinking behind a growing trend among surgeons in the United States — have patients go into training before they come in for an operation.
The Michigan Surgical & Health Optimization Program MSHOP has been going on for the past five years.
Now, the American College of Surgeons is ramping up a program called Strong for Surgery.
The idea is simple.
“In all other areas of life you show up prepared. You should do the same thing for surgery” said Dr. Thomas K. Varghese Jr., general thoracic surgeon, an associate professor at the University of Utah School of Medicine, and a fellow with the American College of Surgeons.
The Strong for Surgery program began in Washington state.
That’s where Varghese learned about it. He continued to employ it when he moved to Utah. Now he’s involved in the American College of Surgeons program.
The pre-surgery routine has four basic items on its checklist for doctors to consider about their patients.
These are nutrition, glycemic control, medication management, and smoking cessation.
The plan now is to expand to include exercise and general wellness for appropriate patients.
“We need to get patients ready,” Varghese told Healthline. “Why are we waiting for patients to get to the hospital before doing that?”
Varghese said the pre-surgery training needs to be different for different patients.
Some can exercise more than others. Some need to lose weight while others don’t.
But there are things all patients can do.
Varghese said he tries to make sure all his patients eat nutritiously in the weeks leading up to their operations.
He also urges anyone who smokes to stop before their surgery. Alcohol consumption should be limited.
And any regular medication should be carefully moderated.
Varghese said he usually doesn’t have serious problems convincing his patients to cooperate.
“A lot of patients are open to this. They want the best results,” he said.
Dr. Clifford Ko, the director of quality at the American College of Surgeons, agrees patients need to support the program.
“Healthcare relies on both providers and patients to achieve optimal outcomes,” Ko told Healthline. “Providers will often identify important issues to address, however, sometimes these issues rely on buy in and compliance.”
The Michigan program
The medical professionals at the Michigan program have been getting patients to train for surgery for years.
Dr. Michael Englesbe, a transplant surgeon at Michigan Medicine, has been championing the “strong for surgery” idea for the past decade.
In February, he and several colleagues published a study that looked at the pre-surgery routines of 641 patients.
The study authors said that basic fitness and wellness coaching beforehand can reduce a surgical patient’s average hospital stay from seven to five days.
They also concluded the pre-surgery regimen can reduce medical costs by 30 percent.
“We do a lot in medicine to get people ready for surgery, but they’re primarily administrative tasks — checking off boxes that don’t necessarily make a patient better,” Englesbe said in a press statement.
The MSHOP program focuses on four key pre-operation areas.
One centers on movement, in essence encouraging patients to exercise. Most MSHOP patients are told to walk 12 miles a week in preparation for surgery.
The second focus is on breathing, where patients are advised on how to get their lungs healthy for surgery. This training involves exercise as well as quitting smoking.
Patients are also encouraged to eat well and to simply relax to relieve stress before their surgery.
The MSHOP curriculum is now offered in 20 hospitals and 30 practices across Michigan. More than 1,200 patients at Michigan Medicine have participated.
“Patients don’t care about costs or how long they’re going to be in the hospital; they just want to get through the experience,” Englesbe said. “This is an empowering tool that helps them do something positive in the face of a very negative event.”