If you’ve been told you need surgery — whether it’s a hip or knee replacement, heart surgery, or a hernia repair — your first instinct might be to take it easy and wait. But growing evidence shows that what you do before surgery can be just as important as what happens in the operating theatre. That’s the idea behind prehabilitation, and it’s changing how we think about planned procedures for people over 50.
TL;DR
- Prehabilitation means getting physically and mentally fit before planned surgery to improve recovery outcomes.
- Research shows prehabilitated patients have shorter hospital stays, fewer complications, and faster return to independence.
- Key components include cardiovascular exercise, strength training, nutritional optimisation, and mental preparation.
- Ireland’s NTPF waiting lists mean many patients have time to prehabilitate — use that window wisely.
- Your GP, physiotherapist, and dietitian can help build a personalised prehab plan through the CDM Programme and HSE community services.
What Is Prehabilitation?
Prehabilitation — or ‘prehab’ — is the process of improving your physical fitness, nutrition, and mental readiness before a planned surgery or medical procedure. Think of it as training for surgery the way an athlete prepares for a competition. The goal is to go into the operating theatre in the best possible condition, so your body can recover more effectively afterwards.
The concept has strong backing from organisations including the Royal College of Surgeons, the Enhanced Recovery After Surgery (ERAS) Society, and the World Health Organisation. Research published in the British Medical Journal and the Lancet consistently shows that patients who prehabilitate have better surgical outcomes, shorter hospital stays, and fewer post-operative complications.
Why Prehab Matters More After 50
As we age, our physiological reserve — the body’s capacity to cope with stress — naturally diminishes. Surgery places enormous demands on the body: anaesthesia, blood loss, tissue repair, and the stress response all draw on reserves that may be reduced in older adults. TILDA (The Irish Longitudinal Study on Ageing) research has highlighted that even among community-dwelling adults over 50, rates of pre-frailty are significant, meaning many people go into surgery already at a disadvantage.
Prehabilitation helps to build up that reserve. Even modest improvements in fitness before surgery can make a meaningful difference to recovery. A 2023 Cochrane review found that prehabilitation reduced post-operative pulmonary complications by up to 50% in patients undergoing major abdominal surgery.
The Four Pillars of Prehabilitation
1. Physical Exercise
This is the cornerstone of any prehab programme. The aim is to improve cardiovascular fitness, muscle strength, and functional capacity. You don’t need to run marathons — even regular walking, chair-based exercises, or light resistance training can make a real difference.
A good starting point:
- Walking: Aim for 30 minutes most days, building gradually. Ireland’s Slí na Sláinte routes and local parks are ideal.
- Strength exercises: Simple movements like sit-to-stands, wall press-ups, and resistance band work. Your Local Sports Partnership (LSP) may offer suitable classes.
- Breathing exercises: Particularly important before chest or abdominal surgery. Deep breathing and incentive spirometry help maintain lung function.
Your GP can refer you to a HSE community physiotherapist, or you can access private physiotherapy (tax-deductible at 20% under Revenue’s med1 relief). The Irish Society of Chartered Physiotherapists (ISCP) maintains a find a physio directory.
2. Nutritional Optimisation
Surgery increases your body’s demand for protein, vitamins, and minerals. Malnutrition is surprisingly common among older adults in Ireland — TILDA data suggests that up to 10% of community-dwelling adults over 65 are at risk of malnutrition, and that figure rises sharply among those with chronic conditions.
Key nutritional priorities before surgery:
- Protein: Aim for 1.2–1.5g per kg of body weight daily. Good sources include eggs, fish, chicken, beans, lentils, and dairy.
- Iron and B12: Anaemia before surgery increases complication risk. Ask your GP to check your full blood count (FBC) well in advance.
- Vitamin D: Deficiency is widespread in Ireland, particularly in winter. Supplementation (10–25 micrograms daily) is recommended by the HSE for adults over 65.
A registered dietitian can provide personalised advice. Under the CDM Programme, your GP can refer you to a HSE community dietitian, or find a private dietitian through the Irish Nutrition and Dietetic Institute (INDI) at indi.ie.
3. Mental and Emotional Preparation
The psychological side of prehabilitation is often overlooked, but anxiety before surgery is extremely common and can genuinely affect outcomes. Research shows that pre-operative anxiety is associated with higher pain levels after surgery, slower wound healing, and longer hospital stays.
Practical strategies include:
- Information gathering: Understanding what to expect reduces anxiety. Ask your surgical team for written information or attend any pre-operative assessment clinics offered.
- Relaxation techniques: Simple breathing exercises, progressive muscle relaxation, or guided meditation apps can help manage pre-surgical nerves.
- Social support: Talk to family and friends about your concerns. If anxiety is significant, your GP can refer you to HSE counselling services or organisations like Aware (1800 80 48 48) or the Samaritans (116 123).
- Practical planning: Arrange post-operative support in advance — transport home, help at home, time off work. Having a plan reduces worry.
4. Lifestyle Modifications
Two changes can make an outsized difference:
- Smoking cessation: Even stopping four weeks before surgery significantly reduces the risk of wound infections, chest complications, and delayed healing. The HSE’s QUIT service (Freephone 1800 201 203) offers free support and nicotine replacement therapy.
- Reducing alcohol: Heavy alcohol use impairs immune function and increases bleeding risk. Aim to reduce or stop alcohol intake at least two weeks before surgery. If you need support, contact your GP or the HSE Drugs and Alcohol Helpline (1800 459 459).
Making the Most of Waiting Lists
Ireland’s surgical waiting times remain a challenge. As of 2026, the National Treatment Purchase Fund (NTPF) reports that tens of thousands of patients are waiting for planned procedures. While waiting is frustrating, this period offers a genuine opportunity to prehabilitate.
Rather than viewing the wait as dead time, consider it your training window. Speak to your GP about starting a prehab programme as soon as you’re placed on a waiting list. Some hospitals, including St. James’s Hospital in Dublin and University Hospital Galway, have begun offering structured prehabilitation programmes, particularly for patients awaiting major cancer surgery.
If a formal programme isn’t available in your area, your GP and primary care team can help you build an individualised plan. Under the CDM Programme (Chronic Disease Management), regular reviews with your practice nurse or GP are covered for medical card and GP visit card holders — and these visits are an ideal time to discuss prehabilitation goals.
What the Evidence Says
The research is compelling:
- A study in the British Journal of Surgery found that prehabilitated patients undergoing colorectal surgery had a 30% reduction in post-operative complications.
- The ERAS Society recommends prehabilitation as a standard component of enhanced recovery pathways across all surgical specialties.
- Research from Trinity College Dublin has highlighted that exercise-based prehabilitation can improve functional capacity by 10–15% in as little as four to six weeks.
Getting Started: A Practical Checklist
If you have a planned surgery ahead, here’s how to begin:
- Talk to your GP: Discuss your fitness level and ask about prehab options. Request blood tests (FBC, vitamin D, kidney function) to identify any nutritional gaps.
- Get moving: Start with what you can do — even 10 minutes of walking daily is a start. Build up gradually.
- Eat well: Focus on protein, fruit, vegetables, and staying well hydrated.
- Stop smoking: If applicable, contact the HSE QUIT service (1800 201 203).
- Manage your mind: Practice simple relaxation techniques. Don’t be afraid to ask for psychological support if needed.
- Plan ahead: Organise help at home for after surgery, arrange transport, and prepare your home (remove trip hazards, stock the freezer with meals).
Where Críonna Health Fits In
At Críonna Health, we believe that healthy ageing is about being proactive, not reactive. Prehabilitation is a perfect example of this philosophy — taking charge of your health before a major event, rather than waiting to pick up the pieces afterwards. Whether you’re facing surgery next month or next year, the time to start preparing is now.
📷 Photo by Mark Timberlake (@mtimber71) on Unsplash
