What is prehabilitation?
Prehabilitation (prehab) means getting ready for cancer treatment in whatever time you have before it starts. It is a programme of support and advice that some NHS hospitals are using. It covers three particular parts of your health:
- what you're eating and your weight
- physical activity or exercise
- mental wellbeing
Stopping smoking and cutting down on alcohol can also help. It helps while you're having treatment, with your recovery, as well as improving your overall health.
The video below is about the universal interventions of prehabilitation. This means it is for anyone affected by cancer.
Hello I'm Zoe
I expect you're here because you or
perhaps a family member or friend have
been diagnosed with cancer and are about
to have surgery or start some other form
of cancer treatment
Understandably you might be worried and
In this video we would like to support
you by showing what you can do to
and explaining why preparation is so
The hospital or your healthcare team
might also call this prehabilitation or
Research says that when preparing for
cancer surgery or other cancer treatment
you should focus on free lifestyle
Eat a varied diet
Be physically active
And three take care of your mental
Focusing on these three areas and
whatever time you have before your
surgery or treatment starts can help you
to leave hospital earlier
reduce the risk of side effects and feel
more in control of your health
Also if you stop smoking and cut down on
alcohol the benefits to your cancer
treatment recovery and overall health
could be even greater
We understand that following a cancer
diagnosis you might go for a period of
uncertainty and anxiety which can lead
to a loss of appetite and weight
Being underweight can affect how well
you cope with and recover from your
treatment and if you feel like this
try to continue eating using the advice
on eating a varied diet in this video
A varied diet means eating a wide range
of foods in the right proportions and
drinking plenty of fluids to achieve and
maintain a healthy body weight
but this doesn't mean you can't allow
yourself the occasional treat
divide your plate at each meal like this
Each slice shows you how much of a food
group should be on your plate
The amount of protein in each meal
should weigh the same number of grams as
half your body weight in kilograms
protein is important to build muscle and
in preparation for surgery
eating a varied diet with lots of
protein helps the body fight off
infections and heal itself
if you're already on a special diet
because of other health conditions such
speak to your doctor your specialist
nurse or your dietitian to get the diet
advice that's specific to you
Cancer and cancer treatments are often
compared to running a marathon
in the same way that it's advisable to
train before running a marathon it's
important to increase your physical
activity before you have surgery
radiotherapy or chemotherapy
Research shows that you can improve your
fitness and build muscle in as little as
two weeks so it's worth doing the prehab
activities recommended even if there's
only a short time before your cancer
You might not have been physically
active for a long time and starting now
might feel impossible but many people
who felt the same have managed to do it
and feel the benefits
How much physical activity you can do
and at what level differs from person to
Aim for two and a half hours of moderate
or one and a quarter hour of vigorous
activity per week as well as some
strength building exercises like weight
training or yoga twice a week
While it is safe to exercise when you
have cancer you need to do physical
activities that are right for you So
speak to your GP or healthcare team for
advice on your situation
Being physically active boosts your
helps with anxiety and depression and
reduces your risk of heart disease and
type 2 diabetes
Anxiety or depression often starts at
the time of diagnosis or when you're
You might be feeling overly worried or
panicked which are symptoms of anxiety
or you might feel low in mood and not
yourself wanting to withdraw from the
world around you which are symptoms of
Try to keep in mind that a big part of
what you're feeling during this time is
a normal response to a very stressful
and a way of coming to terms with it
Getting ready for treatment will help
you feel prepared and stop the feelings
of anxiety or depression from getting
If you're finding it hard to manage make
sure you get the support you need
Taking care of your mental health will
improve the quality of your life long
and research shows that for people with
some pre-existing mental health
conditions making the most of that
support could better your chance of
overcoming certain cancers
We understand you might be going through
a lot and making these lifestyle changes
might sound overwhelming
but remember everyone will have
different needs and abilities So use
this video as a guide Do what you can
and be kind to yourself
Don't hesitate to ask your healthcare
team for advice
they will want to help you during this
And once treatment is over it's
important to carry on looking after
stick with a varied diet stay physically
active and look after your mental health
this will all help you live better in
the long term
How does prehabilitation help?
At diagnosis, your medical team should screen you for any problems in the three areas above. Research shows that if you get support early on and are as healthy as possible, you are more likely to:
- leave hospital sooner after surgery
- cope better with the side effects of cancer treatment
- have fewer side effects
- have more treatment choices
- have better long-term health
Prehabilitation plays a role in all your cancer care. That includes diagnosis, treatment and follow up. It continues as rehabilitation as part of your recovery package.
Feeling more in control
Following a prehabilitation programme can help you feel more in control of your physical and mental health. You can cope better during treatment and recover better if you are in control. By continuing to take care of your diet, physical fitness and mental health, you can live well in the long term.
Is there prehabilitation in every hospital?
At the moment, not everyone having cancer treatment will have prehabilitation. Research shows that it is helpful for people having surgery. But researchers think it might also help people having other cancer treatments. These are treatments such as chemotherapy and radiotherapy.
You might have prehabilitation at your cancer hospital or a local leisure centre as part of a:
- NHS programme or service
- research trial
Some hospitals offer it to people with certain types of cancers. These cancers include:
- upper GI (gastrointestinal)
But it is not available in every hospital at the moment. And there are differences depending on which UK nation you live in.
What happens if I’m not offered prehabilitation?
Not having prehabilitation will not affect the treatment you have for your cancer. You will still have the best possible treatment. Knowing about it can help you see what you can do to be in the best health possible before starting treatment.
So, before you start treatment, talk to your doctor, specialist nurse or other members of your healthcare team. Tell them if you're worried about your diet, physical fitness or mental health. They can give advice or may refer you to a specialist.
You can also take part in prehab activities independently should you prefer to do so. The following places have prehab programmes. You can use the information on their website. Always check with your GP or healthcare team before starting.
- Prepwell (South Tees)
- Active Against Cancer (Harrogate)
- Prehab2Rehab (South Wales)
- Aintree Prehab service
- PERCS (Ireland)
- Somerset Prehabilitation for Cancer
How does prehabilitation work?
There are 4 stages to prehabilitation:
Screening means the team caring for you will look at:
- your weight, whether you have had any weight loss or weight gain recently, as well as your ability to eat and drink
- how physically active and strong you are
- your mental well being
Screening aims to find problems as early as possible and get you as fit as possible for treatment. This means that you might have screening for prehabilitation at the same time as you are having tests to diagnose your cancer.
Everyone with a cancer diagnosis has a Holistic Needs Assessment (HNA). The HNA is a questionnaire that looks at your needs as a whole person and not just your cancer. The HNA shows what needs you might have during your cancer treatment. Your medical team can use it as part of prehabilitation screening.
You will also have screening with several other questionnaires.
If your screening shows that you are fine, your team will ask you to focus on three lifestyle behaviours until you start cancer treatment. These are also called universal interventions (see below). They are:
- eating a wide range of foods in the right proportions, also called a varied diet
- being more physically active and doing exercises
- looking after your mental wellbeing
Depending on the results of your screening, your medical team will assess your needs. They might ask you more about your history, examine you or do other special tests if they want to know more.
They may refer you to specific 'prehab' teams. They can be in the hospital or community. They will do the assessments. The teams can include:
- exercise specialists
- occupational therapists
- other NHS staff
So, if your screening shows that you might not be very fit, you will have a physical fitness assessment. This might be:
- a 6 minute walk test
- an incremental shuttle walk test - a test that looks at how far you can walk, with the pace increasing gradually every minute at the sound of a beep
And if it shows you could have problems to do with your diet, you will have a nutritional assessment. This is to make sure you are getting enough of the types of food necessary for good health.
The team will also want to know your weight and the amount of fat and muscle (body composition) in your body. This is so that your body is in the best condition possible before treatment.
You will have an assessment of your psychological needs if it shows that your mental health is at risk. Your HNA will give the team more information on these needs.
The results of these assessments will show your medical and prehab teams:
- what your needs are
- how much support you might need
- what the best methods are for improving your physical, nutritional and mental health in the time before treatment
An intervention means helping you to cope with and recover from treatment. Not everyone will have the same needs. And how much support you need might also differ from others. So, your team will look at your specific situation.
There are 3 types of interventions you might have:
Universal interventions are for anyone with cancer and their families. It focuses on three lifestyle changes, namely diet, physical activity and mental health. It also focuses on other areas of your health which you can change when living with cancer. Focusing on your behaviour in these areas can help you to live well in the long term.
The other areas of health are:
- keeping to a healthy weight
- stopping smoking
- drinking alcohol within the suggested limits
This might include your team talking to you about a particular area of your health. They might give you information or signpost you elsewhere, such as a stop smoking service. Or they might ask you to look at websites, use apps or watch videos.
It might be that you only need universal interventions to support you.
A targeted intervention is planned support from an expert. They aim to help you make a change in a particular area of your health. They are for people with cancer who:
- are at risk of long-term (late) effects of treatment
- have other long-term health conditions
- need extra support to successfully do their recommended prehab activities
Your team might refer you to an exercise class if you need support with physical activity. This might be a group class or a one to one class. The class might be at a local gym with a cancer exercise specialist. Or it might be doing exercises with someone through a video call.
For problems with diet, a dietitian can tell you what to do and guide you. They can help with diet problems because of your cancer or conditions such as diabetes.
Good muscle strength is important before you start treatment. The advice on diet and exercise will help with this.
Some people need support to help them deal with specific areas of mental health. This might include dealing with anxiety, a low mood or problem solving. A healthcare professional with training in one of these areas can support you.
Exercise and continuing your daily activities can help support your mental health when dealing with a cancer diagnosis.
Specialist interventions are for people with cancer whose assessment showed you:
- have complex needs
- are having major treatment
- have severe changes because of treatment
- have a disability
- are at higher risk of having problems if they try to do the prehab activities
So, if you can't do much physical activity, you might need specialist support. A qualified cancer exercise professional and physiotherapist at the hospital or a local leisure centre can help you.
Some people might have more complex diet problems, such as:
- difficulty swallowing
- weight loss
- changes to how their digestive system works
In these situations, a dietitian might prescribe you diet support. These can be:
- food through a tube into their stomach (enteral nutrition)
- intravenous (drip) feeds called parenteral nutrition (PN)
A counsellor or psychologist can offer help if you have problems to do with your mental health. Some people need specialist therapy or psychiatric support. Support from a specialist is important if you have been suffering from a mental health problem before your cancer diagnosis.
You might need a mix of different levels of support. Universal interventions might support some of your needs. But other problems might need targeted or specialist interventions. You might also move between interventions over time.
It is important that your prehab team know how much you can do, as well as what your needs and wishes are. They will adapt your prehab activities accordingly.
Monitoring your progress when doing the prehab activities is important. This is before and after treatment. It will help the prehab team to understand:
- what changes (if any) are happening
- how this relates to your cancer treatment
- whether they need to change anything
How much monitoring you need will depend upon whether you are doing your prehab interventions:
- independently (universal)
- with regular support from your prehab team (targeted or specialist)
Prehab teams are interested to know how the activities have been helping you. This will help them to show the importance of it and that more people should have it.
So, monitoring not only helps to understand what is happening to you, but can help other people affected by cancer in the future.
We have more detailed information about the three parts to prehab.
For information about eating well:
For information about how to be physically active and exercise:
We have detailed information about looking after your well being when you have cancer.