This pillar is about being physically active, with members following cardio and strength training programs. The main goal here is to improve cardiorespiratory fitness and increase muscle mass.

People new to exercise may find it difficult to start a fitness program and may even be fearful. For both safety and pleasure, we suggest that the members do not exercise alone. Someone should join or supervise their training sessions.  

Before starting their physical fitness program, the members need to review the exercise clearance and warning signs. You should review these too, especially if you are new to training and will be participating.

Other than joining in, you could also help with setting up a workout schedule, arranging a training environment, or getting equipment.

After exercise the body needs to recover to become stronger and more efficient. This pillar refers to recovery from the fitness program, not recovery after surgery. This writer (Dr. Mahoney) likes to say “train hard … recover harder”.

This pillar includes routines to ensure efficient and painless movement as well as guidance on healthy sleep practices.

Sleep is one of the most important components of prehab, so discuss sleep with the person you are supporting. Adequate sleep helps with every other aspect of the program - it boosts energy, helps metabolism, enhances immune function, and improves mental health.

If you are a bed partner, perhaps go to bed at the same time. Or do your best to not disturb the member’s sleep time.

Committing to a regular mobility routine is also important. People new to exercise should not be doing the fitness program if they are not doing the mobility program, which includes stretching and other routines.  

Mobility work is beneficial even without the fitness program; it prepares the body’s tissues for the period after surgery when regular activity may be decreased.

Proper nutrition helps the body to build muscle before surgery. After surgery, it helps healing and recovery. 

Poor nutrition is associated with poor surgical outcomes. Some people preparing for surgery may be malnourished, while others may be overweight or obese. The nutrition goals are different for each, but ensuring an adequate protein intake is the main focus for both.

Preparation is the cornerstone of a successful nutrition plan. So whoever is doing the grocery shopping, meal planning and cooking needs to be involved in ensuring that healthy foods form the diet. 

Making environmental changes can also be very important, in particular for people without optimal body weights. Make it inconvenient to eat poorly by keeping certain foods out of the house.

Finally, making nutritional changes work best when everybody in the home is involved. It will be hard for the person preparing for surgery to make healthy eating choices if others in the house are not doing so.

The content is this pillar explains how to actively prepare the mind for surgery. Mental training before surgery is as important as physical training and deserves equal attention. 

Encourage the person you are supporting to review this content. They can select topics to suit their needs. You can help them manage emotions and stressors as well; you can motivate, cheerlead and lend a helping hand during any lows.

For those with a diagnosed mental illness, we recommend help beyond PrehabMD. Arranging in-person professional care from a qualified mental health professional may be needed.

To get the most out of the program, we highly recommend that members plan and log their efforts and activities.They have been provided specific tools, checklists, and a logbook for setting goals and creating a plan to achieve those goals.  

You can work with the person you are supporting to set feasible goals; you can make suggestions, nudge a bit if needed, or get them to draw back if their goals are unrealistic. You can’t set goals for them though. Goals imposed by others commonly backfire and may prove counterproductive. 

But you can hold them accountable to the goals they set: for instance, by reviewing a checklist of activities at the end of each week. And offering the appropriate congratulations!

You can also help with expectations. For example, weight loss may or may not happen in a few weeks. But even if no weight is lost there could be muscle gained.

People are more likely to make healthy behaviour changes if those around them do too. So one of the best things you can do is to join in - do the fitness program together, follow the nutrition plan together or quit smoking together.

And there are many other ways of helping. For example, if you have the means, but lack time, perhaps your contribution can be a healthy meal plan order, protein supplements, workout shoes or equipment. Or you can support them behind the scenes, like helping to arrange appointments or to carry out tasks that they cannot do during their prehab period. 

Even if you live at a distance you can provide support by regularly checking-in on loved ones to see how they’re doing, listening to and motivating them, and letting them know they can call you when they need. Many activities can also be done virtually, including supervising, or even participating in workouts.  

Family, friends and community are an important part of the solution. But they can also be part of the problem. It may seem obvious, but if someone is trying to quit smoking, don’t smoke in front of them. If someone is trying to clean up their diet, don’t eat donuts in front of them. 

And remember, you can do the program with them, but you can’t do it for them. There is no point trying to push someone up a ladder more quickly than they want to go.