Fitter Better Sooner – leaflet

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Having an operation is a major event in someone’s life and it’s normal for them to feel anxious about it.

Fitter patients who are able to improve their health and activity levels recover from surgery more quickly and with fewer complications. What you do in the time leading up to surgery can have a really big impact on your recovery and long term health.

This leaflet and the other resources in the toolkit will provide you with the information you need to become fitter and better prepared for your operation. 

You can read the procedure-specific leaflets in the Preparing for Surgery – Fitter Better Sooner toolkit and view the accompanying animation. You can also download a copy of the animation via Vimeo.

 

 

Your role in preparing for surgery

Having surgery is a big moment in your life and it’s normal to feel anxious about it.

Fitter patients who are able to improve their health and activity levels recover from surgery more quickly.

What you do now can have a really big impact on your recovery.

Taking an active role in planning and preparing for your operation will help you feel in control, leave hospital sooner and get back to normal more quickly. Waiting times for surgery may be longer in some areas, but you can use this time to prepare for your surgery.

This information will give you general advice on what you can do to get the best outcome from your surgery.

A patient story by Roger (not his real name)

I was overweight and a lifelong smoker. The surgeon and anaesthetist had already told me that my surgery would be more difficult and that I would need to stay in the High Dependency Unit (HDU) afterwards, which might delay the date of my surgery if a bed wasn’t available.

My anaesthetist spoke to me about some changes that I could start to make to help my recovery and encouraged me to read the information in Fitter Better Sooner and watch the animation. That evening I watched the animation with my family. My daughter knew how worried I really was. They encouraged me to have a go at making some lifestyle changes.

I had wanted to stop smoking for a long time but never had the will to go through with it. It was hard, but eventually I managed. I also decided to start walking and tried to walk slightly further each day. Before I only walked somewhere if I really had to, but I really started to enjoy it. I felt myself get fitter and also got to know the people living in my area.

I have diabetes but I’d not taken it very seriously. I made an appointment at the GP surgery. The nurse helped me understand more about what food I should eat to better control my diabetes and encouraged me to gradually lose some weight. She gave me a machine to help me keep an eye on the sugar level in my blood. I lost 4kg in the six weeks before my surgery. Feeling healthier and fitter gave me a lot more confidence going for my surgery. I had been quite depressed and worried about it before.

After my op I was on the HDU for a day and then back to the ward. I was in hospital longer than I should have been, because my wound did not heal well at first, but I had no serious complications. The physio at the hospital gave me breathing exercises and encouraged me to walk around the ward to keep active and speed up my recovery.

Three months after my op I am still feeling the benefits of the changes I have made. I don’t need my inhaler as often as I used to and I find it easier to walk up the stairs. I still love my walks, my weight keeps dropping and I feel much more optimistic about the future. 

 

The healthcare team

Many staff from different healthcare professions will work together to make your surgery and recovery go smoothly. They will look after you before, during and after your surgery. This is often referred to as the perioperative team. 

But it all starts with you.

 

 

Preparing your body

Lifestyle changes

There are many changes you can make to reduce the risks of surgery. Small changes, even over a short time, can make a big difference.

Exercise

Your heart and lungs have to work harder after an operation to help the body to heal. If you are already active, they will be used to this. While you are waiting for your operation, try and increase your activity levels.

Brisk walking, swimming, cycling, gardening or playing with your children or grandchildren are all helpful. Swimming can be helpful for those with obesity or joint pain. Try to do any activity which makes you feel out of breath at least three times per week. Start slowly and stay within your limits. Take advice if exercise is difficult for you. Stop and ask for medical advice if you develop new problems including chest pain, dizziness or your heart beat becomes irregular. Activities that improve your strength and balance will also be useful for your recovery, for example daily ‘sit-to-stand’ exercises.

You can see some examples here from Moving Medicine – Chair-based Exercise Programme.

Who can help me?

  • There are a number of mobile apps to help you set goals and track your progress, such as ‘Active 10’ and ‘Couch to 5K’ on the NHS website.
  • Try joining a free Council or community walking group or environmental volunteering scheme in your local area. As well as giving you encouragement and support to start walking and exercising, they are enjoyable and will boost your mood. Ask your GP surgery what is available in your area.
  • If you have back or joint pain and you see a physiotherapist, ask them for exercises that you can do. There is also information on exercising on the Versus Arthritis website.
  • For people who are frail, a gentle walk every day, sit-to-stand exercises, stair climbing and reducing time sitting are a good start.
  • Depending on where you live you may have access to NHS ‘health trainers’ who can help motivate you and offer advice.

These are only some ideas and there will be many health and fitness programmes that you can explore in your local area.

Healthy diet

Your body needs to repair itself after surgery – eating a healthy diet before and after your surgery can really help. This means getting enough protein and ‘5 a day’ or more of fruit and vegetables. These help wound healing and your immune system. 

Who can help me?

The NHS – Eat well website has useful resources and information. Your GP surgery may be able to give you some advice and information on healthy eating if they have a dietitian service.

Weight

If you are overweight, losing weight can help reduce the stress on your heart and lungs. You can find out if you’re a healthy weight using the NHS BMI healthy weight calculator.

Losing weight can also help you to:

  • lower your blood pressure
  • improve your blood sugar level
  • reduce pain in your joints
  • reduce your risk of blood clots after surgery
  • reduce your risk of wound infections after surgery
  • allow you to exercise more easily
  • reduce the risks associated with having an anaesthetic.

More information about the benefits of losing weight before an operation and the increased risks of having surgery with obesity can be found in our leaflet Anaesthesia and your weight.

Who can help me?

There will be local weight loss schemes and exercise opportunities in your area. The NHS has a Weight Loss Plan app. Your GP surgery or pharmacy may be able to weigh you and signpost you to advice on healthy eating. If you have obesity, your GP may also refer you for bariatric (weight loss) surgery to reduce the risks and improve your outcomes before they refer you for other procedures. Some councils also have schemes that can support you so it is also worth looking at your local council website or contacting them.

You may find it helpful to join a weight loss class. In some areas, NHS health trainers may be available to help you.

More information and additional resources can be found on the NHS website.

Alcohol

Alcohol can have many effects on the body, but importantly it can reduce the liver’s ability to produce the building blocks necessary for healing. If you drink regularly you should make sure you are drinking within the recommended limits or lower. If you drink more than this, you should also aim to cut down before your operation to improve your body’s ability to heal after surgery and to avoid withdrawal symptoms during your stay in hospital.

Who can help me?

You can find information on recommended limits and how to reduce the amount of alcohol you drink on the NHS website (tips on cutting down) and the NHS Better Health – Drink less website.

Smoking

Stopping smoking is hard, but the good news is that quitting or cutting down shortly before surgery can reduce your length of stay in hospital and improve wound healing and lung function. Preparing for surgery offers a real opportunity to commit to stopping smoking.

Who can help me?

Find out if there is a local Stop Smoking Service in your area.

The following organisations have useful information on the benefits of quitting smoking before surgery:

More information on the interventions that can support patients prepare for surgery can also be found on the Centre for Perioperative Care (CPOC) website.

 

 

Medical conditions

Many medical conditions can affect recovery from surgery. It is important to make sure any known conditions are controlled as well as possible ahead of your surgery.

You can also book in for a general NHS health check at your GP surgery if you are between 40 and 74 years old.

Diabetes

Good control of your blood sugar is really important to reduce your risk of infections after surgery. If your blood sugar readings or HbA1c measurement (a blood test that  checks your longer term diabetic control) is high, you may benefit from changes to your medication or diet.

Think also about your diet and weight. Your diabetic control will improve if you lose weight. For patients with type 2 diabetes, with or without obesity, a Mediterranean or a low carbohydrate diet can be helpful. More information on diabetes and diet can be found on the British Dietetic Association (BDA) website.

If you haven’t had your HbA1c checked in the past six months, you can request a test at your GP surgery. If needed, the team can recommend any changes well ahead of the operation. This will reduce the risk of your surgery being delayed.

High blood pressure (hypertension)

Blood pressure should be controlled to safe levels to reduce your risk of heart disease and stroke. Sometimes operations may be delayed if it is too high. If you haven’t had your blood pressure checked in the last year, or you know your blood pressure is poorly controlled, ask for a check at your surgery well ahead of your operation. Some pharmacies also offer blood pressure checks.

If you have, or borrow, a blood pressure machine you can let your GP surgery know the result. Some GP surgeries have automated machines and you may not need to make an appointment to use these.

If your blood pressure is high, your GP can check your medications and make any changes needed ahead of the operation.

Lifestyle changes can help control and reduce high blood pressure. You can find more information on the NHS website.

Anaemia (low levels of iron in the blood)

Treating your anaemia before surgery reduces the chance of you needing a blood transfusion. It will also help your recovery and make you feel less tired after your surgery.

One third of adults having major surgery are anaemic. If you have been bleeding or if you have a long-term condition, request a blood test at your GPs to check whether you are anaemic.

Anaemia should be diagnosed as early as possible for the treatment to be effective. If you are concerned that you might be anaemic, you should talk to your GP, pharmacist or surgical team about treatment to improve your blood count well ahead of the surgery.

Many people have iron deficiency anaemia and a diet consisting of iron rich foods, such as green leafy vegetables, meat and nuts, can help. Some people also need more vitamin B12 and folate:

  • iron is found in: red meat, beans and nuts
  • vitamin B12 is found in: meat, fish, cheese or eggs
  • folate is found in: green leafy vegetables, broccoli, brussels sprouts, asparagus, peas, chickpeas, brown rice and liver.

If picked up early, anaemia is usually treated with iron tablets and an iron rich diet. In some cases you may be offered a dose of intravenous iron given through an infusion directly into your veins. This works more quickly than tablets, but there are some additional risks. An infusion is usually offered if the surgery cannot be delayed.

You can find more information on the NHS website about iron deficiency anaemia.

Heart, lung and other medical problems

If you have any other long-term medical problems, consider asking your GP surgery for a review of your medications, especially if you think your health is not as good as it could be.

Anxiety and mental health

Most people feel some anxiety about having surgery. If the thought of going into hospital is making you very anxious or upset, it may be helpful to talk about your concerns with your GP. In some areas, GPs can refer you for specific support.

You can find out more information about how to manage anxiety before an operation in our Preparing your mind before surgery webpages.

Many techniques including mindfulness, relaxation, breathing exercises or yoga can help you relax before and after your surgery.

If you are taking medication for your mental health, it is important to let the team at the hospital know about this during your preoperative assessment. They will usually ask you to continue this medication throughout your hospital stay. It is important to take it to the hospital with you. They can also help organise any specific support you might need for your time in hospital or return home.

You can find more information and support at NHS Better Health – every mind matters.

Dental health

If you have loose teeth or crowns, a visit to the dentist may reduce the risk of damage to your teeth during an operation.

It’s also important to have good dental hygiene and for your teeth and gums to be in good condition before the surgery, as this will reduce the risk of infection.

More information can be found on the NHS website.

 

 

Practical preparation for your operation

We know that coming into hospital for surgery can be a worrying time. Talk to your family and friends about going into hospital and tell them how they can help you. Don’t underestimate how tired you may be afterwards.

Give the below checklist some thought well in advance of the operation.

  • How will I pass the time? – have some headphones and music, books, tablet computer or puzzles. Don’t forget chargers.
  • What can I do to relax? – learn some breathing and mindfulness techniques, try yoga or listen to relaxing music and calming apps. In addition, the College, in partnership with the British Society of Clinical and Academic Hypnosis (BSCAH), has produced a series of recordings which might help you to relax before surgery.
  • What do I need to prepare at home? – you may find it difficult to move around when you return from hospital – you might consider sleeping on the ground floor and getting mobility aids if you think you’ll need them, but generally you will recover quicker if you keep moving after surgery.
  • Who can look after my elderly relatives? – if friends and family cannot help, contact your local Council and your local carer service. You can find more information on The Carers Trust website.
  • How will I get to and from the hospital? – can someone drive you? If you are eligible for hospital transport, the hospital may be able to organise transport for you.
  • Do I have enough easy-to-cook meals and healthy snacks for when I get home? – think who might be able to help prepare meals or help with your shopping afterwards. You might want to sign up for a home delivery service with a supermarket or store some meals in your freezer before you go to hospital.
  • Who can look after my children or pets? – ask friends and family to help or to be on standby. To help you with childcare, they may need to arrange time off work too. If you have significant difficulties looking after your children following an operation, talk to your local council or your health visitor.
  • Do I have enough medication and batteries for my hearing aid to last me in hospital and when I get home? – you will usually be asked to take your usual medication into hospital with you in the original packaging. Remember to take this and all your personal belongings back home with you when you are discharged.
  • Do I have some over-the-counter painkillers at home? – you may need to take some during your recovery as instructed by the hospital.
  • What do I need to pack? – if you are staying in hospital overnight you should think about toiletries, nightwear, comfortable clothes and footwear which is sturdy but easy to put on. It is important to get out of bed, get dressed and start to move as soon as your operation allows – those who do this get home sooner and recover quicker. Temperatures in hospital can vary, so some layers of clothing can be useful. See the NHS website for further information.
  • What else would be helpful to do? – get your house and garden in order. Get up to date with your general affairs and finances. This will mean you do not have to worry about these whilst you recover.
  • Whom should I let know I am going into hospital? – friends and family can usually give you practical support. It is also good to have people to talk with whilst you are at home recovering. Many people will want to help your recovery, so let them know how they can help in plenty of time.
  • Should I have a shower/bath before going to hospital? – this is important to minimise the risk of infection. You may also be given antiseptic wash to use to help further reduce the risk.
  • What happens if my surgery is delayed? – the preoperative assessment team will contact you if your procedure needs to be postponed and they will advise you on restarting any medication that might have been stopped.

 

 

Questions to ask

Practical questions to ask your perioperative team about your surgery

Members of the perioperative team at the hospital will discuss your anaesthetic, surgery and recovery period. They will talk through any particular risks you might have from both your anaesthetic and surgery and any choices you have. They will give you information to read at home. There will be a contact number to ring if you need to ask more questions.

Below are some questions that you might want to ask the perioperative team.

  • What time do I need to stop eating and drinking before surgery?
  • Are any changes needed to my medication before and on the day of my surgery?
  • What do I need to pack for the hospital?
  • Do I need to remove nail varnish, gels or piercings?
  • Can I have visitors? When are the visiting times?
  • Will someone at the hospital shave me if needed before my surgery?
  • When can I Drink, Eat and Mobilise (get up and walk around) after my operation (DrEaMing)? I have heard this can help get me home sooner?
  • When can I expect to go home?
  • What help can I expect to need at home afterwards?
  • How long will it be before I can shower/bathe again?
  • Are there any important ‘dos’ and ‘don’ts’ for my recovery?
  • Will I have stitches or staples that need to be taken out?
  • How much time will I need to arrange off work?
  • Who will give me a fit/sick note for my employer?
  • Will I have a check-up afterwards?
  • How long might it be before I can walk/swim/play golf/run again?
  • When can I drive afterwards?
  • How long will it be before my life is roughly back to normal?

You can also read our Patient Frequently Asked Questions (FAQs).

 

 

What can I expect during my recovery?

Your recovery starts immediately after your operation when you are still in the hospital. For many surgical procedures there is now no need to rest in bed for a long time after surgery or the need to be ‘nil by mouth’ postoperatively. Many hospitals will aim to get you Drinking, Eating and Mobilising within 24 hours of surgery, known as DrEaMing. Patients who do so have shorter hospital stays and reduced complications. Ask the healthcare team when you can drink, eat or mobilise after the operation.

Before you leave the hospital, your nurse will give you written information about what to expect during your recovery at home and how to manage any pain you might experience. This will also include anything to look out for and a number to call if you are worried.

Our procedure specific leaflets on some of the most common surgical operations give more detailed information on how to prepare for different types of surgery and what to expect afterwards.

Practical help to keep you motivated during your recovery

Depending on what surgery you are having, recovery may take many weeks. Don’t worry if some days go better than others, as this is normal. It can be useful to keep a recovery diary which you can continue after you go home. Try and get into a routine and get up in the morning at a regular time. A list of daily goals can give structure to your day and help monitor your progress.

Visits and phone calls from family and friends can cheer you up and encourage you to reach your goals. If you have the technology, make use of WhatsApp, Facetime and online platforms like Zoom to keep in touch with people. Be careful though not to tire yourself out.

Additional resources available online

 

 

Enhanced recovery

What does the term ‘enhanced recovery’ mean?

Enhanced recovery is the name given to a programme that aims to get you back to your normal health as quickly as possible after a major operation. Hospital staff look at all the evidence of what you and they can do before, during and after your surgery to help give you the best chances for a quick and full recovery. This should get you home sooner.

The programmes will vary depending on what operation you are having and which hospital you are being treated at, but may include:

  • improving your fitness levels before your operation if there is enough time
  • treating any other long-term medical conditions
  • reducing the time you fast by giving you water and carbohydrate drinks before your surgery
  • giving you medication to prevent sickness after surgery
  • considering the best ways of giving pain relief during the operation
  • using local anaesthetic blocks or regional anaesthetics where possible
  • giving you the best pain relief afterwards to get you moving quicker
  • encourage you to Drink, Eat and Mobilise within 24 hours of surgery (DrEaMing)
  • reducing the time you have catheters and drips
  • teaching you exercises to help you recover after your operation.

By following an enhanced recovery programme, there are usually fewer complications after surgery. There is also less chance of you needing to go back into hospital again.

 

 

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Disclaimer

We try very hard to keep the information in this leaflet accurate and up-to-date, but we cannot guarantee this. We don’t expect this general information to cover all the questions you might have or to deal with everything that might be important to you. You should discuss your choices and any worries you have with your medical team, using this leaflet as a guide. This leaflet on its own should not be treated as advice. It cannot be used for any commercial or business purpose. For full details, please click here.

Second Edition, May 2022
This leaflet will be reviewed within three years of the date of publication.

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