Prehabilitation (or rehabilitation before surgery) can help you be healthy and strong before surgery and improve your recovery afterward. The Surgical Prehabilitation and Readiness (SPAR) program will guide you over the next few weeks and give you strategies and goals to prepare for your surgery. If you have any questions, please call your doctor.


Research has shown that people who are stronger before surgery do better. Exercising before surgery can make you stronger. Having a healthy heart and lungs will help you during your surgery. It will also make it easier for you to recover after your surgery. Even walking can help with strength and endurance.

Boost Your Activity

Step 1: Your SPAR coordinator will work with you to set activity goals.

  • Choose an activity goal that you can achieve. Getting regular exercise will help you get stronger. If you are new to exercise, start slow and listen to your body. You can work your way up to doing more exercise.
  • The Centers for Disease Control and Prevention (CDC) Physical Activity Guidelines recommend about 40 minutes of physical activity every day.
  • Our goal for most patients is to walk at least 6,000 steps (or about 2 miles) every day.
  • Be sure to follow all activity and lifting restrictions provided by your surgical team and physical therapist.

Step 2: Set up your Fitbit.

  • Your team will give you a Fitbit to help you track and achieve your physical activity goals. The team will help you set up the Fitbit and answer any questions you have.
  • The Fitbit will track your active minutes, steps taken, and let you know when you have achieved your daily goal.
  • Be sure to wear your Fitbit as much as possible. This will give your doctor the best information about your physical activity.


A good program includes activities that you enjoy and that work with your schedule. When it is safe to do so, joining a group activity can be good motivation. Sharing your activity goal with a friend or family member can motivate you to get exercise every day.

How to exercise safely and effectively:

  • Warm up: Walk or perform other activity slowly for the first few minutes. This will help your heart, lungs, muscles, and joints get ready for exercise.
  • Peak activity: Move a little more quickly. Listen to your body! If you become short of breath, slow down or take a break.
  • Cool down: Slow down again for a few minutes, until your breathing returns to normal.
  • If you can’t exercise at a moderate pace for a long time, try interval training. For example, walk at a comfortable pace for 3 minutes, then increase your speed or incline for 1 minute, then go back to the comfortable pace for 3 minutes. Repeat as tolerated.

Strengthening Your Lungs

Having strong and healthy lungs is important before surgery. Your team will give you a device called an Incentive Spirometer. The team will show you how to use this device to take deep breaths. The spirometer will help you strengthen your lungs. Using the spirometer every day can help reduce your risk of breathing problems like pneumonia after surgery. Start using your spirometer when your team asks you to do so. Track your spirometer use on the Activity Log and share your progress with your team.


Take 30 spirometer breaths every day. To reach this goal, try taking 10 spirometer breaths, 3 times each day.

How to use the Incentive Spirometer

Incentive Spirometer
  • Sit up straight.
  • Put the mouthpiece in your mouth and close your lips tightly around it.
  • Breathe in slowly and deeply through your mouth. As you take the breath, you will see the ball rise inside the device. Focus on keeping the ball in the “best” or “better” range.
  • Once your lungs are full, remove the mouthpiece from your mouth, hold your breath for 3 seconds, then breathe out normally.
  • Rest for a few seconds and then repeat.
  • If you feel lightheaded or dizzy while using the spirometer, stop and breathe normally for a few minutes.

Stop smoking and the use of nicotine products.

Smoking can increase the risk of problems after surgery, such as wound infections, healing problems, pneumonia, and heart attack. When you smoke, it makes your lungs weaker. This means there is less oxygen in your blood. Oxygen is one of the most important things that you need to heal after surgery. You will not be able to smoke or use nicotine products during your hospital stay.

Ask us for a referral to the Tobacco Cessation Program.

  • Ask us for a referral to the Freedom From Smoking program. This six-week, group smoking cessation program is offered through the Health and Cancer Infromation Center at Siteman Cancer Center. You will learn the quitting strategies used by other successful ex-smokers and how to minimize withdrawal symptoms, cope with temptation and avoid relapse.
  • Talk with your regular doctor about prescribing medicine or a nicotine replacement to help you handle the urge to smoke.
  • Reach out to your health insurance plan to learn about smoking cessation covered benefits or quit programs.
  • Try a mobile app that can help you quit.
  • Most importantly, never quit quitting. Most people need to try many times before they succeed. Set a date to give up smoking.
  • Free tobacco cessation resources:
  • Call 1-800-QUIT-NOW (784-8669) •

Choose Healthy Foods

Having surgery is like running a marathon. Both require preparation and nutrition in the weeks leading up to the main event, and in the days and weeks after, for recovery and healing.

Here are some reasons to improve your diet:

Increased Energy Needs

Your body uses up a lot of energy during and after surgery. Add calories by eating foods with extra nutrients, such as nuts, dried fruit, eggs, and cheese.

Lowered Immunity

Your body uses up a lot of energy during and after surgery. Be sure to eat fruits and vegetables in addition to adequate amounts of protein. If you think you don’t eat all the nutrients you need, consider taking a multi-vitamin daily.

Weight Loss

Your body uses up a lot of energy during and after surgery. Add calories by eating foods with extra nutrients, such as nuts, dried fruit, eggs, and cheese.

Muscle Loss

After using up carbs and protein, the body starts breaking down muscle to create energy. Muscle loss can lead to lower strength and longer recovery. Protect your muscles by adding high protein foods to each meal or snack.

Major workout

In surgery, you will burn more energy than you would running for 2 1⁄2 hours. Increasing your carbohydrate (carb) intake a few days before surgery can keep you from running out of energy.


Eating a healthy diet before and after surgery will help yourbody handle the stress of surgery, fight infection and heal quickly.



Eat at least 60 grams, or 6 oz., of protein daily. Your body will have higher protein needs after surgery, radiation or chemotherapy. Good sources of protein are eggs, skinless poultry, fish, shellfish, lean beef, pork (round or loin cuts), soy products (such as tofu or soy milk), beans, peas, lentils, nuts, seeds, nut milks and protein powders.

Fruits and Vegetables

Eat several servings of fruits and vegetables daily. Fresh and frozen “are preferred” over canned. Fruits and vegetables are full of vitamins, minerals and antioxidants that promote healing tissue and bone growth. To turn fruits and veggies into a high protein drink, add protein powder and blend up with fruits or veggies you enjoy. This high-protein smoothie can be used as a snack or a meal replacement.

Whole Grains

Include whole grains daily. Whole-grain foods are labeled as “whole” grain or “whole” wheat. Whole grains contain generally more fiber, iron and B vitamins. Limit your intake of sugar.

Meal Supplements

Many people need to supplement their diet after surgery with high protein shakes or bars. These shakes and bars are very useful to patients to help meet their calorie and protein needs. They are many different products available and the most important thing is to find a supplement that you enjoy. If you do not like the taste of a supplement it is unlikely you will drink it. So, don’t stock up before sampling. Some examples of meal supplements include Ensure, Boost, Carnation Breakfast Essentials and Premier Protein.  You can also make your own high protein shakes/supplements using protein powder, yogurt, or peanut butter mixed with fruits or veggies. Homemade versions are less expensive than commercial products.

Create a Positive Mindset

It is normal to feel anxious, nervous, and hesitant about your upcoming surgery. Managing the stress of preparing for surgery can be challenging.

Keep a gratitude journal.

We encourage you to start by keeping a gratitude journal. Gratitude is the quality of being thankful. This can help you keep a positive attitude before surgery. Gratitude not only reduces stress, but helps increase your mental strength, and has been shown to improve your health. It can lower blood pressure, improve immune function, decrease pain, and help you sleep better.

A simple and well-known approach to keeping a gratitude journal is called “Three Good Things.” Every evening, write down 3 things that went well for you that day. These can be things you are grateful for or events that brightened your day.

For example:

I am grateful for…

  1. a restful sleep last night,
  2. being able to help my neighbor today, and
  3. the support group I found in my community.

What additional strategies can help reduce stress, anxiety and pain?


Practicing mindfulness can help you focus on the present, rather than worry about the future or regret the past. You can practice mindfulness sitting in a quiet space, while going for a walk, or doing activities like yoga or tai chi.

Mindful breathing exercise:

  • Breathe in through your nose for 5 seconds, hold the breath in for 2 seconds. Exhale for 5 seconds.
  • Imagine breathing in positive feelings and blowing out stressful or negative feelings.
  • Find a soothing mantra to repeat to yourself. Try, “I am relaxed and calm. I trust my surgeon. I see a life where I am strong and healthy, enjoying _______ (include something you enjoy doing now or hope to do after surgery).”
  • When your mind gets distracted, or you experience anxious thoughts, simply recognize the thought briefly without making judgment. Then refocus on your breath.


Aim for 7-9 hours a night to help your body and immune system work at its best.

Create a support system

Make time to see friends and family. Ask them to support you in your new healthy habits.


Laughter releases tension and brings about positive physical changes in your body.

Doodle, draw, or color

The repetitive and rhythmic motions can help you relax, quiet your mind or serve as a form of meditation. Create your own work, or use a mandalas coloring book. Mandalas are designs that are usually circular geometric patterns. These books, or coloring pages, are easily found in stores and online.

Get active

Walking can help you feel less stressed, improve your mood and help you sleep.

Listen to music

Music can help lower your threshold for pain, improve your mood, and relieve stress and anxiety.

Think positively

Positive self-talk can help shift your perspective. When you have a negative thought, take a moment to consider whether the thought is reasonable. Try to reframe the negative thought into something more positive. For example, “It will take me months to recover from this surgery,” might be replaced with, “I am doing everything I can to make my surgery go well. Joining SPAR will help me take control of my recovery.”


For general requests or to refer a patient to the SPAR program, please fill out one of the forms below and a member of our SPAR team will be in contact soon.

Communicate securely with your physician’s office:

As a patient of a Washington University physician, you have access to a secure, convenient and free way to manage your personal health care information.

MyChart: Your Secure Online Health Connection

  • Manage appointments
  • Get test results
  • Message your doctor and their team
  • Check on FMLA
  • Pay bills
  • Request prescription
  • Ask non-threatening health/diet related questions

Contact your doctor’s office to receive an email containing a link that automatically enrolls you in MyChart.