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The rehab mindset whispers, “Finish your cancer treatment and then we will send you to rehab to strengthen your body.” The patient is passive in this equation. Problem solving is sequential - once we cure the cancer, rehabilitation follows. Then, you can continue with life.

The prehab mindset, by contrast, is proactive. It asks, “How can I adapt to my medical challenges and maximize recovery?” In this model, a recovery mindset begins soon after diagnosis. A pathway to wellness is mapped out at the beginning, not the end, of cancer treatment, hence the name, prehab.

Prehab makes sense today because the majority of cancer patients are cured. An expectation of recovery is reasonable. Additionally, a sizable number of incurable cases live extended lifespans with cancer seen as a chronic illness. Here too, an expectation of maximizing wellness earlier is helpful.

Physical Prehab

Consider physical wellness. Prehab challenges you to think about fitness ahead of cancer treatments or surgery. What can you do to prepare physically? Perhaps a modified gym class or brainstorming adaptive exercise with your personal trainer. Right after the surgery, how will you take your first step on the road to recovery? It might be a symbolic walk around the nurses’ station with your visitors or a gentle walk with your dog when you arrive home.

The prehab mindset even extends to the arduous process of chemotherapy. Are there ways to bring gym, yoga or physical therapy to your hospital or living room? Some hospitals have physical therapy for orthopedic cases but not for every cancer patient. Ask your oncologist to order  PT from the get-go. This is a talk-back to the, “You must rest,” mentality of recovery from illness.

In fact, top cancer hospitals such as Memorial Sloan Kettering are developing adaptive exercise programs with personal trainers and classes that exemplify the prehab mindset. Similarly, many hospital rooms have small exercise bikes. While not an intense spin class, with a little music and a few laughs you can get your legs pumping for ten minutes. Many of us have exercise routines. If you have a surgical catheter in your chest and cannot manage your usual push-ups, what adaptive exercises can you do instead? Perhaps stretching or gentle squats next to your hospital bed. The secret of prehab is an adaptive mindset.

Work Prehab

Think about adapting your work to the illness process. For some this might mean answering emails or continuing mentorship. For others conferencing into team meetings or just checking in regularly is helpful. Some of my patients continue to run their businesses remotely throughout cancer treatment. This is possible because patients experience considerable waiting around, boredom and also moments of feeling just fine.

Psychological Prehab

Consider your mental health through a prehab lens. How can you nurture your inner wellbeing? Who will you discuss problems with? What’s your plan for loneliness? How will you manage your family responsibilities? Here are some examples from my patients:

  • A transplant patient worked with her yoga teacher at home to “maintain mental sanity”
  • A patient with metastatic colon cancer never missed his weekly massage, which, he said, helped untangle his mind
  • A mother and her girlfriends devised a schedule to help with  family meals and after school activities while she was in hospital
  • A blog humorously called a “Blaaah-g" was sent by email to worried friends
  • Weekly telephone counseling with a therapist who had previously helped during a divorce crisis
  • A regular attendee of religious services made friends with the hospital chaplain

Prehab, from the psychological perspective means decreasing helplessness, receiving love and support, finding meaning, sustaining hope, maintaining autonomy and addressing problems actively.

The Downside of Prehab

Prehab fueled by over-optimistic expectations can result in predictable failure and demoralization. For example, coaching by well intentioned family to “push harder” when this is unrealistic is counter-productive.

My suggestion is to approach prehab with realistic optimism and a spirit of gentle experimentation. Test what works and what needs to be tweaked. Taken in a measured dose, the prehab mindset is an adaptive approach to physical activity, work and maintaining your spirits  in the face of cancer.

Let me know what you think of prehab!

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