The one step that can cut your risk of complications after surgery

Stepping out for at least an hour a day may halve your risk of suffering complications after surgery.

New findings presented at the recent American College of Surgeons Clinical Congress 2023, in Boston, showed that people who already walk at least 7,500 steps a day (around 3.7 miles, or 6km, which takes around an hour at a brisk walking pace) are half as likely to suffer from post-operative complications such as blood clots, wound infections or organ failure, than people who walk less than this.

And you don’t have to have been doing this long-term to benefit. Even just a few days of walking this distance before surgery can help, according to the study by the Medical College of Wisconsin in the U.S.

Around 30 per cent of people experience some kind of complication after an operation, and in most cases this occurs once the patient has been discharged.

To prevent these complications, patients are encouraged to get back on their feet as soon as possible after surgery. And in recent years, there has also been a focus on ‘prehabilitation’ – preparing for surgery in advance to ensure optimum fitness and wellbeing – as this, too, helps prevent complications.

Around 30 per cent of people experience some kind of complication after an operation (Stock photo) 

Obesity, high blood pressure and poor lung function all increase the risk of problems after surgery.

Researchers came up with the specific figure of 7,500 steps a day after looking at data from fitness tracker devices worn by 475 people participating in a major programme by the U.S. government’s research agency, the National Institutes of Health, which is gathering health data from more than one million American citizens. The patients (whose average age was 57) who walked this amount were 51 per cent less likely to suffer complications in the 90 days after surgery, regardless of the complexity of the operation or how ill they were to start with.

Although some patients had only just started walking longer distances, others had data showing they had enjoyed regular 6km walks going back months or years before they underwent operations, which ranged from minor to major procedures and included orthopaedic surgery and neurosurgery.

According to the researchers, it didn’t matter if the patients had walked this distance just for a few days or a few years. Anai Kothari, an assistant professor in surgical oncology who led the research, said walking an hour a day was a proxy for the patient’s general health and fitness.

‘We use a lot of information to try to decide and think through surgical risk,’ he said. ‘This is an additional point of reference that practitioners can use.’

Obesity, high blood pressure and poor lung function all increase the risk of problems after surgery (Stock photo) 

Professor Dame Clare Gerada, former president of the Royal College of GPs, told Good Health that so strong is the evidence that prehabilitation can make a difference to patient outcomes after surgery, that many NHS hospitals run programmes designed to help people improve their diets and fitness with videos and apps. ‘Exercise has a positive effect on every cell in the body,’ she says. ‘Stressing your body within tolerable levels helps keep your heart strong and your lungs healthy, as well as maintaining bone density.

‘It improves your circulation, lowers blood pressure and stimulates production of chemicals that improve your mood.’

Prehabilitation is even more important as we get older, says Ruthe Isden, head of health influencing at the charity Age UK.

‘It’s good for everyone but becomes more necessary as we get older because of physiological changes in the body, such as the slowing down of cell regeneration and changes in cellular activity, which lead to lower immune system function and poorer cardiovascular health, and loss of muscle mass,’ she says. These can all delay recovery and may lead to increasing frailty.

A U.S. study of almost 17,000 older women (average age 72), published in JAMA Internal Medicine in 2019, found that women who walked 4,400 steps a day (3km, or just under two miles) had 41 per cent lower risk of dying over the following four years compared with women who walked just 2,700 steps (2km, or 1.2 miles). Death rates continued to fall the more steps a woman walked – until 7,500 steps a day, when the risk plateaued.

Separately, a review of 12 studies involving 110,000 people of all ages, published in October in the Journal of the American College of Cardiology, cast doubt on the widely used 10,000 steps a day sweet-spot target, suggesting that patients get the same health benefits from fewer steps.

Researchers from Spain, the Netherlands and the U.S. found that 8,700 steps a day (around four miles, or 6.4km) can reduce risk of premature death by up to 60 per cent. Even just 2,700 steps daily may cut the chance of dying prematurely, or of a heart attack or stroke. A faster pace was linked with a lower risk of death, regardless of how many steps walked.

While ‘every step is good’, says Professor Gerada, other forms of exercise will also be beneficial.

‘Some people may prefer non-weight-bearing exercises such as swimming, or getting on a bike in the gym, which puts less stress on the knees,’ she adds.