Lesson 1: Prehabilitation

Receiving a breast cancer diagnosis can leave you feeling as though everything is happening to you. Appointments, tests and treatment plans can quickly become overwhelming, and it's easy to feel that there's nothing you can do until the day of your operation.

The good news is that there are positive steps you can take before surgery that may help you feel stronger, more confident and better prepared for your recovery. This is known as prehabilitation, or prehab.

Prehabilitation is about improving your physical and emotional wellbeing before surgery so that your body is in the best possible condition to recover afterwards. Think of it as training for an important event. Just as someone preparing for a marathon wouldn't wait until race day to start exercising, preparing your body before surgery can help you recover more effectively.

Research has shown that people who take part in prehabilitation programmes often experience benefits such as:

• Better physical fitness before surgery

• Improved shoulder movement and flexibility

• Greater confidence going into treatment

• Reduced anxiety and stress

• Better tolerance of treatment

• Faster return to everyday activities

• Improved overall quality of life during recovery

While everyone's recovery is different and no programme can guarantee a particular outcome, looking after your body beforehand gives you the best possible foundation for healing.

The Four Pillars of Prehabilitation

1. Keep Moving

You don't need to become an athlete. Gentle, regular movement helps maintain your strength, flexibility and cardiovascular fitness, all of which can support your recovery.

Aim for around 20–30 minutes of activity on most days if you're able. This could include:

• Walking

• Gentle cycling

• Swimming (if appropriate before surgery)

• Yoga or Pilates

• Light stretching

Listen to your body. Some movement is usually better than none, but don't push through pain or exhaustion. If you're unsure what is appropriate for you, speak with your healthcare team.

2. Nourish Your Body

Your body needs the right nutrients to prepare for surgery and repair tissues afterwards.

Try to include:

• Protein with each meal (such as eggs, fish, chicken, beans, lentils, Greek yoghurt or tofu)

• Plenty of colourful fruit and vegetables

• Wholegrains for energy

• Healthy fats, such as nuts, seeds and olive oil

• Regular fluids to stay hydrated

Good nutrition isn't about eating perfectly. It's about giving your body the building blocks it needs for healing.

3. Prioritise Rest and Sleep

Quality sleep supports your immune system, helps regulate hormones and gives your body time to repair itself.

If you're struggling to sleep because of worry, try:

• Keeping a regular bedtime

• Limiting caffeine later in the day

• Avoiding screens for an hour before bed

• Reading, listening to calming music or practising breathing exercises

Remember that rest is productive. Your body does some of its most important healing while you sleep.

4. Support Your Emotional Wellbeing

Preparing emotionally is just as important as preparing physically.

It's completely normal to experience fear, uncertainty or sadness before surgery.

Helpful strategies include:

• Talking openly with trusted family or friends

• Writing down your worries in a journal

• Practising mindfulness or meditation

• Using slow breathing exercises

• Accepting offers of help from others

Looking after your mental wellbeing can help reduce stress and make the surgical experience feel more manageable.

Changes You Can Make Before Cancer Treatment

Preparing for cancer treatment is about giving your body the best possible foundation for the journey ahead. Small changes made before treatment begins can help support your overall health, improve your fitness and help you feel more prepared.

Here are some positive steps you can consider:

Stop smoking if you smoke
Stopping smoking before treatment can bring many benefits, including improving your circulation, supporting your lungs and helping your body heal more effectively.

Consider your alcohol intake
If you drink alcohol, reducing your intake can be beneficial for your general health and wellbeing. If you're unsure what changes may be helpful for you, seek advice from your healthcare team.

Review your overall health
Before starting treatment, it can be helpful to make sure any existing health conditions are well managed and that your healthcare team is aware of any regular medications or supplements you take.

Remember, prehabilitation isn't about making huge changes overnight or being perfect. It's about taking small, achievable steps that help you feel stronger, more confident and better prepared for the next stage of your journey.

Gentle Shoulder Exercises Before Surgery

If your breast care team has not advised otherwise, maintaining shoulder mobility before surgery can make it easier to regain movement afterwards.

These exercises should never be painful. Move only within a comfortable range.

Shoulder Rolls

Roll both shoulders forwards ten times.

Then backwards ten times.

Repeat two to three times each day.

Shoulder Shrugs

Lift your shoulders towards your ears.

Hold for two seconds.

Relax slowly.

Repeat ten times.

Shoulder Blade Squeezes

Sit or stand tall.

Gently squeeze your shoulder blades together.

Hold for five seconds.

Repeat ten times.

Arm Raises

Slowly raise both arms forwards to shoulder height or as far as comfortable.

Lower slowly.

Repeat ten times.

Wall Walks

Stand facing a wall.

Walk your fingers slowly up the wall until you feel a gentle stretch.

Hold for five seconds.

Walk your fingers back down.

Repeat five to ten times.

Neck Stretches

Tilt your head gently towards one shoulder.

Hold for 15 seconds.

Repeat on the other side.

Repeat three times.

Daily Walking

Walking is one of the simplest and most effective ways to prepare for surgery.

If possible, aim for:

• 20–30 minutes on most days, or

• Several shorter walks if that feels more manageable.

Walking supports your heart and lungs, boosts circulation, helps maintain muscle strength and can also improve mood and reduce anxiety.

A Gentle Reminder…

Preparing for surgery isn't about doing everything perfectly. Some days you'll feel motivated, while on others you may simply need to rest - and that's okay.

Every nourishing meal, every short walk, every stretch and every moment you spend looking after yourself is an investment in your recovery.

Be kind to yourself. Small, consistent actions really do add up, and by taking these simple steps now, you're giving yourself the strongest possible foundation for the weeks ahead.

Your Next Step

Now that you understand the importance of prehabilitation, I'd love you to put these ideas into practice. I've created a free 7-Day Prehabilitation Challenge to help you take small, positive steps each day in the lead-up to your surgery.

Rather than trying to change everything at once, this simple printable guide will help you focus on the things that can make a real difference - keeping gently active, nourishing your body, staying hydrated, practising your shoulder exercises, and taking time to care for your emotional wellbeing.

Download and print the challenge today, then keep it somewhere you'll see it each day, such as on your fridge or bedside table. Tick off your progress as you go and remember that every small action is helping to prepare your body and mind for surgery.

Further Support: Prehabilitation Videos

If you'd like to learn more about prehabilitation and the positive steps you can take before cancer treatment, Macmillan Cancer Support has created a helpful series of short videos. These videos explain what prehabilitation is and how small changes to your physical activity, nutrition, emotional wellbeing and lifestyle habits can help you feel more prepared for treatment and recovery.

The videos cover topics including staying active, eating well, looking after your mental wellbeing, reducing alcohol intake and stopping smoking. They are a great resource to help you understand how preparing your body and mind before treatment can support your overall health and wellbeing.

You can watch the videos here: Macmillan Cancer Support – Prehabilitation Videos.