Prehab Exercises for Patients due to have DIEP Reconstruction
In collaboration with your surgeon, the physiotherapists at The Nightingale Centre have created an exercise programme for patients due to have a DIEP (Deep Inferior Epigastric Perforator) reconstruction.
Prehabilitation (prehab) means getting your mind and body ready for surgery. It’s a programme of support and advice, and covers three main areas of your health:
- Physical activity or exercise
- Diet and nutrition
- Mental wellbeing
The benefits of prehab include reducing the time you spend in hospital, reducing complications and shortening your recovery time following your operation. Macmillan have created some short videos about Prehabilitation. To view these videos, click the link below:
You might be having an immediate DIEP reconstruction, which means that you may only have a few weeks to prepare for your surgery. Research has shown that you only need 3 weeks of prehab to see improvements in your fitness levels and strength. If you’re having a delayed DIEP reconstruction, you will have a lot more time to prepare for surgery. Taking small steps to improve your fitness and strength will contribute to a smoother and quicker recovery period.
Guidelines to Completing the Prehab Exercises
The stretching exercises can be performed between 2-3 times a day.
The strengthening exercises should be performed between 2-4 times a week.
Only progress on to the next exercise level when you’re finding the previous level too easy.
IMPORTANT: If you have any back problems, take care when performing the exercises. Back pain shouldn’t stop you from completing exercises, but the exercises may need to be tailored for you.
When undergoing chemotherapy, radiotherapy, surgery or any other treatment for cancer, you may be given specific advice on which activities you may or may not do when undergoing your treatment, and it is important to follow this advice. Please consult a healthcare professional involved in your care if you have any concerns regarding activities or exercises on this website.
If you have any questions, please telephone the Nightingale Physiotherapy Team on
0161 291 4268 (Mon-Fri 8am-4pm).
Stretching Exercises
Stretching certain areas of your body before your surgery, such as your shoulders and lower back, can help with your recovery after. Stretching increases blood flow to muscles, improves flexibility, and reduces muscle tension. This can lead to a quicker recovery post-surgery, as your body is better prepared to move and regain strength.
The stretching exercises can be performed between 2-3 times a day.
Level 2 - In standing, take one arm up over your head and slowly bend sideways from your waist. Hold for up to 10 seconds and then return to the starting position. To make the exercise harder, you can clasp both arms above your head for an increased stretch. Repeat 2-3 times each side.
Tip – Imagine you’re stuck between two panes of glass, do not allow your shoulders to twist forwards or backwards during the exercise.
Level 2 - Stand with your hand on a door frame, above shoulder height. Slowly turn your feet away from the doorframe, feeling the stretch at the front of your chest. Hold for 10-20 seconds. Repeat 2 times each side.
Strengthening Exercises
The strengthening exercises should be performed between 2-4 times a week. We advise that you complete each exercise between 6-12 times (the number of repetitions advised is under each picture), but the number of repetitions you do will be up to you and how you feel. If you can only manage a few repetitions, stick to what you’re comfortable with and progress as you feel able. From each numbered exercise, choose only one exercise to perform (either level 1 or level 2).
Only progress on to the next exercise level when you’re finding the previous level too easy.
If you have any back problems, take care when performing the exercises. Back pain shouldn’t stop you from completing exercises, but the exercises may need to be tailored for you.
Glutes/Lower Limb
Lie down on your back with your feet flat on the floor / bed, hip width apart. Slowly flatten your back into the floor / bed, squeezing your tailbone between your buttocks. Return to the starting position. Repeat 8-12 times.
Level 2 - As above, lie down on your back with your feet flat on the floor, hip width apart. Slowly flatten your back into the floor / bed, peeling your spine off the surface until you’re in a ‘bridge’ position. Squeeze your bottom muscles and hold for a few seconds. Slowly return to the starting position. Repeat 8-12 times.
Progression – to make this exercise harder, you could perform hip dips whilst in the bridge position, dropping one hip down to the floor and then squeezing your muscles to return to a bridge. You could also place a weight or a heavy book over your hips.
Progression – to make this exercise harder, you could put an ankle weight on the outer leg or place some exercise band around both ankles.
Level 2 - Lie on your side on the floor with your elbow underneath you. Bend your bottom knee, keeping the top knee straight. Slowly push through your elbow and knee, lifting your hip off the floor. Hold for 5 seconds, then return to the starting position. Repeat 8-12 times. Progression – to make this exercise harder, you could hold the position for longer, or you could take your top leg away from the floor and perform hip abduction in this side plank position.
Progression – to make this exercise harder, try not to sit down on the chair, but just allow your bottom to touch the seat quickly and then return to standing.
Level 2 - Stand with your hands clasped in front of your chest, toes facing forwards, legs shoulder width apart. Stick your bottom out behind you and squat down as far as comfortable. Hold for a few seconds, and then return to standing. Repeat 8-12 times.
Progression – to make this exercise harder, hold a weight at your chest whilst performing the exercise.
Tip – Keep everything from the waist up still. Don’t allow your top hip to roll back too far whilst performing the exercise.
Level 2 - Lie on your side with a pillow under your head, your hips bent to approx. 45° and knees bent to approx. 90°. Straighten your bottom leg so that your top knee falls to touch the floor / bed. Your shoulders and hips should be stacked on top of each other. Rest your top hand on the floor. Slowly lift the top knee upwards. Hold for a few seconds, then return to the starting position. Repeat 8-12 times on each side.
Tip – Keep everything from the waist up still. Don’t allow your top hip to roll back too far whilst performing the exercise.
Level 2 - Sit on your bed or floor with your legs straight out in front of you, with support behind your upper back. Slowly pull your toes towards you and lift your leg off the floor (your heel should be approx. 6-8 inches off the floor). Hold for a few seconds, then relax. Repeat 8-12 times on each leg.
Tip – ensure your knee remains straight throughout the exercise.
Progression – to make the exercise harder, you can try and hold your leg off the bed for 10 seconds or add an ankle weight.
Core/Abdominal
Level 2a - Sit on the floor with your heels on the floor, knees bent in front of you. Clasp your hands together at the front of your chest. Lean back slightly, and slowly twist your upper body to the right. Hold for a few seconds, and then return to the starting position facing forwards. Then twist your upper body to the left. Repeat 6-8 times in each direction.
Level 2b - start in the same position as level 1, but this time lean back further and take your feet off the floor. Slowly twist your upper body to the right. Hold for a few seconds, then twist your body to the left. Repeat 8-12 times in each direction. Progression - To make the exercise harder, you hold a hand weight at your chest.
Caution – take care performing this exercise if you have pre-existing back problems.
Level 2 - Lie down flat on the floor and place your hands behind your head. Slowly bring one knee towards your chest. At the same time, bring your opposite elbow to that knee. Repeat 8-12 times each side.
Caution – only perform this exercise if you are confident to do so and have no pre-existing back problems.
Level 2 - Lie on the floor or bed with your arms by your side. Slowly lift your head and chest off the floor but keep looking at the floor. Hold for a few seconds and then return to the starting position. Repeat 6-8 times.
To make the exercise harder, you can also lift your feet off the floor.
Shoulder/Upper Limb
Progression - to make the exercise harder, step your feet slightly further away from the wall.
Level 2 - Sit or stand. Hold a small weight in each hand (you can use any weight between 0.5kg-4kg, use whatever weight you’re comfortable with). Bend both your elbows so your fists are pointing upwards, with the weights are near your shoulders. Push the weights up over your head, straightening your elbows. Slowly return to the start position. Repeat 8-12 times.
Tip – if you don’t have any weights at home, you could use small water bottles or tinned food items (which weigh roughly 0.5kg).
Level 2 - Stand. Place one knee on a chair or bench and place the same hand also on the chair/bench. Hold a weight in the other hand with your arm straight (you can use any weight between 0.5kg-4kg, use whatever weight you’re comfortable with). Slowly bend your elbow up towards the ceiling. Hold for a few seconds, then return to straighten your arm. Repeat 8-12 times.
Tip – squeeze your shoulder blades together when you’re performing the exercise.
Cardiovascular Fitness
The Government recommends 150 minutes of moderate exercise a week, which is approximately 30 minutes per day 5 days a week. Activities could include:
- Walking to the local shops and carrying your shopping
- Walking outdoors
- Running/Jogging
- Climbing stairs (instead of taking the lift)
- Avoiding sitting down for long periods of time
- Completing day to day activities whilst standing
- Housework including ironing, cooking, vacuuming, washing up and laundry
- Playing with your children or grandchildren
- Gardening
- Dancing
- Cycling
- Swimming
- Yoga/Pilates
- Zumba
You can find out more about exercise and the benefits on the NHS website: www.nhs.uk/live-well/exercise/