There are often patients who believe that major surgery hurts “vital energy” and that they should stay in bed after surgery and should not be active, and there are also patients who are afraid to move because of wound pain or fear of accidents such as wound splitting, falling, or drainage tube dislodging. The first thing you need to do is to make sure that you have a good idea of what you are doing.
What are the benefits of early activity after gastric cancer surgery?
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- Promote recovery of gastrointestinal function In general, the earlier patients move around after gastric cancer surgery, the faster they can pass gas and defecate. Patients should plan activities under the guidance of doctors to promote local and systemic blood circulation and enhance gastrointestinal motility through physical activities; early activities in the hospital bed can also lead to changes in body position, which in turn promotes gastrointestinal peristalsis, speeds up the discharge of intestinal contents and promotes recovery of gastrointestinal function.
- Prevention of postoperative complications Early postoperative activity is one of the most effective measures to prevent postoperative complications, particularly helping to prevent pulmonary infection and deep vein thrombosis. Early active activity increases pulmonary ventilation, promotes secretion clearance, prevents pulmonary infection, and promotes physical recovery. In the early postoperative period, if the patient is unable to leave the bed, the medical staff will usually instruct him/her to do active or passive exercises of the lower limbs regularly, such as leg extension and knee flexion, etc. Early bed activity when the condition allows can promote venous blood return to the lower limbs and prevent deep vein thrombosis after surgery.
- Early activity helps postoperative physical and psychological recovery Early activity can increase physical coordination and self-care ability, reduce the degree of decline in physical function and the incidence of delirium in patients with gastric cancer after surgery, and also reduce anxiety symptoms, improve sleep quality, reduce fatigue, decrease pain and enhance well-being.
What factors can affect post-operative activity?
- Incisional pain Abdominal surgery is probably the most painful of all surgery types, especially gastric cancer surgery, where about 70% of patients feel severe pain. In the past, people had misconceptions about pain, believing that pain was a natural process of disease and that postoperative analgesic use would affect recovery and should be used sparingly, so they failed to pay enough attention to reasonable pain control, and about 50%-70% of patients did not have timely relief of postoperative pain. However, failure to relieve postoperative pain in a timely manner can affect postoperative activities and delay recovery. The use of optimal pain relief and allowing early activity are prerequisites to facilitate postoperative recovery.
- Postoperative fatigue Postoperative fatigue is a manifestation of patients in a stressful state, mainly related to the degree of trauma and postoperative nutritional status. Postoperative fatigue is often experienced by patients with gastric cancer and is related to preoperative physical condition, preoperative fatigue level, body weight, size of surgical trauma, metabolic response and postoperative physical condition deterioration, while elderly people may be more prone to postoperative functional status due to fatigue.
- Inconvenience and discomfort After gastric cancer surgery, many tubes will be left in place, such as gastric tube, urinary catheter, abdominal drainage tube, infusion line, etc.; it is inconvenient to require patients to press the surgical incision by hand and protect various tubes when moving; some patients will also have nausea and other discomfort due to the gastric tube, all of the above factors can cause inconvenience to patients. All of these factors can cause patients to have difficulty moving around.
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In addition, some patients with early activity may experience discomfort, such as dizziness, palpitations, shortness of breath, incisional pulling, abdominal cramping, and low back pain, which can cause concern about early activity. In fact, early activity must be measured and gradual, and when any of these symptoms appear, rest in time to avoid danger.
- Other factors Some postoperative patients with gastric cancer have concerns about getting out of bed because they worry that getting out of bed will lead to accidents such as incision cracking, falling, extravasation of infusion, and dislodging of drainage tube; some patients do not know that they should move early and do not know how to move and how to arrange the amount of activity. In addition, patients’ awareness and attitude toward getting out of bed can likewise affect early postoperative activity and the amount of activity.
How should I be active early after gastric cancer surgery?
In China, the literature suggests that patients should be active early after surgery.
In China, the literature suggests that patients can start early activity 6 hours after surgery. Doctors usually instruct patients to move their limbs actively, mainly flexion and extension of the fingers, wrists, elbows, shoulders, hips, knees, ankles, and toes, with small, gentle, and slow movements to avoid painful incisions caused by excessive strain.
How to move 6 to 24 hours after surgery:
- For breathing exercises, the patient is placed in a semi-sitting position with the eyes slightly closed, inhaling through the nose and exhaling slowly with a 1:2 or 1:3 inhalation-to-expiration ratio, and breathing exercises are performed once or twice every 4 hours. At the same time, the healthcare provider will provide instructions to help the patient cough effectively and cough up airway secretions.
- Turn in bed, alternating between left-sided, flat-lying, and right-sided positions, every 30 minutes to 2 hours.
- For upper limb exercises, do flexion and extension of the fingers→elbow→shoulder joints twice a day, 10 times each time, with the aid of a hand grip.
- Lower extremity exercises, including active and passive activities, with a full range of activities for each joint, from toe end → toe → ankle → knee → hip joint, flexion, extension, inversion and valgus movements, 2 times a day, 10 times each time.
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Movement methods 24-72 hours after surgery:
- Breathing exercises.
- For respiratory exercises, patients were encouraged to breathe deeply on postoperative day 1, and the exercises were performed once every 2 hours for 5 repetitions. Others were given back tapping to promote sputum excretion.
- Turn in bed, once every 30 minutes to 2 hours.
- Chest expansion, 2 or 3 times a day, 5 times each time.
- For upper limb exercises, the healthcare provider will instruct the patient to do upper limb flexion, extension, lifting, holding, and pulling exercises, such as touching the forehead and back of the occiput with the hand, 10 to 20 times each time, 2 or 3 times a day.
- Lower extremity exercises: The provider will instruct the patient to perform flexion, extension, lifting, and stirring in bed (e.g., simulating a bicycle) 2 or 3 times a day, 5 times each time.
- Sit-up training, in the order of sitting against, sitting with support, sitting by oneself, sitting at the edge of the bed, and sitting with hanging feet.
- Activities out of bed, hand-held standing, leaning standing, standing by oneself, small range of motion at the bedside, large range of motion at the bedside, and casual motion, 2 or 3 times a day for 15 to 20 minutes each time, as directed by the physician on a case-by-case basis, with gradual and progressive increases in activity.
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Mobility after 72 hours postoperatively:
Progressively increase the intensity of exercise from the previous level, with the primary goal of being able to complete all exercises standing up and gradually increasing the speed and distance of walking.
Patients undergoing minimally invasive surgery (e.g., laparoscopic gastrectomy for gastric cancer) may be able to increase their activity level by advancing their postoperative activity time appropriately based on the above recommendations.
There are many benefits of early activity after gastric cancer surgery, and patients should gradually and progressively increase their activities under the guidance of their healthcare providers for early recovery. (Contributed by Jun Yan Zhang, Department of Gastrointestinal Oncology, The First Hospital of China Medical University)