who only by moving can balance

We are rapidly approaching surgery attempt #2 (three weeks today!) and perhaps unsurprisingly I am becoming kind of monofocussed again.

Item: low-fibre snacks. Lots of the How To Pack For A Hospital Stay advice, which I am going back over to soothe myself with, includes "bring snacks". The problem: most of the snacks I habitually avail myself of are either low-fibre or... suitable for storing at room temperature...

So far I'm kind of at "supermarket cheese scones???" but those don't address the part where what I really want is vegetables.

Annoyingly I don't yet know what my dietary restrictions post-surgery, i.e. when I'll actually need the snacks, are likely to be! Like, I might be on short-term low fibre because of bowel needing to heal even if I don't wind up with a stoma! I don't know what "short term" means in this context! Nobody can tell me anything useful until I come around!

I have Handled My Feelings About This by writing myself a (short) list in the Food Bullshit notebook of Acceptable Snacks. Suggestions welcome. (... I will put the list as it currently stands in a comment.)

I have also, in said notebook, copied out the Trust's generic guidance on reintroducing high-fibre foods.

Item: migraines. Oh yeah they're still happening and they're still clearly menstrual and I will not be shocked if, at some point in the next few days, I decide it's time to go read a bunch of case studies as models for Writing Myself Up, because good grief.

Item: exercise. Sense of agency yadda yadda has led me to the term "prehabilitation", which I think I was not previously familiar with, which in turn has reinforced my conclusion that probably the best thing I can do between now and surgery to Improve Outcomes is "improve quality of rest and do as much exercise as possible" where "possible" importantly includes appropriate recovery time.

Also I just, as discussed, got a Garmin watch.

So: the amount of exercise I am already doing is associated with 1-3 fewer days in hospital and up to about 56% lower complication rate, depending on the surgery and who you ask and so on and so forth. That much is good and cheering to know.

I have also been poking at step counts in comparison to ~how many steps~ I'm already typically getting! I'm annoyed that Influence of perioperative step volume on complication rate and length of hospital stay after colorectal cancer surgery is a study protocol rather than something reporting results yet. But whereas there isn't really much on "how many steps is it advisable to aim for, like, in general?" (or at least wasn't last time I was looking), there are lots of small-scale studies on step counts in the vicinity of surgery. In a fairly small number of elderly patients, daily step counts <2500 were associated with much longer hospital stays and much higher rates of complications. For pancreatectomy, 4300 steps per day was a cut-off for significant differences in the rate of severe complications. Analysis of data from patients who underwent a wide range of surgeries found that 7500 steps per day was associated with a 45% lower chance of complications within 30 days of surgery... using Fitbit data, which is particularly cheering for me because Fitbit tends to report significantly higher step counts than Garmin does[1] and my average step count for the last year according to Fitbit is currently hanging out at a bit over 7000. So between now and surgery I'm working on (sustainably!) bumping that up, shockingly.

I have just, in the process of writing up this post, found a pilot study investigating the use of accelerometers to measure how long it takes people to get back to baseline activity post-laparoscopic surgery -- small n (=25), but I'm interested that the answer (for "intermediate surgery") is indeed "more than five weeks".

And then there was the question of "how soon before surgery should I cut back on exercise?" because, y'know, if my watch is saying "ooooh that's gonna be 61 hours to recover from completely", maybe I want to be not doing that kind of activity the day before I abruptly give my body a lot more to be very unhappy about!

In terms of Exercise separate from Step Counts: Short term high-intensity interval training in patients scheduled for major abdominal surgery increases aerobic fitness (2022) shows that 3 weeks of 3 sessions a week increased (measurably and significantly) cardiorespiratory fitness (though not functional ability), and signposts a meta-analysis indicating that higher VO₂ peak values are associated with lower all-cause mortality. Association of preoperative High-Intensity Interval Training with cardiorespiratory fitness and postoperative outcomes among adults undergoing major surgery, a systematic review and meta-analysis published in 2023 found moderate-quality evidence for reductions in complications as well as the improvement in cardiorespiratory fitness.

Okay, cool, so... I'm three weeks out from surgery and I wanna add some HIIT to my schedule. What do I want it to look like? I don't knooooow, everyone uses different patterns, but that 2022 study I linked to used as their protocol

approximately 30 min of stationary cycling. Interval training alternated 1 min of high (with the goal of reaching 90% max heart rate at least once during the session) and low/moderate‐intensity cycling.

Next problem: balancing The Issue Of My Knee versus Actually Getting Cardio. Today's experiment in using the exercise bike's pre-programmed "Performance 1" mode was unsatisfactory in this regard, in that I wasn't quiiite getting my heart rate to where I wanted it and my knee was grumbling. So, okay, how about I don't vary the resistance level (which is what that programme was doing) but do pick a comfortable-for-knee level and then adjust effort?

Well, one minute on/one minute off sounds mildly terrifying, given Knee. One on/two off, maybe? 20s/40s might be more manageable and seems to also be a recommended pattern. (Indeed I've now just seen 20s/2m...) But I don't wanna have to pay attention to the clock (mostly I've been doing steady-state cardio by distracting myself with a timed clicky game) so, urgh, interval timer? Work out how it works on the watch vs just set one up on the phone and have it beep at me?

I dither. But, hey, I've got about 24h before my next experiment in which to come to some conclusions...

[1] Note that this is a deliberate decision not blithe overreading: given the problem of "okay, so what if someone doesn't take many steps today because they spent the entire time on their bike?" (for example), Fitbit have chosen to convert "active minutes" to pseudo-steps so as to tell you you've Met Your Step Goal on days when you've been physically active even if that's mostly not been walking or running, whereas Garmin have gone "fuck that, you want data we're giving you data" and will report how many actual steps it thinks you've made.