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Updated 30 September 2022

It is important to prepare your home, so it is ready for your return from surgery at the hospital. Don't forget, friends and family can often help and support you with this. 

Respiratory exercises - the iCOUGH technique

Some of you will be provided with incentive respiratory spirometers which enable you to help train your lungs for your surgery. These have been generously donated by Friends of DCH. One of the techniques we use is known as the iCOUGH technique. 

If you are not provided with a device, you can help train your lungs by performing 10 slow deep breaths, four times a day for two weeks before your day of surgery – similar to a 'yoga breath'. This is also a good way of relaxing prior to surgery. 

You can explore the different elements which make up the iCOUGH programme below.

If you have attended an appointment, you will have received an incentive spirometer and been shown how to use it. If not, or if you need a reminder, the video below will show you what to do.

You should aim for 3-5 deep breaths. Remember to bring your spirometer to hospital with you.

Sometimes deep breathing and coughing can be difficult to perform due to pain and/or tiredness. This can increase your risk of developing chest complications. If your pain is not under control, please speak to your nurse.

It is very important to be able to cough up any secretions/phlegm you may have to help prevent chest complications. This may be uncomfortable so use a rolled up towel or your hands to support your wound and press firmly whilst coughing. Many patients worry they may damage their wound by doing this or coughing strongly, but please be reassured this is not the case.

Below is a breathing exercise called the Active Cycle of Breathing Technique (ACBT)

Breathing control
Normal relaxed breathing
Place your hand on your tummy and gently breathe in and out, your tummy should rise as you breathe in.

Deep breathing
Keep your shoulders and chest relaxed and take a deep breath in as much as you can
Sniff a little more in
Hold 3 seconds and relax out
Repeat 3-5 times.

Take a breath in
Open your mouth
Huff out a forced breath as if you are steaming up a mirror, but in a short, sharp movement.

You should try to complete ACBT or incentive spirometer every waking hour. e.g. 8am ACBT, 9am incentive spirometer, 10am ACBT etc

Good oral care reduces the risk of chest complications. We encourage patients to brush their teeth, tongue and roof of mouth 2 x day to maintain good oral hygiene.

Please bring your dentures and mouth-care products with you.

Involve your friends and family in what you need to do. They can help you achieve your goals with encouragement and support.

For every day you spend in bed you lose 1-2% of your muscle strength. Getting up and about early will help prevent this and aid your recovery. It also helps you to take deeper breaths and reduces your risk of getting a chest complication.

It is expected that you will begin mobilising the day after your surgery but it can often be the same day. If you are struggling with this the ward staff are there to help. You may have several drips or drains attached to you. The ward staff can help you with these and show you how to hook them up to allow you to walk.

Drips and drains should not prevent you from walking.

You should aim to increase the distance walked each day and to be walking independently as early as possible but if you are struggling with your mobility, you may be referred to a physiotherapist. Family or friends can also support and encourage you with your walking if it is safe to do so.

If you normally use a walking aid please bring this into hospital with you.

When you are in bed, sit as upright as possible (when you are not asleep) and try not to slump. Aim not to lie completely flat but with the head of the bed lifted up a little (ideally a third of the way between flat and upright). Side lying is also good. If you are unable to reposition yourself, please ask a staff member to help you.

Eating well

You can improve your diet by increasing your protein intake to about 1.5kg a day and reducing your carbohydrate intake. An ideal way to do this is to log everything you eat in a diary or by using an app. This will allow you to see the quantities and types of food you eat. 

Health conditions

Health conditions that you may already have such as high blood pressure, anaemia and diabetes should be reviewed so you are in the best condition to have surgery. Keeping your blood sugars between 6-10, maintaining a blood pressure of 140/80 or less and a blood count (haemoglobin level) of 13 for both men and women is ideal for any surgery.


Many of us have busy lives and sometimes this means we are less active. Doing 30 minutes of an activity such as walking, swimming, dancing or cycling which increases your heart rate is beneficial. Ideally you should aim to do 30 minutes of exercise every day. By making certain areas of your body stronger (depending on your surgery) this will improve your recovery time and progress. Read more activities you can do before and after surgery.

Behavioural change

We would ask all patients to stop smoking for a minimum of six weeks before surgery and reduce to a maximum of 14 units or stop alcohol for four weeks before surgery.

Satisfaction and wellbeing 

We understand patients can often be anxious about their surgery. If you are aged 65 plus and have a history of depression, previous or current poor pain control or are taking long-term medications, you may benefit from additional help from our pain team before surgery which we can help organise. 

Shared decision making

Shared decision making (SDM) is the process whereby patients and clinicians work together to make evidenced based decisions centred on patient values and preferences. This may be to select a test or intervention such as going ahead with surgery. SDM ensures individuals are supported to make decisions which are right for them. Click here for more information or watch the animation from the Centre for Perioperative Care below.