Effect of total-body prehabilitation on postoperative outcomes: a systematic review and meta-analysis

Abstract

Objective To systematically review the evidence of pre-operative exercise, known as 'prehabilitation', on peri-and postoperative outcomes in adult surgical populations. Design Systematic review and meta-analysis. Data sources CENTRAL, Medline, EMBASE, CINAHL, PsycINFO and PEDro were searched from 1950 to 2011. Methods Two reviewers independently examined relevant, English-language articles that examined the effects of pre-operative total-body exercise with peri-and postoperative outcome analysis. Given the nascence of this field, controlled and uncontrolled trials were included. Risk of bias was assessed using the Cochrane Risk of Bias Assessment tool. Only data on length of stay were considered eligible for meta-analysis due to the heterogeneity of measures and methodologies for assessing other outcomes. Results In total, 4597 citations were identified b y t he s earch s trategy, o f w hich 2 1 s tudies w ere i ncluded. Trials w ere g enerally small (median = 54 participants) and of moderate to poor methodological quality. Compared with standard care, the majority of studies found that total-body prehabilitation improved postoperative pain, length of stay and physical function, but it was not consistently effective in improving health-related quality of life or aerobic fitness in the studies that examined these outcomes. The meta-analysis indicated that prehabilitation reduced postoperative length of stay with a small to moderate effect size (Hedges' g = −0.39, P = 0.033). Intervention-related adverse events were reported in two of 669 exercising participants. Conclusion The literature provides early evidence that prehabilitation may reduce length of stay and possibly provide postoperative physical benefits. Cautious interpretation of these findings is warranted given modest methodological quality and significant risk of bias.

Gait Speed Predicts 30-Day Mortality After Transcatheter Aortic Valve Replacement

“…In addition to helping improve decision making with regard to TAVR, gait speed may help identify the patients who would most likely benefit from prehabilitation, which is a form of training aimed at preventing injury and strengthening reserves. 30,31 Gait speed assessments should be incorporated into a multistep pathway, inclusive of comprehensive geriatric consultation and comorbidity review. 32 Gait speed, as a continuous variable and with cut points, is predictive of morbidity and mortality in older adults across a range of settings: community populations, 10 those with cardiovascular disease, 33 those with acute coronary syndrome, 34,35 and patients undergoing percutaneous coronary intervention 11 or cardiac surgery.…”

Comprehensive geriatric assessment in the older cancer patient: coming of age in clinical cancer care

“…The practice of prehabilitation therapy has been beneficially employed in areas such as orthopedic and cardiovascular surgery [88] and has more recently been applied to cancer care, especially in older patients [89,90]. Cancer prehabilitation is defined as the care that occurs between the time of cancer diagnosis and the beginning of acute treatment [88–90], which on average may be expected to be approximately 4 weeks.…”

“…Cancer prehabilitation is defined as the care that occurs between the time of cancer diagnosis and the beginning of acute treatment [88–90], which on average may be expected to be approximately 4 weeks. Prehabilitation may also take place during administration of neoadjuvant therapy, in the period before surgery in diseases such as breast cancer.…”

Sarcopenia Adversely Impacts Postoperative Complications Following Resection or Transplantation in Patients with Primary Liver Tumors

“…18–23 In turn, the preoperative identification of patients at high risk of experiencing perioperative complications is important to allow for preoperative patient selection, as well as “pre-habilitation” conditioning in the hopes of optimizing outcomes following surgical intervention. 24–26 …”