Preoperative Exercise Training to Prevent Postoperative Pulmonary Complications in Adults Undergoing Major Surgery. A Systematic Review and Meta-analysis with Trial Sequential Analysis

Abstract

Rationale: Preoperative poor physical fitness and respiratory muscle weakness are associated with postoperative pulmonary complications that result in prolonged hospital length of stay and increased mortality. Objectives: Examine the effect of preoperative exercise training on the risk of postoperative pulmonary complications across different surgical settings. Methods: We searched MEDLINE, Web of Science, Embase, Pedro, and the Cochrane Central Register, without language restrictions, for studies from inception to July, 2020. We included randomized controlled trials that compared patients receiving exercise training with those receiving usual care or sham training before cardiac, lung, esophageal, or abdominal surgery. Postoperative pulmonary complications were the main outcome; secondary outcomes were preoperative functional changes, postoperative mortality, cardiovascular complications and hospital length of stay. The study was registered with PROSPERO (N° CRD42018096956). Results: From 29 studies, 2'070 patients were pooled for meta-analysis. Compared to the control group, preoperative exercise training was associated with a lower incidence of postoperative pulmonary complications (23 studies, 1'864 patients, [RR] 0.52; 95% CI 0.41-0.66, grading of evidence: moderate); Trial Sequential Analysis confirmed effectiveness and there was no evidence of difference of effect across surgeries, type of training (respiratory muscles, endurance or combined) and preoperative duration of training. At the end of the preoperative period, exercise training resulted in increased peak oxygen uptake (weighted mean difference [WMD] +2 ml/kg/min, 99%CI 0.3 to 3.7) and higher maximal inspiratory pressure (WMD +12.2

The effect of preoperative chest physiotherapy on oxygenation and lung function in cardiac surgery patients: a randomized controlled study

“…It also helps in atelectasis prevention and gas exchange improvement. 16 ET has been shown to improve early cardiovascular adaptation by means of an increase in blood volume and enhanced vasodilatation, sympathetic neural drive relief and improved ventricular relaxation. All these factors facilitate the delivery and uptake of oxygen to accommodate the demand of energy within active skeletal muscle.…”

“… 28 , 29 In addition, ET elevates ventilation load and physiological adaptive alterations within the respiratory muscles, which may confer higher strength and resistance to fatigue. 16 Chest physiotherapy is one of the procedures applied to eliminate PPCs after cardiac surgery, although there is no evidence to confirm the efficacy of these techniques. 30 No consensus has been reached on the most appropriate and effective treatment.…”

“… 13 - 15 Hence, these strategies have been applied within the preoperative period to facilitate postoperative recovery. 16 …”

Can Previous Levels of Physical Activity Affect Risk Factors for Cardiorespiratory Diseases and Functional Capacity after COVID-19 Hospitalization? A Prospective Cohort Study

“…In this context, high levels of physical activity have been associated with a lower risk of severe COVID-19 outcomes and mortality [ 17 – 20 ]. Indeed, physical activity and functional capacity are associated with lower complications and better recovery to several clinical conditions [ 21 , 22 ]. Thus, it is reasonable to speculate that previous levels of physical activity may affect COVID-19 sequelae and persistent symptoms.…”

Cost‐effectiveness analysis of home‐based rehabilitation compared to usual care for people with inoperable lung cancer

“…With improvements in survival, greater attention to survival quality is essential. Rehabilitation interventions, including exercise, delivered at all stages along the cancer treatment continuum, are effective in improving cancer-related fatigue (Mustian et al, 2017), HRQoL, and physical function (Buffart et al, 2017;Mishra et al, 2012) and minimising postoperative complications (Assouline et al, 2020).…”