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World Journal of Surgery

, Volume 37, Issue 4, pp 711–720 | Cite as

Effect of Preoperative Exercise on Cardiorespiratory Function and Recovery After Surgery: a Systematic Review

  • Daniel P. LemanuEmail author
  • Primal P. Singh
  • Andrew D. MacCormick
  • Bruce Arroll
  • Andrew G. Hill
Article

Abstract

Background

This systematic review aims to investigate the extent to which preoperative conditioning (PREHAB) improves physiologic function and whether it correlates with improved recovery after major surgery.

Methods

An electronic database search identified randomized controlled trials (RCTs) investigating the safety and efficacy of PREHAB. The outcomes studied were changes in cardiorespiratory physiologic function, clinical outcomes (including length of hospital stay and rates of postoperative complications), and measures of changes in functional capacity (physical and psychological).

Results

Eight low- to medium-quality RCTs were included in the final analysis. The patients were elderly (mean age >60 years), and the exercise programs were significantly varied. Adherence to PREHAB was low. Only one study found that PREHAB led to significant improvement in physiologic function correlating with improved clinical outcomes.

Conclusion

There are only limited data to suggest that PREHAB confers any measured physiologic improvement with subsequent clinical benefit. Further data are required to investigate the efficacy and safety of PREHAB in younger patients and to identify interventions that may help improve adherence to PREHAB.

Keywords

Inspiratory Muscle Inspiratory Muscle Training Inspiratory Muscle Strength Physiologic Endpoint Physiologic Improvement 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

This study required no external sources of funding. Dr, Lemanu is the recipient of a Clinical Research Training Fellowship awarded by the Health Research Council of New Zealand.

Conflicts of interest

The authors have no potential or real conflicts of interest to declare.

References

  1. 1.
    Carli F, Zavorsky GS (2005) Optimizing functional exercise capacity in the elderly surgical population. Curr Opin Clin Nutr Metab Care 8:23–32PubMedCrossRefGoogle Scholar
  2. 2.
    Topp R, Swank AM, Quesada PM et al (2009) The effect of prehabilitation exercise on strength and functioning after total knee arthroplasty. PM R 1:729–735PubMedCrossRefGoogle Scholar
  3. 3.
    Ackerman IN, Bennell KL (2004) Does pre-operative physiotherapy improve outcomes from lower limb joint replacement surgery? A systematic review. Aust J Physiother 50:25–30PubMedGoogle Scholar
  4. 4.
    Valkenet K, van de Port IGL, Dronkers JJ et al (2011) The effects of preoperative exercise therapy on postoperative outcome: a systematic review. Clin Rehabil 25:99–111PubMedCrossRefGoogle Scholar
  5. 5.
    Moher D, Liberati A, Tetzlaff J et al (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 151:264–269PubMedGoogle Scholar
  6. 6.
    Jadad AR, Moore RA, Carroll D et al (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17:1–12PubMedCrossRefGoogle Scholar
  7. 7.
    Arthur HM, Daniels C, McKelvie R et al (2000) Effect of a preoperative intervention on preoperative and postoperative outcomes in low-risk patients awaiting elective coronary artery bypass graft surgery: a randomized, controlled trial. Ann Intern Med 133:253–262PubMedGoogle Scholar
  8. 8.
    Carli F, Charlebois P, Stein B et al (2010) Randomized clinical trial of prehabilitation in colorectal surgery. Br J Surg 97:1187–1197PubMedCrossRefGoogle Scholar
  9. 9.
    Dronkers J, Veldman A, Hoberg E et al (2008) Prevention of pulmonary complications after upper abdominal surgery by preoperative intensive inspiratory muscle training: a randomized controlled pilot study. Clin Rehabil 22:134–142PubMedCrossRefGoogle Scholar
  10. 10.
    Dronkers JJ, Lamberts H, Reutelingsperger IM et al (2010) Preoperative therapeutic programme for elderly patients scheduled for elective abdominal oncological surgery: a randomized controlled pilot study. Clin Rehabil 24:614–622PubMedCrossRefGoogle Scholar
  11. 11.
    Hoogeboom TJ, Dronkers JJ, van den Ende CHM et al (2010) Preoperative therapeutic exercise in frail elderly scheduled for total hip replacement: a randomized pilot trial. Clin Rehabil 24:901–910PubMedCrossRefGoogle Scholar
  12. 12.
    Hulzebos EH, Helders PJ, Favie NJ et al (2006) Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery: a randomized clinical trial. JAMA 296:1851–1857PubMedCrossRefGoogle Scholar
  13. 13.
    Weidenhielm L, Mattsson E, Brostrom LA et al (1993) Effect of preoperative physiotherapy in unicompartmental prosthetic knee replacement. Scand J Rehabil Med 25:33–39PubMedGoogle Scholar
  14. 14.
    Weiner P, Zeidan F, Zamir D et al (1998) Prophylactic inspiratory muscle training in patients undergoing coronary artery bypass graft. World J Surg 22:427–431. doi: 10.1007/s002689900410 PubMedCrossRefGoogle Scholar
  15. 15.
    Giannoudis PV, Dinopoulos H, Chalidis B et al (2006) Surgical stress response. Injury 37:S3–S9PubMedCrossRefGoogle Scholar
  16. 16.
    Thompson WR, Gordon NF, Pescatello LS (2009) ACSM’s guidelines for exercise testing and prescription. Lippincott Williams & Wilkins, New YorkGoogle Scholar
  17. 17.
    Bassett DR Jr, Howley ET (2000) Limiting factors for maximum oxygen uptake and determinants of endurance performance. Med Sci Sports Exerc 32:70–84PubMedGoogle Scholar
  18. 18.
    Hagberg JM (1987) Effect of training on the decline of VO2max with aging. Fed Proc 46:1830–1833PubMedGoogle Scholar
  19. 19.
    Beaupre LA, Lier D, Davies DM et al (2004) The effect of a preoperative exercise and education program on functional recovery, health related quality of life, and health service utilization following primary total knee arthroplasty. J Rheumatol 31:1166–1173PubMedGoogle Scholar
  20. 20.
    Crowe J, Henderson J (2003) Pre-arthroplasty rehabilitation is effective in reducing hospital stay. Can J Occup Ther 70:88–96PubMedGoogle Scholar
  21. 21.
    D’Lima DD, Colwell CW Jr, Morris BA et al (1996) The effect of preoperative exercise on total knee replacement outcomes. Clin Orthop Relat Res 326:174–182PubMedCrossRefGoogle Scholar
  22. 22.
    Ferrara PE, Rabini A, Maggi L et al (2008) Effect of pre-operative physiotherapy in patients with end-stage osteoarthritis undergoing hip arthroplasty. Clin Rehabil 22:977–986PubMedCrossRefGoogle Scholar
  23. 23.
    Gilbey HJ, Ackland TR, Wang AW et al (2003) Exercise improves early functional recovery after total hip arthroplasty. Clin Orthop Relat Res 408:193–200PubMedCrossRefGoogle Scholar
  24. 24.
    Gocen Z, Sen A, Unver B et al (2004) The effect of preoperative physiotherapy and education on the outcome of total hip replacement: a prospective randomized controlled trial. Clin Rehabil 18:353–358PubMedCrossRefGoogle Scholar
  25. 25.
    Nielsen PR, Jorgensen LD, Dahl B et al (2010) Prehabilitation and early rehabilitation after spinal surgery: randomized clinical trial. Clin Rehabil 24:137–148PubMedCrossRefGoogle Scholar
  26. 26.
    Rooks DS, Huang J, Bierbaum BE et al (2006) Effect of preoperative exercise on measures of functional status in men and women undergoing total hip and knee arthroplasty. Arthritis Rheum 55:700–708PubMedCrossRefGoogle Scholar
  27. 27.
    Rosenfeldt F, Braun L, Spitzer O et al (2011) Physical conditioning and mental stress reduction: a randomised trial in patients undergoing cardiac surgery. BMC Altern Med 11:20CrossRefGoogle Scholar
  28. 28.
    Vukomanovic A, Popovic Z, Durovic A et al (2008) The effects of short-term preoperative physical therapy and education on early functional recovery of patients younger than 70 undergoing total hip arthroplasty. Vojnosanit Pregl 65:291–297PubMedCrossRefGoogle Scholar
  29. 29.
    Kim DJ, Mayo NE, Carli F et al (2009) Responsive measures to prehabilitation in patients undergoing bowel resection surgery. Tohoku J Exp Med 217:109–115CrossRefGoogle Scholar
  30. 30.
    Ainsworth BE, Haskell WL, Herrmann SD et al (2011) 2011 Compendium of physical activities: a second update of codes and MET values. Med Sci Sports Exerc 43:1575–1581PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2013

Authors and Affiliations

  • Daniel P. Lemanu
    • 1
    • 3
    Email author
  • Primal P. Singh
    • 1
  • Andrew D. MacCormick
    • 1
  • Bruce Arroll
    • 2
  • Andrew G. Hill
    • 1
  1. 1.Department of Surgery, South Auckland Clinical SchoolUniversity of AucklandAucklandNew Zealand
  2. 2.Department of General Practice and Primary Health CareUniversity of AucklandAucklandNew Zealand
  3. 3.Department of Surgery, South Auckland Clinical SchoolMiddlemore HospitalAucklandNZ

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