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Physical activity recommendations pre and post abdominal wall reconstruction: a scoping review of the evidence

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Abstract

Purpose

There are no universally agreed guidelines regarding which types of physical activity are safe and/or recommended in the perioperative period for patients undergoing ventral hernia repair or abdominal wall reconstruction (AWR). This study is intended to identify and summarise the literature on this topic.

Methods

Database searches of PubMed, CINAHL, Allied & Complementary medicine database, PEDro and Web of Science were performed followed by a snowballing search using two papers identified by the database search and four hand-selected papers of the authors’ choosing. Inclusion—cohort studies, randomized controlled trials, prospective or retrospective. Studies concerning complex incisional hernia repairs and AWRs including a “prehabilitation” and/or “rehabilitation” program targeting the abdominal wall muscles in which the interventions were of a physical exercise nature. RoB2 and Robins-I were used to assess risk of bias. Prospero CRD42021236745. No external funding. Data from the included studies were extracted using a table based on the Cochrane Consumers and Communication Review Group’s data extraction template.

Results

The database search yielded 5423 records. After screening two titles were selected for inclusion in our study. The snowballing search identified 49 records. After screening one title was selected for inclusion in our study. Three total papers were included—two randomised studies and one cohort study (combined 423 patients). All three studies subjected their patients to varying types of physical activity preoperatively, one study also prescribed these activities postoperatively. The outcomes differed between the studies therefore meta-analysis was impossible—two studies measured hernia recurrence, one measured peak torque. All three studies showed improved outcomes in their study groups compared to controls however significant methodological flaws and confounding factors existed in all three studies. No adverse events were reported.

Conclusions

The literature supporting the advice given to patients regarding recommended physical activity levels in the perioperative period for AWR patients is sparse. Further research is urgently required on this subject.

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References

  1. Gignoux B et al (2021) Incidence and risk factors for incisional hernia and recurrence: retrospective analysis of the French national database. Colorectal Dis 23(6):1515–1523

    Article  PubMed  Google Scholar 

  2. Cherla DV, Poulose B, Prabhu AS (2018) Epidemiology and disparities in care: the impact of socioeconomic status, gender, and race on the presentation, management, and outcomes of patients undergoing ventral hernia repair. Surg Clin North Am 98(3):431–440

    Article  PubMed  Google Scholar 

  3. Poulose BK et al (2012) Epidemiology and cost of ventral hernia repair: making the case for hernia research. Hernia 16(2):179–183

    Article  CAS  PubMed  Google Scholar 

  4. Hadeed JG et al (2011) Complex abdominal wall hernias: a new classification system and approach to management based on review of 133 consecutive patients. Ann Plast Surg 66(5):497–503

    Article  CAS  PubMed  Google Scholar 

  5. Slater NJ et al (2014) Criteria for definition of a complex abdominal wall hernia. Hernia 18(1):7–17

    Article  CAS  PubMed  Google Scholar 

  6. Holihan JL et al (2015) Adverse events after ventral hernia repair: the vicious cycle of complications. J Am Coll Surg 221(2):478–485

    Article  PubMed  Google Scholar 

  7. Lode L et al (2021) Enhanced recovery after abdominal wall reconstruction: a systematic review and meta-analysis. Surg Endosc 35(2):514–523

    Article  PubMed  Google Scholar 

  8. Slim K, Standaert D (2020) Enhanced recovery after surgical repair of incisional hernias. Hernia 24(1):3–8

    Article  CAS  PubMed  Google Scholar 

  9. Bhargava A et al (2021) Physical activity pre and post complex abdominal wall reconstruction: where is the evidence? PROSPERO CRD42021236745 2021; 15th March. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021236745

  10. Chapter 5: Collecting data. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (eds) Cochrane handbook for systematic reviews of interventions version 6.1 September 2020 [cited 2021 11th January]. Available from: www.training.cochrane.org/handbook

  11. Sterne JA et al (2016) ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 355:i4919

    Article  PubMed  PubMed Central  Google Scholar 

  12. Sterne JAC et al (2019) RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 366:l4898

    Article  PubMed  Google Scholar 

  13. Page MJ et al (2021) Updating guidance for reporting systematic reviews: development of the PRISMA 2020 statement. J Clin Epidemiol 134:103–112

    Article  PubMed  Google Scholar 

  14. Wohlin C (2014) Guidelines for snowballing in systematic literature studies and a replication in software engineering. In: Proceedings of the 18th international conference on evaluation and assessment in software engineering. Association for Computing Machinery, London, England, United Kingdom, p Article 38

  15. Liang MK et al (2018) Modifying risks in ventral hernia patients with prehabilitation: a randomized controlled trial. Ann Surg 268(4):674–680

    Article  PubMed  Google Scholar 

  16. Pezeshk RA et al (2015) Complex abdominal wall reconstruction: a novel approach to postoperative care using physical medicine and rehabilitation. Plast Reconstr Surg 136(3):362e–369e

    Article  CAS  PubMed  Google Scholar 

  17. Jensen KK, Kjaer M, Jorgensen LN (2016) Isometric abdominal wall muscle strength assessment in individuals with incisional hernia: a prospective reliability study. Hernia 20(6):831–837

    Article  CAS  PubMed  Google Scholar 

  18. Jensen KK, Backer V, Jorgensen LN (2017) Abdominal wall reconstruction for large incisional hernia restores expiratory lung function. Surgery 161(2):517–524

    Article  PubMed  Google Scholar 

  19. Jensen KK et al (2016) Enhanced recovery after giant ventral hernia repair. Hernia 20(2):249–256

    Article  CAS  PubMed  Google Scholar 

  20. Jensen KK, Kjaer M, Jorgensen LN (2014) Abdominal muscle function and incisional hernia: a systematic review. Hernia 18(4):481–486

    Article  CAS  PubMed  Google Scholar 

  21. Ahmed MG et al (2018) Effect of preoperative abdominal training on abdominal muscles strength outcomes after ventral hernia repair. Med J Cairo Univ 86:4495–4501

    Article  Google Scholar 

  22. McGuinness LA, Higgins JPT (2021) Risk-of-bias visualization (robvis): an R package and Shiny web app for visualizing risk-of-bias assessments. Res Synth Methods 12(1):55–61

    Article  PubMed  Google Scholar 

  23. Jensen KK et al (2017) Abdominal wall reconstruction for incisional hernia optimizes truncal function and quality of life: a prospective controlled study. Ann Surg 265(6):1235–1240

    Article  PubMed  Google Scholar 

  24. Grove TN et al (2021) Perioperative optimization in complex abdominal wall hernias: Delphi consensus statement. BJS Open 5(5)

  25. Onerup A et al (2021) Effect of short-term homebased pre- and postoperative exercise on recovery after colorectal cancer surgery (PHYSSURG-C): a randomized clinical trial. Ann Surg

  26. Schwartz CE et al (2021) Moving toward better health: exercise practice is associated with improved outcomes after spine surgery in people with degenerative lumbar conditions. Can J Surg 64(4):E419–E427

    Article  PubMed  PubMed Central  Google Scholar 

  27. Hulzebos EH et al (2012) Preoperative physical therapy for elective cardiac surgery patients. Cochrane Database Syst Rev 11:CD010118

    PubMed  Google Scholar 

  28. Fischer JP et al (2014) Analysis of risk factors, morbidity, and cost associated with respiratory complications following abdominal wall reconstruction. Plast Reconstr Surg 133(1):147–156

    Article  CAS  PubMed  Google Scholar 

  29. Novitsky YW et al (2012) Transversus abdominis muscle release: a novel approach to posterior component separation during complex abdominal wall reconstruction. Am J Surg 204(5):709–716

    Article  PubMed  Google Scholar 

  30. Stoppa RE (1989) The treatment of complicated groin and incisional hernias. World J Surg 13(5):545–554

    Article  CAS  PubMed  Google Scholar 

  31. Nielsen MO et al (2020) Short-term safety of preoperative administration of botulinum toxin A for the treatment of large ventral hernia with loss of domain. Hernia 24(2):295–299

    Article  CAS  PubMed  Google Scholar 

  32. Wegdam JA et al (2020) Prehabilitation of complex ventral hernia patients with Botulinum: a systematic review of the quantifiable effects of Botulinum. Hernia

  33. Elstner KE et al (2020) Selective muscle botulinum toxin A component paralysis in complex ventral hernia repair. Hernia 24(2):287–293

    Article  CAS  PubMed  Google Scholar 

  34. Weise D, Weise CM, Naumann M (2019) Central effects of botulinum neurotoxin-evidence from human studies. Toxins (Basel) 11(1):21

    Article  CAS  Google Scholar 

  35. Guttormson R et al (2008) Are postoperative activity restrictions evidence-based. Am J Surg 195(3):401–403; discussion 403–404

  36. Cobb WS et al (2005) Normal intraabdominal pressure in healthy adults. J Surg Res 129(2):231–235

    Article  PubMed  Google Scholar 

  37. Gerten KA et al (2008) Intraabdominal pressure changes associated with lifting: implications for postoperative activity restrictions. Am J Obstet Gynecol 198(3):306e1-5

    Article  Google Scholar 

  38. Junge K et al (2001) Elasticity of the anterior abdominal wall and impact for reparation of incisional hernias using mesh implants. Hernia 5(3):113–118

    Article  CAS  PubMed  Google Scholar 

  39. Konerding MA et al (2011) Maximum forces acting on the abdominal wall: experimental validation of a theoretical modeling in a human cadaver study. Med Eng Phys 33(6):789–792

    Article  PubMed  Google Scholar 

  40. Forbes J et al (2012) Timing of return to work after hernia repair: recommendations based on a literature review. Brit Columbia Med J 54(7):341–345

    Google Scholar 

  41. Blazek D et al (2019) Systematic review of intra-abdominal and intrathoracic pressures initiated by the Valsalva manoeuvre during high-intensity resistance exercises. Biol Sport 36(4):373–386

    Article  PubMed  PubMed Central  Google Scholar 

  42. Garber CE et al (2011) American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc 43(7):1334–1359

    Article  PubMed  Google Scholar 

  43. Gunnarsson U, Johansson M, Strigard K (2011) Assessment of abdominal muscle function using the Biodex System-4. Validity and reliability in healthy volunteers and patients with giant ventral hernia. Hernia 15(4):417–421

    Article  CAS  PubMed  Google Scholar 

  44. Stark B et al (2012) Validation of Biodex system 4 for measuring the strength of muscles in patients with rectus diastasis. J Plast Surg Hand Surg 46(2):102–105

    Article  PubMed  Google Scholar 

  45. Parker M et al (2011) Pilot study on objective measurement of abdominal wall strength in patients with ventral incisional hernia. Surg Endosc 25(11):3503–3508

    Article  PubMed  Google Scholar 

  46. Krpata DM et al (2012) Design and initial implementation of HerQLes: a hernia-related quality-of-life survey to assess abdominal wall function. J Am Coll Surg 215(5):635–642

    Article  PubMed  Google Scholar 

  47. Bigolin AV et al (2020) What is the best method to assess the abdominal wall? Restoring strength does not mean functional recovery. Arq Bras Cir Dig 33(1):e1487

    Article  PubMed  PubMed Central  Google Scholar 

  48. Strigard K et al (2016) Giant ventral hernia-relationship between abdominal wall muscle strength and hernia area. BMC Surg 16(1):50

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Kato S et al (2020) Reliability of the muscle strength measurement and effects of the strengthening by an innovative exercise device for the abdominal trunk muscles. J Back Musculoskelet Rehabil 33(4):677–684

    Article  PubMed  Google Scholar 

  50. Grabiner MD, Jeziorowski JJ, Divekar AD (1990) Isokinetic measurements of trunk extension and flexion performance collected with the biodex clinical data station. J Orthop Sports Phys Ther 11(12):590–598

    Article  CAS  PubMed  Google Scholar 

  51. Estrazulas JA et al (2020) Evaluation isometric and isokinetic of trunk flexor and extensor muscles with isokinetic dynamometer: a systematic review. Phys Ther Sport 45:93–102

    Article  PubMed  Google Scholar 

  52. Guilhem G et al (2014) Validity of trunk extensor and flexor torque measurements using isokinetic dynamometry. J Electromyogr Kinesiol 24(6):986–993

    Article  PubMed  Google Scholar 

  53. Criss CN et al (2014) Functional abdominal wall reconstruction improves core physiology and quality-of-life. Surgery 156(1):176–182

    Article  PubMed  Google Scholar 

  54. den Hartog D et al (2010) Isokinetic strength of the trunk flexor muscles after surgical repair for incisional hernia. Hernia 14(3):243–247

    Article  Google Scholar 

  55. Ueland W et al (2020) The contribution of specific enhanced recovery after surgery (ERAS) protocol elements to reduced length of hospital stay after ventral hernia repair. Surg Endosc 34(10):4638–4644

    Article  PubMed  Google Scholar 

  56. Stearns E et al (2018) Early outcomes of an enhanced recovery protocol for open repair of ventral hernia. Surg Endosc 32(6):2914–2922

    Article  PubMed  Google Scholar 

  57. Mohapatra S, Balaji M, Ganapathi R (2019) Application of enhanced recovery pathway in abdominal wall reconstruction surgery in a tertiary care hospital in Andhra Pradesh. Int J Surg Sci 3(4):141–143

    Article  Google Scholar 

  58. Majumder A et al (2016) Benefits of multimodal enhanced recovery pathway in patients undergoing open ventral hernia repair. J Am Coll Surg 222(6):1106–1115

    Article  PubMed  Google Scholar 

  59. Harryman C et al (2020) Enhanced value with implementation of an ERAS protocol for ventral hernia repair. Surg Endosc 34(9):3949–3955

    Article  PubMed  Google Scholar 

  60. Fayezizadeh M et al (2014) Enhanced recovery after surgery pathway for abdominal wall reconstruction: pilot study and preliminary outcomes. Plast Reconstr Surg 134(4 Suppl 2):151S-159S

    Article  CAS  PubMed  Google Scholar 

  61. Colvin J et al (2019) Enhanced recovery after surgery pathway for patients undergoing abdominal wall reconstruction. Surgery 166(5):849–853

    Article  PubMed  Google Scholar 

  62. Crocetti D et al (2020) Dietary protein supplementation helps in muscle thickness regain after abdominal wall reconstruction for incisional hernia. Am Surg 86(3):232–236

    Article  PubMed  Google Scholar 

  63. Gormley J et al (2020) Impact of rectus diastasis repair on abdominal strength and function: a systematic review. Cureus 12(12):e12358

    PubMed  PubMed Central  Google Scholar 

  64. Emanuelsson P et al (2016) Operative correction of abdominal rectus diastasis (ARD) reduces pain and improves abdominal wall muscle strength: a randomized, prospective trial comparing retromuscular mesh repair to double-row, self-retaining sutures. Surgery 160(5):1367–1375

    Article  PubMed  Google Scholar 

  65. Olsson A et al (2019) Cohort study of the effect of surgical repair of symptomatic diastasis recti abdominis on abdominal trunk function and quality of life. BJS Open 3(6):750–758

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  66. Jensen KK et al (2019) Enhanced recovery after abdominal wall reconstruction reduces length of postoperative stay: an observational cohort study. Surgery 165(2):393–397

    Article  PubMed  Google Scholar 

  67. DuBay DA et al (2007) Incisional herniation induces decreased abdominal wall compliance via oblique muscle atrophy and fibrosis. Ann Surg 245(1):140–146

    Article  PubMed  PubMed Central  Google Scholar 

  68. Culbertson EJ et al (2013) Reversibility of abdominal wall atrophy and fibrosis after primary or mesh herniorrhaphy. Ann Surg 257(1):142–149

    Article  PubMed  Google Scholar 

  69. Mazzocchi M et al (2014) A study of postural changes after abdominal rectus plication abdominoplasty. Hernia 18(4):473–480

    Article  CAS  PubMed  Google Scholar 

  70. Wilhelmsson S et al (2017) Abdominal plasty with and without plication-effects on trunk muscles, lung function, and self-rated physical function. J Plast Surg Hand Surg 51(3):199–204

    Article  PubMed  Google Scholar 

  71. Staalesen T, Olsen MF, Elander A (2015) The effect of abdominoplasty and outcome of rectus fascia plication on health-related quality of life in post-bariatric surgery patients. Plast Reconstr Surg 136(6):750e–761e

    Article  CAS  PubMed  Google Scholar 

  72. Temel M, Turkmen A, Berberoglu O (2016) Improvements in vertebral-column angles and psychological metrics after abdominoplasty with rectus plication. Aesthet Surg J 36(5):577–587

    Article  PubMed  Google Scholar 

  73. Paiuk I, Wasserman I, Dvir Z (2014) Effects of abdominal surgery through a midline incision on postoperative trunk flexion strength in patients with colorectal cancer. Hernia 18(4):487–493

    Article  CAS  PubMed  Google Scholar 

  74. Khan OA et al (2012) Impact of training on outcomes following incisional hernia repair. Acta Chir Belg 112(6):432–435

    Article  CAS  PubMed  Google Scholar 

  75. Pommergaard HC et al (2014) No consensus on restrictions on physical activity to prevent incisional hernias after surgery. Hernia 18(4):495–500

    Article  PubMed  Google Scholar 

  76. Rodrigues MA et al (2018) Preoperative respiratory physiotherapy in abdominoplasty patients. Aesthet Surg J 38(3):291–299

    Article  PubMed  Google Scholar 

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No funding sources were used for this study.

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Authors and Affiliations

  1. Department of General Surgery, Wirral University Teaching Hospitals NHS Foundation Trust, Arrowe Park Hospital, Arrowe Park Rd, Upton, CH49 5PE, Wirral, UK

    S. T. Adams & C. J. Walsh

  2. Department of General Surgery, St Helen’s and Knowsley Teaching Hospitals NHS Trust, Rainhill, Prescot, UK

    S. T. Adams

  3. Department of Plastic Surgery, St Helen’s and Knowsley Teaching Hospitals NHS Trust, Rainhill, Prescot, UK

    S. T. Adams

  4. Department of General Surgery, North Middlesex University Hospital NHS Trust, London, UK

    N. H. Bedwani

  5. Royal Devon and Exeter NHS Foundation Trust, Exeter, UK

    L. H. Massey & N. J. Smart

  6. Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK

    A. Bhargava

  7. College of Life and Environmental Sciences, Sport and Health Sciences, University of Exeter, Exeter, UK

    C. Byrne

  8. Digestive Disease Center, Bispebjerg University Hospital, Copenhagen, Denmark

    K. K. Jensen

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  1. S. T. Adams
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Correspondence to S. T. Adams.

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Adams, S.T., Bedwani, N.H., Massey, L.H. et al. Physical activity recommendations pre and post abdominal wall reconstruction: a scoping review of the evidence. Hernia 26, 701–714 (2022). https://doi.org/10.1007/s10029-022-02562-5

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  • DOI: https://doi.org/10.1007/s10029-022-02562-5

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