Preoperative physical exercise for patients undergoing cardiac surgery: a systematic review
Refereed conference paper presented and published in conference proceedings

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Abstract- Background and aims:
Physical deconditioning from existing comorbidity and physical inactivity commonly occurs in patients waiting for elective cardiac surgery. While this preoperative period presents an opportunity for prehabilitation to improve postoperative outcomes, the effectiveness of such intervention is unclear. Our study objective was to synthesize the evidence of preoperative physical activity/exercise training (PET) program on postoperative recovery in adults undergoing coronary artery bypass grafting with or without valve surgery.

- Methods:
Randomized controlled trials (RCT) and quasi-experimental studies were searched for in the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and CINAHL databases from inception to October 2018. To assess the quality of intervention reporting of included studies, two independent reviewers used the Cochrane Risk of Bias Tool, the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) Working Group guidelines to evaluate the quality of evidence, and the template for intervention description and replication (TIDieR) checklist and guide. The mean difference (MD) and relative risk (RR) with associated 95% confidence intervals (95% CI) were estimated using a random-effects model. We assessed the heterogeneity as low, moderate, and high using I2 values of 25%, 50%, and 75%, respectively.

- Results:
After identifying 2640 references, we included seven RCTs and one quasi-experimental study with a total of 761 participants. The mean (95% CI) TIDieR score (0-24) of included studies was 15.6 (13.9-17.4). The timing of PET programs, mostly supervised by physiotherapists and exercise specialists, varied from 1 week to 16 weeks before surgery. PET programs reduced the postoperative hospital length of stay by 0.66 days (95% CI: -0.96 to -0.35, I2=0%, very low-certainty evidence) and total hospital length of stay by 0.66 days (95% CI: -1.28 to -0.04, I2=43%, low-certainty evidence) when compared to usual care. PET programs might make little or no difference to reducing the risk of postoperative atrial fibrillation (RR 0.75, 95% CI: 0.38 to 1.46, I2=50%, very low-certainty evidence) and increasing subsequent uptake of cardiac rehabilitation (RR 1.42, 95% CI: 0.87 to 2.30, I2=44%, low-certainty evidence).

- Conclusions:
PET programs may reduce the total and postoperative hospital length of stay. However, there is the potential for overestimating the treatment effects due to the low-to-very low-certainty of evidence. The reporting quality of included studies was moderate as PET program adherence by patients was rarely assessed. The conclusions of the review will likely change once the results of a few RCTs currently in progress are included.
Acceptance Date18/04/2019
All Author(s) ListKing Wai Derek YAU, Malcolm John UNDERWOOD, Gavin Matthew JOYNT, Anna LEE
Name of ConferenceResearch Poster Exhibition 2019
Start Date of Conference08/05/2019
End Date of Conference30/05/2019
Place of ConferenceThe Chinese University of Hong Kong
Country/Region of ConferenceHong Kong
Proceedings TitleResearch Poster Exhibition 2019
Place of PublicationChinese University of Hong Kong
LanguagesEnglish-United Kingdom

Last updated on 2019-09-09 at 09:35