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


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AbstractBackground and aims:
Physical deconditioning from lack of exercise commonly occurs in patients waiting for elective cardiac surgery. While this time 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 program (PET) on postoperative recovery in adults undergoing coronary artery bypass grafting with or without valve surgery.

Methods:
We searched for randomized controlled trials (RCT) and quasi-experimental studies in the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and CINAHL databases from inception to October 2018. Two independent reviewers used the Cochrane Risk of Bias Tool, GRADE to evaluate the quality of evidence and the template for intervention description and replication (TIDieR) checklist and guide to assess the quality of intervention reporting of included studies. The mean difference (MD) and relative risk (RR) with associated 95% confidence intervals (95% CI) were estimated using a random-effects model. We assessed heterogeneity using the I2 statistic.

Results:
Of the 2639 references identified, we included six RCTs and one quasi-experimental study with 735 participants from Australia, Brazil, Canada, Taiwan and United Kingdom. The mean (95% CI) TIDieR score (0-24) of included studies was 15.6 (13.5-17.6). The timing of PET program, mostly supervised by physiotherapists, varied from 1 week to 16 weeks before surgery. Compared to usual care, PET reduced the postoperative length of stay by 0.66 days (Figure 1, very low-certainty evidence). PET might make little or no difference to reducing the risk of postoperative atrial fibrillation (RR 0.64, 95% CI: 0.26-1.57, I2=58%, very low-certainty evidence) and increasing subsequent uptake of cardiac rehabilitation (RR 1.42, 95% CI: 0.87-2.30, I2=44%, low-certainty evidence).

Conclusions:
PET may reduce postoperative length of stay. The reporting quality of included studies was moderate as program adherence was rarely assessed.
Acceptance Date26/02/2019
All Author(s) ListKing Wai Derek YAU, Malcolm John UNDERWOOD, Gavin Matthew JOYNT, Anna LEE
Name of Conference13th International Society of Physical and Rehabilitation Medicine World Congress
Start Date of Conference09/06/2019
End Date of Conference13/06/2019
Place of ConferenceKobe
Country/Region of ConferenceJapan
Proceedings TitleThe Journal of The International Society of Physical and Rehabilitation Medicine
Year2019
PublisherMedknow Publications
LanguagesEnglish-United Kingdom
KeywordsCardiac surgery, Preoperative rehabilitation

Last updated on 2020-09-04 at 10:39