Preoperative exercise therapy for elective major abdominal surgery: A systematic review

Abstract

Preoperative exercise therapy might be effective in improving the physical fitness of patients prior to major abdominal surgery, and preoperative chest physiotherapy seems effective in reducing pulmonary complications. However consensus on training method is lacking. Future research should focus on the method and effect of PEXT before high-risk surgical procedures.

The key questions in rehabilitation in thoracic surgery

“…Significant improvements in exercise capacity, lung function, complication rates and hospital LOS are seen. This data concurs with the emerging evidence in other areas of surgery that PR is beneficial (45,46).…”

The physiotherapy management of patients undergoing abdominal surgery

“…Evidence of the effectiveness of prehabilitation is relatively new, yet systematic reviews and meta-analyses have already been undertaken (Lemanu et al 2013, Olsén and Anzén 2012, Valkenet et al 2011, although only two focused solely on major abdominal surgery (Pouwels et al 2014, Pouwels et al 2015. Valkenet et al (2011) and Santa Mina (2014) conducted metaanalyses on the effects of preoperative interventions including inspiratory muscle training (IMT) and/or exercise training in patients undergoing major cavity and orthopaedic surgery.…”

“…To our knowledge, there are only two systematic reviews specifically relating to prehabilitation in abdominal surgery (Pouwels et al 2014, Pouwels et al 2015. These two reviews detailed six RCTs in both laparoscopic and open abdominal surgery (Pouwels et al 2014) and five studies in abdominal aortic aneurysm repair specifically (Pouwels et al 2015).…”

“…These two reviews detailed six RCTs in both laparoscopic and open abdominal surgery (Pouwels et al 2014) and five studies in abdominal aortic aneurysm repair specifically (Pouwels et al 2015). Studies investigated strength and/or aerobic training, breathing exercises, education and IMT or combinations of these.…”

“…The heterogeneity of the investigations precluded meta-analyses as studies utilised a variety of frequencies, intensities, durations, modes, locations and outcome measures. Both reviews (Pouwels et al 2014, Pouwels et al 2015 determined that preoperative exercise therapy is associated with improved physical fitness in patients prior to major abdominal surgery, but, due to heterogeneity and small sample sizes, whether this results in fewer complications or faster recovery remains unclear.…”