Effect of total-body prehabilitation on postoperative outcomes: A systematic review and meta-analysis

Objective To systematically review the evidence of pre-operative exercise, known as ‘prehabilitation’, on peri- and postoperative outcomesin adult surgical populations.Design Systematic review and meta-analysis.Data sources CENTRAL, Medline, EMBASE, CINAHL, PsycINFO and PEDro were searched from 1950 to 2011.Methods Two reviewers independently examined relevant, English-language articles that examined the effects of pre-operative total-bodyexercise with peri- and postoperative outcome analysis. Given the nascence of this field, controlled and uncontrolled trials were included. Riskof bias was assessed using the Cochrane Risk of Bias Assessment tool. Only data on length of stay were considered eligible for meta-analysisdue to the heterogeneity of measures and methodologies for assessing other outcomes.Results In total, 4597 citations were identified by the search strategy, of which 21 studies were included. Trials were generally small(median = 54 participants) and of moderate to poor methodological quality. Compared with standard care, the majority of studies found thattotal-body prehabilitation improved postoperative pain, length of stay and physical function, but it was not consistently effective in improvinghealth-related quality of life or aerobic fitness in the studies that examined these outcomes. The meta-analysis indicated that prehabilitationreduced postoperative length of stay with a small to moderate effect size (Hedges’ g = −0.39, P = 0.033). Intervention-related adverse eventswere reported in two of 669 exercising participants.Conclusion The literature provides early evidence that prehabilitation may reduce length of stay and possibly provide postoperative physicalbenefits. Cautious interpretation of these findings is warranted given modest methodological quality and significant risk of bias.© 2013 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.