Pre-habilitation exercise therapy before elective abdominal aortic aneurysm repair
Fenton C, Tan AR, Abaraogu UO, McCaslin JE Exercise therapy before rehabilitation before elective abdominal aortic aneurysm repair. Cochrane Database of Systematic Reviews 2021, No. 7. Art. No.: CD013662. doi: 10.1002 /14651858.CD013662.pub2. Accessed July 31, 2021.
Commentary
This study was designed to evaluate the effect of an exercise program on perioperative and postoperative morbidity and mortality associated with elective abdominal aortic aneurysm repair.
The primary outcome was the identification of four RCTs involving a total of 232 participants with AAA who were clinically diagnosed as suitable for elective interventions, comparing pre-rehabilitation exercise therapy with usual care (no exercise).
In three of the four included trials, pre-rehabilitation exercise therapy was supervised and hospital-based, while in the remaining trial, the first session was supervised in the hospital, but subsequent sessions were completed in the participant's home without supervision.
The dose and schedule of pre-habilitation exercise therapy varied across the trials with three to six sessions per week and one hour duration per session for one to six weeks. The types of exercise therapy included circuit training, moderate-intensity continuous exercise, and high-intensity interval training.
These trials have a high risk of bias and the certainty of evidence for each of the outcomes is low to very low.
Overall, it will be unclear whether pre-habilitation exercise compared to usual care (no exercise) reduces the incidence of 30-day mortality after AAA repair.
The effect of pre-rehabilitation exercise compared to usual care (no exercise) on the occurrence of cardiac and renal complications is also unknown. Compared to usual care (no exercise), the effect of pre-rehabilitation exercise on reducing pulmonary complications is also unknown, as is the effect on reducing post-operative bleeding.
There was no difference at all between the exercise and usual care (no exercise) groups in terms of ICU length of stay, length of hospital stay, or quality of life, and the same is true for the reduction in postoperative bleeding.
No studies reported data on ventilator days and changes in aneurysm size before and after exercise.
The authors conclude that
Due to the very low certainty of the evidence, it is unclear whether pre-habilitation exercise therapy reduces 30-day mortality, pulmonary complications, the need for re-intervention, or post-operative bleeding. Pre-rehabilitation exercise therapy may slightly reduce cardiac and renal complications compared to usual care (no exercise).
More RCTs of high methodological quality with large sample sizes and long-term follow-up are needed. Key questions need to include the type and cost-effectiveness of the exercise program, the minimum number of sessions and program duration needed to produce clinically important benefits, and the group of participants and type of restoration that will provide the most benefit.
