Key result
Self-reported preoperative physical activity was not consistently associated with postoperative cardiac surgical outcomes, demonstrating mixed findings across 11 cohort studies (n=5,733).
Why the study?
Does preoperative physical activity improve postoperative outcomes in adult cardiac surgical patients?
Systematic Review (n=5,733)
Does preoperative physical activity improve postoperative outcomes in adult cardiac surgical patients?
Current literature does not support a clear association between self-reported preoperative physical activity and improved postoperative cardiac surgical outcomes due to mixed findings and methodological limitations.
Does not support using self-reported activity for postoperative risk prediction; leaves open whether objective measures improve outcome models.
OBJECTIVES: The objective of this systematic review was to study the impact of preoperative physical activity levels on adult cardiac surgical patients' postoperative: (1) major adverse cardiac and cerebrovascular events (MACCEs), (2) adverse events within 30 days, (3) hospital length of stay (HLOS), (4) intensive care unit length of stay (ICU LOS), (5) activities of daily living (ADLs), (6) quality of life, (7) cardiac rehabilitation attendance and (8) physical activity behaviour. METHODS: A systematic search of MEDLINE, Embase, AgeLine and Cochrane library for cohort studies was conducted. RESULTS: Eleven studies (n=5733 patients) met the inclusion criteria. Only self-reported physical activity tools were used. Few studies used multivariate analyses to compare active versus inactive patients prior to surgery. When comparing patients who were active versus inactive preoperatively, there were mixed findings for MACCE, 30 day adverse events, HLOS and ICU LOS. Of the studies that adjusted for confounding variables, five studies found a protective, independent association between physical activity and MACCE (n=1), 30-day postoperative events (n=2), HLOS (n=1) and ICU LOS (n=1), but two studies found no protective association for 30-day postoperative events (n=1) and postoperative ADLs (n=1). No studies investigated if activity status before surgery impacted quality of life or cardiac rehabilitation attendance postoperatively. Three studies found that active patients prior to surgery were more likely to be inactive postoperatively. CONCLUSION: Due to the mixed findings, the literature does not presently support that self-reported preoperative physical activity behaviour is associated with postoperative cardiac surgical outcomes. Future studies should objectively measure physical activity, clearly define outcomes and adjust for clinically relevant variables. REGISTRATION: Trial registration number NCT02219815. PROSPERO number CRD42015023606.
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Kehler et al. (2017) conducted a systematic review in Adult cardiac surgical patients (n=5,733). Preoperative physical activity vs. Preoperative physical inactivity was evaluated on Major adverse cardiac and cerebrovascular events (MACCEs), 30-day adverse events, hospital length of stay, and ICU length of stay. Self-reported preoperative physical activity was not consistently associated with postoperative cardiac surgical outcomes, demonstrating mixed findings across 11 cohort studies (n=5,733).
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