Prehabilitation exercise therapy before elective abdominal aortic aneurysm repair

Area of Science:

• Cardiovascular Surgery
• Nephrology
• Pulmonology
• Geriatrics

Background:

• Abdominal aortic aneurysm (AAA) is a dangerous aortic dilation, with rupture risk increasing with size.
• Elective AAA repair carries significant perioperative and postoperative risks.
• Prehabilitation exercise aims to improve patient functional capacity before surgery to enhance outcomes.

Purpose of the Study:

• To assess the impact of exercise programs on perioperative and postoperative morbidity and mortality in patients undergoing elective AAA repair.

Main Methods:

• Searched multiple databases for randomized controlled trials (RCTs) comparing prehabilitation exercise to usual care for AAA repair patients.
• Included four RCTs with 232 participants; assessed methodological quality using the Cochrane risk of bias tool.
• Extracted data on mortality, complications, length of stay, and quality of life; used GRADE to evaluate evidence certainty.

Main Results:

• Four RCTs (232 participants) were included, all with a high risk of bias and low to very low certainty of evidence.
• Prehabilitation exercise may reduce cardiac (RR 0.36) and renal complications (RR 0.31), but evidence is low certainty.
• Uncertainty remains regarding effects on 30-day mortality, pulmonary complications, re-intervention, and bleeding due to very low certainty evidence.

Conclusions:

• Current evidence is of very low certainty, making it uncertain if prehabilitation exercise reduces mortality, pulmonary complications, re-intervention, or bleeding after AAA repair.
• Prehabilitation exercise might offer slight benefits for cardiac and renal complications.
• High-quality RCTs with larger sample sizes and long-term follow-up are needed to determine optimal exercise protocols and patient selection.