Perioperative Encounter's Impact on Regular Exercise: A Systematic Review and Meta-Analysis

What is it about?

The systematic review and meta-analysis of 57 randomized controlled trials or quasi-randomized trials found that interventions given during the perioperative pathway may slightly increase the amount of physical activity, engagement in physical activity, and health-related quality of life in adults who underwent surgery, compared to usual care. The interventions included education, advice, behavioral mechanisms, and direct physical instruction. The effect sizes were modest, and the wide range of surgical groups, intervention types, and duration of interventions affected the pooled differences between groups. However, the study had some limitations, including the lack of standardization of usual care, inconsistent measures for outcomes, and insufficient studies for some subgroups. The certainty of evidence was moderate to low.

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Why is it important?

This research is important because it evaluates the effectiveness of perioperative interventions to facilitate physical activity (PA) in the medium to long-term, which can lead to better health outcomes. Low levels of PA are associated with poor health outcomes, and the perioperative period, which extends from initial contact in primary care to beyond discharge from hospital, offers a potential opportunity for intervention. However, data regarding the effectiveness of interventions during this period are scarce. This research helps address this gap by systematically reviewing existing literature and providing evidence on the effectiveness of perioperative interventions to promote PA. Key Takeaways: 1. Moderate-certainty evidence suggests that perioperative interventions may increase the amount of PA, engagement in PA, and health-related quality of life in adults undergoing surgery. 2. The effects of interventions varied depending on the type of surgery, intervention components, and duration of interventions. 3. The study found low-certainty evidence for physical fitness and pain. 4. Few studies reported adherence and adverse events, and the certainty of these findings was very low. 5. Participants generally provided positive feedback about the interventions, although this was infrequently reported. 6. The effect sizes were modest, and the mean differences and risk ratios offer a simplistic account of a complex picture due to various factors such as non-standardized 'usual care', multiple intervention components, and moderate recruitment rates. 7. The study used rigorous methods to search and assess the studies, and established more specific inclusion criteria during the review process to manage the large number of studies that met the broad criteria but did not fit with the review objectives.