Pooled Efficacy and Exploration of Effect Modifiers of Exercise Prehabilitation: A Systematic Review and Meta-regression Analysis of Randomized Controlled Trials.

In 30 seconds

This systematic review and meta-analysis pooled randomized controlled trials of exercise prehabilitation in adults undergoing major elective surgery and used meta-regression to examine potential effect modifiers. Across 99 trials involving 8222 participants, exercise prehabilitation was associated with fewer postoperative complications (OR = 0.54; 95% CI, 0.44-0.67; moderate-certainty evidence) and a shorter hospital stay (mean difference = -0.90 days; 95% CI, -1.23 to -0.58; low-certainty evidence). Inspiratory muscle training was the only factor identified as a significant modifier of both outcomes, although evidence for this finding was low certainty.

Key findings

• Exercise prehabilitation likely reduced postoperative complications (OR = 0.54; 95% CI, 0.44-0.67; moderate certainty).
• Length of stay was shorter with prehabilitation (mean difference = -0.90 days; 95% CI, -1.23 to -0.58; low certainty).
• Inspiratory muscle training modified both outcomes: complications (OR = 0.65; 95% CI, 0.44-0.97) and length of stay (MD = -1.04; 95% CI, -1.75 to -0.32), with low-certainty evidence.
• No other prespecified procedural, participant, or program factors were consistent or credible effect modifiers.

Why it matters

The pooled findings suggest exercise prehabilitation may improve two important postoperative outcomes across adults having major elective surgery. However, certainty differs by outcome, and the analysis did not establish which patient, procedural, or program characteristics reliably identify those most likely to benefit. This distinction matters when interpreting pooled effects and considering how broadly they apply.

What to keep in mind

Evidence for shorter length of stay and for inspiratory muscle training as an effect modifier was low certainty; heterogeneity was substantial for length of stay (I2 = 78%).