Common Pre/Post Surgery

What Are the Benefits of Preoperative Exercise in Specific Populations?

Hip Replacement

In patients undergoing this surgery, significant improvements (small to moderate effect sizes) have been observed in pain, function, and length of stay with exercise interventions preoperatively.

Knee Replacement

A 2014 systematic review (Chesham and Shanmugham) concluded that there is minimal evidence so far supporting education and exercise interventions pre-operatively, compared with no physiotherapy or usual care. Interventions reviewed in the 10 RCTs were preoperative exercise; combined exercise and education; combined exercise and acupuncture; neuromuscular electrical stimulation; and acupuncture versus exercise. Outcomes assessed were knee strength, ambulation, and pain. Good quality research into this is ongoing.

However Moyer et al (2017) in their systematic review and meta-analysis found small to moderate effect sizes for pre-rehabilitation in this population. Significant improvements were made in function, quadriceps strength and length of stay.

Cardiac Surgery

A Cochrane review in 2012 found that evidence from small trials suggests that preoperative physical therapy, with an exercise component, for elective cardiac surgery patients reduces postoperative pulmonary complications and length of hospital stay. They concluded that there is a lack of evidence to effect changes to postoperative pneumothorax, or prolonged mechanical ventilation.

It has been known for some years that inspiratory muscle training provided pre-operatively reduces the risk of anaesthetic complications as well as reducing post-operative complications[13] as well as length of postoperative hospital stay and pulmonary function.

Pre-operative exercise reduces the length of stay both in Intensive Care facilities and in hospital[8][1]. A randomised control trial showed positive effects of active cyclic breathing technique and routine physiotherapy on arterial oxygenation, heart rate, and pain perception following Coronary Artery Bypass Graft (CABG) surgery.

Abdominal Surgery

O’Doherty et al (2013) in their systematic review conclude that pre-operative exercise reduces the length of stay both in Intensive Care facilities and in hospital[8][1]. A meta-analysis and systematic review done in 2016 (Moran et al) concluded that more research was needed, but ‘prehabilitation’ consisting of inspiratory muscle training, aerobic exercise, and/or resistance training can decrease postoperative complications after intra-abdominal operations.

Review suggests positive outcomes with preoperative exercises in bariatric surgery. However, further research concerning the exercise intervention mode, intensity, and timing before or after bariatric surgery to maximize cardiorespiratory fitness, physical function, and reducing cardiometabolic risk is required.

Other

Mixed Populations

A systematic review in 2010 found that preoperative exercise therapy is effective for reducing both postoperative complication rates and length of hospital stay after cardiac or abdominal surgery. A Cochrane review in 2015 concluded that preoperative inspiratory muscle training reduced the incidence of postoperative pulmonary complications (such as actelectasis and pneumonia) and length of hospital stay compared with usual care in adults undergoing cardiac and major abdominal surgery.

Colorectal Surgery

A study on patients undergoing colorectal surgery found benefits from exercise programmes pre-operatively: improved physical function, peak exercise capacity, mental health and self-perceived health

Cancer-resection surgery

A Cochrane review in 2017 found low quality evidence that preoperative exercise training may reduce some risks in those having lung resection surgery for early stage non-small cell lung cancer (NSCLC). These were- developing postoperative pulmonary complications, duration of intercostal catheter use, a reduced postoperative length of stay and improved exercise capacity and FVC post-operatively. 

What Are the Benefits of Post-Operative Exercise?

There is clear evidence for the following surgeries:

Spinal surgery – improved spinal mobility
Total Hip and Knee Replacement surgery – earlier discharge
Colorectal surgery – increased cardiovascular fitness
Breast surgery – fewer side-effects
In many surgeries: reduced risk of blood clots
Cardiac surgery – inspiratory muscle training on length of postoperative hospital stay and pulmonary function
Contraindications to Exercise Pre/Post Surgery

In addition to the absolute contraindications, specific precautions will apply depending on the surgery. The treating team (Doctors, Nurses, Physiotherapists) will give the patient specific advice on this.