The quality of evidence is downgraded by study limitations (unclear allocation concealment and lack of blinding).
Preoperative physical therapy with an exercise component is suggested for patients undergoing elective cardiac surgery.
A Cochrane review [Abstract] 1 included 8 studies with a total of 856 subjects. Three studies used a mixed intervention (including either aerobic exercises or breathing exercises), and 5 used inspiratory muscle training. Only 1 study used sham training in the controls. Preoperative physical therapy reduced postoperative atelectasis and pneumonia but it did not significantly reduce pneumothorax, prolonged mechanical ventilation or all-cause postoperative death. The length of postoperative hospital stay was 3 days shorter in experimental patients versus controls. In the three studies that reported on adverse events, no adverse events occurred. Cost data were not reported.
| Outcome | Participants (studies) | Assumed risk (control) | Corresponding risk (intervention) | Relative risk (95% CI) |
|---|---|---|---|---|
| Atelectasis | 379 (4) | 31.9% | 16.6% | 0.52 (0.32 to 0.87) |
| Pneumonia | 448 (5) | 8.3% | 3.8% | 0.45 (0.24 to 0.83) |
| Pneumothorax | 45 (1) | 15.0% | 1.8% | 0.12 (0.01 to 2.11) |
| Mechanical ventilation > 48 hours | 306 (2) | 2.2% | 1.2% | 0.55 (0.03 to 9.20) |
| Postoperative all-cause mortality | 552 (3) | 2.9% | 1.9% | 0.66 (0.02 to 18.48) |
| Postoperative hospital stay | 347 (3) | The mean postoperative hospital stay was 12.4 days | The mean hospital stay was 3.21 fewer days (5.73 to 0.69 fewer) |
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