Systematic review of preoperative physical activity and its impact on postcardiac surgical outcomes

D Scott Kehler, Andrew N Stammers, Navdeep Tangri, Brett Hiebert, Randy Fransoo, Annette S H Schultz, Kerry Macdonald, Nicholas Giacomontonio, Ansar Hassan, Jean-Francois Légaré, Rakesh C Arora, Todd A Duhamel, D Scott Kehler, Andrew N Stammers, Navdeep Tangri, Brett Hiebert, Randy Fransoo, Annette S H Schultz, Kerry Macdonald, Nicholas Giacomontonio, Ansar Hassan, Jean-Francois Légaré, Rakesh C Arora, Todd A Duhamel

Abstract

Objectives: The objective of this systematic review was to study the impact of preoperative physical activity levels on adult cardiac surgical patients' postoperative: (1) major adverse cardiac and cerebrovascular events (MACCEs), (2) adverse events within 30 days, (3) hospital length of stay (HLOS), (4) intensive care unit length of stay (ICU LOS), (5) activities of daily living (ADLs), (6) quality of life, (7) cardiac rehabilitation attendance and (8) physical activity behaviour.

Methods: A systematic search of MEDLINE, Embase, AgeLine and Cochrane library for cohort studies was conducted.

Results: Eleven studies (n=5733 patients) met the inclusion criteria. Only self-reported physical activity tools were used. Few studies used multivariate analyses to compare active versus inactive patients prior to surgery. When comparing patients who were active versus inactive preoperatively, there were mixed findings for MACCE, 30 day adverse events, HLOS and ICU LOS. Of the studies that adjusted for confounding variables, five studies found a protective, independent association between physical activity and MACCE (n=1), 30-day postoperative events (n=2), HLOS (n=1) and ICU LOS (n=1), but two studies found no protective association for 30-day postoperative events (n=1) and postoperative ADLs (n=1). No studies investigated if activity status before surgery impacted quality of life or cardiac rehabilitation attendance postoperatively. Three studies found that active patients prior to surgery were more likely to be inactive postoperatively.

Conclusion: Due to the mixed findings, the literature does not presently support that self-reported preoperative physical activity behaviour is associated with postoperative cardiac surgical outcomes. Future studies should objectively measure physical activity, clearly define outcomes and adjust for clinically relevant variables.

Registration: Trial registration number NCT02219815. PROSPERO number CRD42015023606.

Keywords: cardiac surgical procedures; exercise; postoperative complications; prognosis.

Conflict of interest statement

Competing interests: None declared.

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Figures

Figure 1
Figure 1
Study flow diagram.

References

    1. Ferguson TB, Hammill BG, Peterson ED, et al. . A decade of change--risk profiles and outcomes for isolated coronary artery bypass grafting procedures, 1990-1999: a report from the STS National Database Committee and the Duke clinical Research Institute. Society of Thoracic Surgeons. Ann Thorac Surg 2002;73:480–9. 10.1016/S0003-4975(01)03339-2
    1. Pfisterer M, Buser P, Osswald S, et al. . Outcome of elderly patients with chronic symptomatic coronary artery disease with an invasive vs optimized medical treatment strategy: one-year results of the randomized TIME trial. JAMA 2003;289:1117–23. 10.1001/jama.289.9.1117
    1. Alexander KP, Anstrom KJ, Muhlbaier LH, et al. . Outcomes of cardiac surgery in patients > or = 80 years: results from the National Cardiovascular Network. J Am Coll Cardiol 2000;35:731–8. 10.1016/S0735-1097(99)00606-3
    1. Anderson L, Oldridge N, Thompson DR, et al. . Exercise-Based Cardiac Rehabilitation for Coronary Heart disease: cochrane Systematic Review and Meta-Analysis. J Am Coll Cardiol 2016;67:1–12. 10.1016/j.jacc.2015.10.044
    1. Macchi C, Polcaro P, Cecchi F, et al. . One-year adherence to exercise in elderly patients receiving postacute inpatient rehabilitation after cardiac surgery. Am J Phys Med Rehabil 2009;88:727–34. 10.1097/PHM.0b013e3181b332a1
    1. Horne D, Kehler DS, Kaoukis G, et al. . Impact of physical activity on depression after cardiac surgery. Can J Cardiol 2013;29:1649–56. 10.1016/j.cjca.2013.09.015
    1. Arthur HM, Daniels C, McKelvie R, et al. . Effect of a preoperative intervention on preoperative and postoperative outcomes in low-risk patients awaiting elective coronary artery bypass graft surgery. A randomized, controlled trial. Ann Intern Med 2000;133:253–62. 10.7326/0003-4819-133-4-200008150-00007
    1. Sawatzky JA, Kehler DS, Ready AE, et al. . Prehabilitation program for elective coronary artery bypass graft surgery patients: a pilot randomized controlled study. Clin Rehabil. 2014;28:648–57. 10.1177/0269215513516475
    1. Herdy AH, Marcchi PL, Vila A, et al. . Pre- and postoperative cardiopulmonary rehabilitation in hospitalized patients undergoing coronary artery bypass surgery: a randomized controlled trial. Am J Phys Med Rehabil 2008;87:714–9. 10.1097/PHM.0b013e3181839152
    1. Society of Thoracic Surgeons. General Thoracic Surgery Database (accessed 17 Feb 2015).
    1. Wells GA, Shea B, O’Connell D, et al. . The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2011. (accessed 25 Jan 2015).
    1. Markou AL, Lasten PJ, Noyez L. Physical activity post myocardial revascularization. ‘’will surgery improve my mobility? J Cardiovasc Surg 2007;48:201–6.
    1. Nery RM, Barbisan JN, Mahmud MI. Influence of the practice physical activity in the coronary artery bypass graft surgery results. Rev Bras Cir Cardiovasc 2007;22:297–302.
    1. Markou AL, Evers M, van Swieten HA, et al. . Gender and physical activity one year after myocardial revascularization for stable angina. Interact Cardiovasc Thorac Surg 2008;7:96–101. 10.1510/icvts.2007.160382
    1. Martini MR, Barbisan JN. Influence of physical activity during leisure time in patients in the follow-up two years after CABG. Rev Bras Cir Cardiovasc 2010;25:359–64.
    1. Nery RM, Barbisan JN. Effect of leisure-time physical activity on the prognosis of coronary artery bypass graft surgery. Rev Bras Cir Cardiovasc 2010;25:73–8.
    1. Rengo G, Galasso G, Vitale DF, et al. . An active lifestyle prior to coronary surgery is associated with improved survival in elderly patients. J Gerontol A Biol Sci Med Sci 2010;65:758–63. 10.1093/gerona/glp216
    1. Giaccardi M, Macchi C, Colella A, et al. . Postacute rehabilitation after coronary surgery: the effect of preoperative physical activity on the incidence of paroxysmal atrial fibrillation. Am J Phys Med Rehabil 2011;90:308–15. 10.1097/PHM.0b013e31820f9535
    1. Cacciatore F, Belluomo Anello C, Ferrara N, et al. . Determinants of prolonged intensive care unit stay after cardiac surgery in the elderly. Aging Clin Exp Res 2012;24:627–34. 10.3275/8521
    1. Noyez L, Biemans I, Verkroost M, et al. . Is a sedentary lifestyle an independent predictor for hospital and early mortality after elective cardiac surgery? Neth Heart J 2013;21:439–45. 10.1007/s12471-013-0444-5
    1. Min L, Mazzurco L, Gure TR, et al. . Longitudinal functional recovery after geriatric cardiac surgery. J Surg Res 2015;194:25–33. 10.1016/j.jss.2014.10.043
    1. van Laar C, Kievit PC, Noyez L. Surgical aortic valve replacement in patients older than 75 years: is there really a quality of life benefit? Neth Heart J 2015;23:174–9. 10.1007/s12471-015-0660-2
    1. van Poppel MN, Chinapaw MJ, Mokkink LB, et al. . Physical activity questionnaires for adults: a systematic review of measurement properties. Sports Med Auckl NZ 2010;40:565–600.
    1. Tremblay MS, Warburton DER, Janssen I, et al. . New Canadian physical activity guidelines. Appl Physiol Nutr Metab 2011;36:36–46. 10.1139/H11-009
    1. Physical activity guidelines Advisory Committee. Physical Activity Guidelines Advisory Committee Report. Washington, DC: U.S: Department of Health and Human Services, 2008.
    1. Lee PH, Macfarlane DJ, Lam TH, et al. . Validity of the International Physical Activity Questionnaire Short form (IPAQ-SF): a systematic review. Int J Behav Nutr Phys Act 2011;8:115 10.1186/1479-5868-8-115
    1. Schmidt MD, Cleland VJ, Thomson RJ, et al. . A comparison of subjective and objective measures of physical activity and fitness in identifying associations with cardiometabolic risk factors. Ann Epidemiol 2008;18:378–86. 10.1016/j.annepidem.2008.01.005
    1. Atienza AA, Moser RP, Perna F, et al. . Self-reported and objectively measured activity related to biomarkers using NHANES. Med Sci Sports Exerc 2011;43:815–21. 10.1249/MSS.0b013e3181fdfc32
    1. Anderson L, Thompson DR, Oldridge N, et al. . Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev 2016;1:CD001800.
    1. Goldfarb M, Drudi L, Almohammadi M, et al. . Outcome Reporting in cardiac surgery trials: systematic review and critical appraisal. J Am Heart Assoc 2015;4:e002204 10.1161/JAHA.115.002204
    1. Abah U, Dunne M, Cook A, et al. . Does quality of life improve in octogenarians following cardiac surgery? A systematic review. BMJ Open 2015;5:e006904 10.1136/bmjopen-2014-006904
    1. Karim MN, Reid CM, Tran L, et al. . Missing Value Imputation improves mortality risk prediction following cardiac surgery: an investigation of an australian patient Cohort. Heart Lung Circ 2017;26:301–8. 10.1016/j.hlc.2016.06.1214

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