Post-Operative Outcomes of Pre-Thoracic Surgery Respiratory Muscle Training vs Aerobic Exercise Training: A Systematic Review and Network Meta-analysis.
Rajesh Kunadharaju, Arjun Saradna, Andrew Ray and 4 others
PMID 36539175WHAT IT FOUND
Preoperative respiratory muscle training or aerobic exercise before thoracic surgery both reduced postoperative pulmonary complications compared with usual care.
The two approaches performed similarly, and the combined-training result rests on only two small trials.
Key findings
01All three preoperative interventions reduced postoperative pulmonary complications compared with usual care: RMT (OR 0.35, 95% CI 0.16 to 0.74), AET (OR 0.33, 95% CI 0.22 to 0.51), and RMT+AET (OR 0.20, 95% CI 0.05 to 0.81). The network meta-analysis found no significant difference among the three interventions.
02Preoperative RMT reduced respiratory failure requiring ventilatory support compared with usual care. Preoperative AET did not show this effect.
03Most AET studies included breathing exercises alongside aerobic exercise, so the effect attributed to AET may partly reflect the breathing component rather than aerobic conditioning alone.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Most studies could not blind patients to the intervention, and the authors note this may inflate the treatment effect. Most AET studies included breathing exercises alongside aerobic exercise, so the effect attributed to AET may partly come from the breathing component. RMT patients were mostly cardiac surgery patients while AET patients were mostly lung surgery patients, so the two groups were not directly comparable in surgical type. The combined RMT+AET result is based on only two trials. No included studies enrolled aortic surgery patients, so findings do not apply to that population. Heterogeneity was substantial in the RMT group (I² = 61%).
The easy way to misread this
Do not read the combined RMT+AET result as proof that adding both beats either alone. The network meta-analysis found no significant difference among the three interventions, and the combined group was based on only two trials. Also, most AET studies included breathing exercises, so the effect attributed to aerobic exercise may partly come from that component.
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