Supervised exercise prehabilitation interventions

Intervention summary:

Two RCTs, one moderate(2) and one weak quality(1), examined the effectiveness of supervised exercise interventions amongst patients waiting for bariatric surgery. 

The weak quality RCT(1) evaluated a core stabilisation exercise program whilst the moderate quality RCT(2) evaluated an aerobic exercise program. In both studies, the intervention program lasted 8-weeks and comprised of two supervised group sessions per week. The intervention in the weak quality RCT comprised of strengthening, endurance and balance exercises whereas the intervention in the moderate quality RCT comprised of aerobic dance-based exercise(1, 2).

In both studies, both the intervention and the control groups received physical activity counselling.

Outcomes:

?

The evidence of effectiveness for supervised prehabilitation exercise interventions is inconsistent for the following outcomes:

Function:

Might be effective (two studies; one moderate(2) and one weak quality(1), both showing a significant effect for intervention when compared to control. Evidence graded as inconsistent overall due to one of the included studies being of weak quality).

Anthropometrics (Total body weight and body composition):

Might not be effective (two studies; one moderate(2) and one weak quality(1), both showing no effect for intervention when compared to control).

Fatigue:

Might be effective (two studies; one moderate(2) and one weak quality(1), both showing a significant effect for intervention when compared to control. Evidence graded as inconsistent overall due to one of the included studies being of weak quality).

Health-related quality of life:

Might be effective (two studies; one moderate(2) and one weak quality(1), both showing a significant effect for intervention when compared to control. Evidence graded as inconsistent overall due to one of the included studies being of weak quality).

Physical activity:

Inconsistent (two studies; one moderate(2) and one weak quality(1). Inconsistent effects across and within each study and across both studies).

?

The evidence of effectiveness for supervised prehabilitation exercise interventions is lacking for the following outcomes:

Balance:

Might be effective (one weak quality study showing a significant effect for intervention when compared to control)(1).

Core stability:

Might be effective (one weak quality study showing a significant effect for intervention when compared to control)(1).

Muscle strength:

Might be effective (one moderate quality study showing a significant effect for intervention when compared to control)(2).

Physical fitness (muscular endurance):

Might be effective (one moderate quality study showing a significant effect for intervention when compared to control)(2).

Biomarkers of metabolic health (heart rate tolerance, beats/min):

Might be effective (one weak quality study showing a significant effect for intervention when compared to control)(1).

Generalisability:

Both studies were conducted in Turkey(1, 2). Therefore, generalisability to the Welsh context should be considered. 

Applicability: 

The interventions took place in adults with morbid obesity waiting for bariatric surgery(1, 2), and therefore may not be applicable to patients waiting for other types of elective surgeries. 

If proceeding with this intervention:

It is suggested that further robust research and thorough evaluation of impact is needed.