Sport, Health and Exercise Science, School of Life Sciences, University of Hull, Hull, UK.
Sport, Health and Exercise Science, School of Life Sciences, University of Hull, Hull, UK; Department of Health Sciences, University of York, York, UK.
Int J Surg. 2018 Aug;56:328-333. doi: 10.1016/j.ijsu.2018.04.054. Epub 2018 May 3.
The Enhanced Recovery after Surgery (ERAS) model integrates several elements of perioperative care into a standardised clinical pathway for surgical patients. ERAS programmes aim to reduce the rate of complications, improve surgical recovery, and limit postoperative length of hospital stay (LOHS). One area of growing interest that is not currently included within ERAS protocols is the use of exercise prehabilitation (PREHAB) interventions. PREHAB refers to the systematic process of improving functional capacity of the patient to withstand the upcoming physiological stress of surgery. A number of recent systematic reviews have examined the role of PREHAB prior to elective intra-cavity surgery. However, the results have been conflicting and a definitive conclusion has not been obtained. Furthermore, a summary of the research area focussing exclusively on the therapeutic potential of exercise prior to intra-cavity surgery is yet to be undertaken. Clarification is required to better inform perioperative care and advance the research field. Therefore, this "review of reviews" provides a critical overview of currently available evidence on the effect of exercise PREHAB in patients undergoing i) coronary artery bypass graft surgery (CABG), ii) lung resection surgery, and iii) gastrointestinal and colorectal surgery. We discuss the findings of systematic reviews and meta-analyses and supplement these with recently published clinical trials. This article summarises the research findings and identifies pertinent gaps in the research area that warrant further investigation. Finally, studies are conceptually synthesised to discuss the feasibility of PREHAB in clinical practice and its potential role within the ERAS pathway.
术后加速康复（ERAS）模式将围手术期护理的多个要素整合到外科患者的标准化临床路径中。ERAS 计划旨在降低并发症发生率、促进手术恢复和缩短术后住院时间（LOHS）。目前 ERAS 方案中尚未包含的一个日益受到关注的领域是使用运动预康复（PREHAB）干预措施。PREHAB 是指系统地提高患者功能能力以承受即将到来的手术生理应激的过程。最近有许多系统评价研究了择期腔内手术前 PREHAB 的作用。然而，结果相互矛盾，尚未得出明确的结论。此外，专门针对腔内手术前运动治疗潜力的研究领域综述尚未完成。需要澄清以更好地告知围手术期护理并推进研究领域。因此，本“综述的综述”批判性地概述了目前关于运动 PREHAB 对接受以下手术的患者的影响的现有证据：i）冠状动脉旁路移植术（CABG），ii）肺切除术，和 iii）胃肠道和结直肠手术。我们讨论了系统评价和荟萃分析的结果，并补充了最近发表的临床试验。本文总结了研究结果，并确定了该研究领域中需要进一步调查的相关空白。最后，对研究进行了概念性综合，以讨论 PREHAB 在临床实践中的可行性及其在 ERAS 途径中的潜在作用。
