Ekici Hatice S, Collins Jemima, Kafadar Aysegul H, Yildirim Mehmet C, Phillips Bethan E, Gordon Adam L
Academic Unit of Injury, Recovery and Inflammation Sciences (IRIS), School of Medicine, University of Nottingham, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE, UK.
Academic Unit of Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK.
Eur Geriatr Med. 2024 Oct;15(5):1259-1266. doi: 10.1007/s41999-024-01028-4. Epub 2024 Aug 12.
With population aging and advances in surgical and anesthetic procedures, the incidence of surgery in patients over the age of 65 years is increasing. One post-operative complication often encountered by older surgical patients is post-operative cognitive dysfunction (POCD). Preoperative exercise training can improve the overall physiological resilience of older surgical patients, yet its impact on post-operative cognition is less well-established.
Six databases (Medline (OVID); EMBASE (OVID); EMCARE (OVID); CINAHL (EBSCOHost), the Cochrane Library, and PubMed) were searched for studies reporting the effect of pre-operative physical training on post-operative cognition. The quality of evidence was assessed using the Mixed Methods Assessment Tool.
A total of 3983 studies were initially identified, three of which met the inclusion criteria for this review. Two studies were pilot randomized trials, and one was a prospective randomized trial. Two of the studies were high-quality. Each study used a different type of physical exercise and cognition assessment tool. Across the studies, post-operative cognition (p = 0.005) and attention (p = 0.04) were found to be better in the intervention groups compared to control, with one study reporting no difference between the groups.
Preoperative physical training may improve post-operative cognitive function, although more research with a consistent endpoint is required. Future studies should focus on patients at high risk of POCD, such as older adults, and explore the impact of different exercise regimes, including frequency, intensity, time, and type.
随着人口老龄化以及外科手术和麻醉技术的进步，65岁以上患者的手术发生率正在上升。老年外科手术患者术后经常遇到的一种并发症是术后认知功能障碍（POCD）。术前运动训练可以提高老年外科手术患者的整体生理恢复能力，但其对术后认知的影响尚不明确。
检索了六个数据库（Medline（OVID）；EMBASE（OVID）；EMCARE（OVID）；CINAHL（EBSCOHost）、Cochrane图书馆和PubMed），以查找报告术前体育锻炼对术后认知影响的研究。使用混合方法评估工具评估证据质量。
初步检索到3983项研究，其中三项符合本综述的纳入标准。两项研究为初步随机试验，一项为前瞻性随机试验。两项研究质量较高。每项研究使用了不同类型的体育锻炼和认知评估工具。在各项研究中，干预组的术后认知（p = 0.005）和注意力（p = 0.04）均优于对照组，一项研究报告两组之间无差异。
术前体育锻炼可能改善术后认知功能，尽管需要更多具有一致终点的研究。未来的研究应关注POCD高危患者，如老年人，并探索不同运动方案的影响，包括频率、强度、时间和类型。
