Department for Exercise Science and Sports Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
University of the Witwatersrand Health Sciences Library, Johannesburg, South Africa.
Syst Rev. 2024 Sep 3;13(1):225. doi: 10.1186/s13643-024-02608-y.
Cirrhosis is the main cause of morbidity and mortality globally, accounting for approximately 1.2 million deaths annually. Impaired aerobic capacity, muscle wasting and reduced muscle strength are significant complications in patients with cirrhosis. Preoperative exercise intervention "prehabilitation" has been recognised as a potential approach to optimise muscle strength, aerobic capacity and body composition as well as quality of life in patients awaiting abdominal surgery. However, there is little evidence on the effects of preoperative exercise on older adults with cirrhosis and awaiting liver transplant. Thus, the primary objective of this systematic review and meta-analysis will be to assess the effects of exercise interventions in improving aerobic capacity, muscle strength and body composition of older adults with cirrhosis and awaiting liver transplant.
This systematic review and metaanalysis protocol was designed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. This systematic review will include all peer-reviewed randomised controlled trials (RCTs), including cluster RCTs, controlled (non-controlled), complex clinical trials (CCTs) or cluster trials, cohort, observational studies published in English from inception until July 2024. The following electronic databases will be searched: MEDLINE (PubMed), Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL (EBSCO) and Scopus (Elsevier) and supplemented by a secondary screening of the reference lists of all included articles. Searches will involve studies with both male and female participants aged 18 years with cirrhosis and awaiting liver transplant. Primary outcomes will include muscle strength, and aerobic capacity. The secondary outcomes include body composition (e.g. body mass index, and thigh circumference). The Cochrane Collaboration Risk of Bias Tool will be used to evaluate quality of the studies and Review Manager (RevMan) V.5.3 (Copenhagen, Denmark: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014). Effect sizes will be expressed as a standardised mean difference, and their 95% confidence intervals will be calculated and presented as a forest plot. The standard χ and I tests will be used to test heterogeneity.
This systematic review and meta-analysis is anticipated to provide meaningful and contemporary evidence on the effects of preoperative exercise in older adults living with cirrhosis and awaiting liver transplant. In addition, the findings will help clinicians with developing safe and effective preoperative exercise regimens for these patients.
肝硬化是全球发病率和死亡率的主要原因，每年约有 120 万人因此死亡。有氧能力受损、肌肉减少和肌肉力量下降是肝硬化患者的严重并发症。术前运动干预“康复”已被认为是优化肌肉力量、有氧能力和身体成分以及改善等待腹部手术的患者生活质量的一种潜在方法。然而，关于术前运动对等待肝移植的老年肝硬化患者的影响，证据很少。因此，本系统评价和荟萃分析的主要目的将评估运动干预对改善等待肝移植的老年肝硬化患者的有氧能力、肌肉力量和身体成分的影响。
本系统评价和荟萃分析方案是按照系统评价和荟萃分析的首选报告项目（PRISMA）指南设计的。本系统评价将包括所有经过同行评审的随机对照试验（RCT），包括聚类 RCT、对照（非对照）、复杂临床试验（CCT）或聚类试验、队列、观察性研究，发表于英语，从开始到 2024 年 7 月。将搜索以下电子数据库：MEDLINE（PubMed）、Cochrane 中央对照试验注册中心（CENTRAL）、CINAHL（EBSCO）和 Scopus（Elsevier），并通过对所有纳入文章的参考文献进行二次筛选来补充搜索。研究将包括年龄在 18 岁及以上的男性和女性参与者，患有肝硬化并等待肝移植。主要结局将包括肌肉力量和有氧能力。次要结局包括身体成分（如体重指数和大腿周长）。将使用 Cochrane 协作风险偏倚工具评估研究质量，并用 Review Manager（RevMan）V.5.3（哥本哈根，丹麦：北欧 Cochrane 中心，Cochrane 协作组，2014 年）进行分析。效应大小将表示为标准化均数差，其 95%置信区间将计算并以森林图表示。将使用标准 χ 和 I 检验检验异质性。
本系统评价和荟萃分析预计将提供关于术前运动对等待肝移植的老年肝硬化患者影响的有意义和现代证据。此外，研究结果将帮助临床医生为这些患者制定安全有效的术前运动方案。
