Preoperative Exercise Has a Modest Effect on Postoperative Pain, Function, Quality of Life, and Complications: A Systematic Review and Meta-Analysis


 
 
 Preoperative exercise (prehabilitation) is commonly used as a method to reduce pain and improve function postoperatively. The purpose of this systematic review was to determine therapeutic benefits of preoperative exercise on postoperative pain, function, quality of life, and risk of complications across various types of surgeries.
 
 
 
 Three electronic databases were used to perform a literature search. Full articles with randomized designs comparing a preoperative exercise program versus no formal program were included. The primary outcome was postoperative pain. Quality of life, function, and postoperative complications were analyzed as secondary outcomes. The primary meta-analysis was performed in those with joint replacement surgery as there were only 5 with other surgical types.
 
 
 
 A total of 28 articles were included, of which 23 were from individuals with total joint replacement surgery. Preoperative exercise resulted in lower pain ≤2 months and 3 to 5 months after joint replacement surgery with a moderate standardized mean difference (SMD [95% CI] at <2 months = −0.34 [−0.59 to −0.09]; at 3 to 5 months = −0.41 [−0.70 to −0.11]) when compared with nonexercised controls. However, ≥ 6 months after joint replacement surgery, preoperative exercise groups showed no significant differences in postoperative pain (SMD = −0.17 [−0.35 to 0.01]) when compared with nonexercised controls. Quality of life and subjective and objective function were improved ≤2 months after joint replacement surgery, but were not different ≥6 months postsurgery. Reduction in risk of postoperative complications was favored with preoperative exercise.
 
 
 
 Preoperative exercise has a modest effect on postoperative pain, function, quality of life within the first 6 months after surgery and reduces the risk of developing postoperative complications in individuals undergoing joint replacement surgery. The effect of preoperative exercise on other surgery types is inconclusive.
