Pooled Efficacy and Exploration of Effect Modifiers of Exercise Prehabilitation: A Systematic Review and Meta-regression Analysis of Randomized Controlled Trials
Bibliographic record
Abstract
BACKGROUND: Low certainty evidence supports exercise prehabilitation's efficacy in reducing complications and length of stay in specific populations. Identification of procedural, participant, and program characteristics associated with greater prehabilitation efficacy is required to optimize effective application of prehabilitation programs. Our objectives were to (1) estimate the pooled efficacy of all approaches to exercise prehabilitation across all procedures, participants, and programs in reducing postoperative complications and length of stay, and (2) identify program, participant, and procedural characteristics associated with greater efficacy of exercise prehabilitation. METHODS: A peer-reviewed search strategy was applied to Ovid Medline, Embase, CINAHL, PsycINFO, Web of Science, and the Cochrane CENTRAL Register of Controlled Trials (inception to March 1, 2022, and updated on October 25, 2023, and April 10, 2024). Randomized controlled trials addressing a population of adults (≥18 years) undergoing major elective surgery where participants were allocated to an exercise prehabilitation intervention were included. A multistage review of 6675 citations and 1220 full texts was completed independently in duplicate using DistillerSR. Data were pooled using random effects pairwise meta-analyses and meta-regression. Certainty of evidence and credibility of effect modifiers were evaluated. Critical outcomes were postoperative length of stay and the incidence of postoperative complications. Effect modifiers and hypotheses were identified a priori and published in the study's registered protocol (CRD42023487683). RESULTS: Across 99 included trials (n = 8222), pooled data suggested that exercise prehabilitation likely reduces complication rates (odds ratio [OR] = 0.54; 95% confidence interval [CI], 0.44-0.67; P < .01; I2 = 45%; moderate certainty) and length of stay (mean difference = -0.90 days; 95% CI, -1.23 to -0.58; P < .01; I2 = 78%; low certainty). Inspiratory muscle training was the only significant effect modifier for greater efficacy of exercise prehabilitation in reducing both complications (OR = 0.65; 95% CI, 0.44-0.97; low certainty) and length of stay (MD = -1.04; 95% CI, -1.75 to -0.32; low certainty). No other prespecified procedural, participant, or program factors were consistent or credible effect modifiers. CONCLUSIONS: Exercise prehabilitation may reduce complications and LoS; however, well-reported multicenter trials synthesized using individual participant data are required to identify procedural, participant, and program factors associated with optimal exercise prehabilitation efficacy.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.115 | 0.241 |
| Meta-epidemiology (narrow) | 0.005 | 0.003 |
| Meta-epidemiology (broad) | 0.040 | 0.078 |
| Bibliometrics | 0.021 | 0.015 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.007 | 0.005 |
| Open science | 0.005 | 0.004 |
| Research integrity | 0.004 | 0.004 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".