title: Preoperative exercise therapy for elective major abdominal surgery: a systematic review.
abstract: OBJECTIVE
  The impact of postoperative complications after Major Abdominal Surgery (MAS) is substantial, especially when socio-economical aspects are taken into account. This systematic review focuses on the effects of preoperative exercise therapy (PEXT) on physical fitness prior to MAS, length of hospital admission and postoperative complications in patients eligible for MAS, and on what is known about the most effective kind of exercise regime.
  
  
  METHODS
  A systematic search identified randomised controlled trials on exercise therapy and pulmonary physiotherapy prior to MAS. The methodological quality of the included studies was rated using the 'Delphi List For Quality Assessment of Randomised Clinical Trials'. The level of agreement between the two reviewers was estimated with Cohen's kappa.
  
  
  RESULTS
  A total of 6 studies were included, whose methodological quality ranged from moderate to good. Cohen's kappa was 0.90. Three studies reported on improving physical fitness prior to MAS with the aid of PEXT. Two studies reported on the effect of training on postoperative complications, showing contradictory results. Three studies focused on the effect of preoperative chest physiotherapy on postoperative lung function parameters after MAS. While the effects seem positive, the optimal training regime is still unclear.
  
  
  CONCLUSIONS
  Preoperative exercise therapy might be effective in improving the physical fitness of patients prior to major abdominal surgery, and preoperative chest physiotherapy seems effective in reducing pulmonary complications. However consensus on training method is lacking. Future research should focus on the method and effect of PEXT before high-risk surgical procedures.
authors: Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands; Department of Epidemiology, CAPHRI Research School, Maastricht University, The Netherlands. Electronic address: sjaakpwls@gmail.com.
authors: Sjaak
authors: S
authors: Pouwels
authors: Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands; Department of Epidemiology, CAPHRI Research School, Maastricht University, The Netherlands. Electronic address: rutger.stokmans@catharinaziekenhuis.nl.
authors: Rutger A
authors: RA
authors: Stokmans
authors: Department of General and Vascular Surgery, Medical Centre Alkmaar, Alkmaar, The Netherlands. Electronic address: e.m.willigendael@mca.nl.
authors: Edith M
authors: EM
authors: Willigendael
authors: Department of Abdominal Surgery, Catharina Hospital, Eindhoven, The Netherlands. Electronic address: simon.nienhuijs@catharinaziekenhuis.nl.
authors: Simon W
authors: SW
authors: Nienhuijs
authors: Department of Surgery, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands. Electronic address: crosman@kpnmail.nl.
authors: Camiel
authors: C
authors: Rosman
authors: Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands. Electronic address: b.vanramshorst@antoniusziekenhuis.nl.
authors: Bert
authors: B
authors: van Ramshorst
authors: Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands; Department of Epidemiology, CAPHRI Research School, Maastricht University, The Netherlands. Electronic address: joep.teijink@catharinaziekenhuis.nl.
authors: Joep A W
authors: JA
authors: Teijink
mesh_terms: D000005:Abdomen / Q000601:surgery*; D017558:Elective Surgical Procedures / Q000379:methods*; D005081:Exercise Therapy; D006801:Humans; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control
keywords: Complications; Major surgery outcomes; Physical exercise; Preconditioning; Preoperative training