title: Pre- and postoperative inspiratory muscle training in patients undergoing cardiac surgery: systematic review and meta-analysis.
abstract: OBJECTIVE
  To determine the effects of pre- and postoperative inspiratory muscle training on length of postoperative hospital stay and pulmonary function in patients undergoing cardiac surgery.
  
  
  METHODS
  We conducted a systematic search using databases (MEDLINE, CINAHL, EMBASE, PEDro and the Cochrane) to find controlled trials evaluating the effects of pre- and postoperative inspiratory muscle training.
  
  
  RESULTS
  Eight studies fulfilled the inclusion criteria. Four were about preoperative inspiratory muscle training (416 patients), three about postoperative inspiratory muscle training (115 patients) and one study about pre- and postoperative inspiratory muscle training (43 patients). Preoperative inspiratory muscle training resulted in improvement in: Reduction in length of postoperative hospital stay of -2 days (95% CI -3.4, -0.7, N = 302), inspiratory pressure of 16.7 cm H2O (95% CI 13.8, 19.5, N = 386), forced expiratory volume in one second of 3% predicted (95% CI 0.1, 6, N = 140), forced vital capacity of 4.6% predicted (95% CI 1.9, 7.4, N = 140). Patients that received preoperative training had an inspiratory muscle training reduced risk of postoperative pulmonary complications, (RR = 0.6; 95% CI 0.5 to 0.8; P = 0.0004, N = 386). Postoperative inspiratory muscle training resulted in improvement in inspiratory pressure of 16.5 cm H2O (95% CI 4.9, 27.8, N = 115), and tidal volume of 185 ml (95% CI 19.7, 349.8, N = 85).
  
  
  CONCLUSIONS
  Pre- and postoperative inspiratory muscle training showed to be a beneficial intervention in the treatment of patients undergoing cardiac surgery.
authors.affiliation: 1 Departamento de Biofunção, Universidade Federal da Bahia, Salvador, Brazil.|2 Programa de Pós-graduação em Medicina e Saúde da Universidade Federal da Bahia, Salvador, Brazil.|3 The GREAT Group (GRupo de Estudos em ATividade física), Brazil.
authors.forename: Mansueto
authors.initials: M
authors.lastname: Gomes Neto
authors.affiliation: 4 Departamento de Fisioterapia da Universidade do Estado da Bahia, Salvador, Brazil.
authors.forename: Bruno P
authors.initials: BP
authors.lastname: Martinez
authors.affiliation: 1 Departamento de Biofunção, Universidade Federal da Bahia, Salvador, Brazil.
authors.forename: Helena Fc
authors.initials: HF
authors.lastname: Reis
authors.affiliation: 3 The GREAT Group (GRupo de Estudos em ATividade física), Brazil.|5 Departamento de Fisioterapia da Universidade Federal de Sergipe, Aracaju, Brazil.
authors.forename: Vitor O
authors.initials: VO
authors.lastname: Carvalho
mesh_terms: D001945:Breathing Exercises / Q000379:methods*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000534:rehabilitation*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008168:Lung / Q000502:physiology; D011183:Postoperative Complications / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods*; D012132:Respiratory Muscles / Q000502:physiology*
keywords: Cardiac surgery; exercise; preoperative care; respiratory muscle training