Abstract
Background: Study heterogeneity limits the certainty of evidence for exercise prehabilitation. This is contributed to by type of supervision because its impact on patient outcomes has yet to be elucidated. This review aimed to compare fitness and clinical outcomes of supervised and unsupervised aerobic exercise.
Methods: This review was prospectively registered on PROSPERO (CRD42023409883) and performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Included studies prospectively compared one primary outcome of supervised or unsupervised moderate-to-high-intensity exercise and controls among adult clinical populations. Primary outcomes were changes in peak oxygen consumption (V˙ O2peak, ml min-1 kg-1) and 6-Minute Walk Test (6MWT, metres) distance and incidence of postoperative complications.
Results: Thirty supervised and 12 unsupervised studies, including 3157 and 1848 patients, respectively, were analysed. No study directly compared supervised and unsupervised exercise. Unsupervised exercise was only significantly associated with 6MWT distance (cumulative mean difference 0.51 m, 95% confidence interval [CI] 0.14-0.87 m, P=0.016). Supervised exercise was significantly associated with V˙ O2peak (cumulative mean difference 0.88 ml min-1 kg-1, 95% CI 0.49-1.27 ml min-1 kg-1, P<0.001), 6MWT (cumulative mean difference 0.39 m, 95% CI 0.07-0.70 m, P=0.025), and complications (odds ratio 0.60, 95% CI 0.39-0.93, P=0.026) which were further reduced with high-intensity exercise (odds ratio 0.53, 95% CI 0.30-0.92, P=0.030) and low risks for bias and therapeutic ineffectiveness (odds ratio 0.41, 95% CI 0.22-0.76, P=0.019).
Conclusions: Both supervised and unsupervised exercise improved 6MWT distance. Supervised high-intensity exercise programmes significantly reduced postoperative complications. Findings were limited by lack of direct comparisons between exercise groups, necessitating further research.
Systematic review protocol: PROSPERO (CRD42023409883).