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Review article

Effect of physiotherapy on vital capacity before major abdominal surgery in cancer patients: a systematic review

Nikolina Šantek orcid id ; Department of Rheumatology, Physical and Rehabilitation Medicine, Clinic Unit of Rehabilitation of Cancer Patients, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
Iva Kirac ; Department of Surgical Oncology, University Hospital for Tumors, Sestre milosrdnice University Hospital Center, Zagreb, Croatia

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Introduction: Cancer is one of the leading causes of death worldwide. However, if diagnosed in an operable stage, it is treated as a chronic disease. As such, long-term results and quality of life requirements imposed a comprehensive approach. Prehabilitation programs encompassing nutritional, physical, and psychological components improved the recovery and minimized the complication rate after surgery. We will focus on physiotherapy as part of prehabilitation in this review.
Methods: For systematic search, we used the MEDLINE/PubMed (National Library of medicine), Cochrane Central Register of Controlled Trials (Wiley), Embase (Elsevier, Web of Science, and Cochrane database of systematic reviews. The last search update was on 15th December 2020. The search included randomized clinical trials or quasi-randomized clinical trials evaluating exercise or other non-pharmacological preoperative interventions in gastrointestinal cancers.
Results: The ten trials included 1058 patients, 535 (50,6%) patients were in the experimental group, and 523 (49,4%) patients were in the control group. Bicycle exercise training was the best-ranked intervention with the standard mean difference (SMD) of 1,4077 (95% C.I. is 0,7018 – 2,1135) to improve vital functional capacity (s, VO˙ 2 at uˆ L). Short-term exercise affected inspiratory muscle strength, and SMD was 1,1819 (95% C.I.,2953 – 2,0684). Short- term intensity training program SMD was 0,8356 (95% C.I. 0,2042 - 1,4669), and short- term intensity program for muscle endurance 0,8156 (95% C.I. 0,2042 – 1,4669). improves respiratory muscle endurance. Small effect was shown on quality of life in high-intensity cycling interval training SMD 0,7439( 95%C.. 0,0856 – 1,4023), WHO performance status in bicycle exercise training SMD 0,7068( 95% C.I. 0,0547 – 1,3589), mean number of complication in high-intensity endurance training SMD 0,3606 (95% C.I. 0,0072 – 0,7141). Conclusion: Although exercise therapy has been shown to improve vital capacity and respiratory muscle strength, there was a lack of comparison between different exercises. Evidence from these indirect-comparisons studies indicated that physical activity should be encouraged during the preoperative period before oncologic surgery.


exercise, rehabilitation, cancer, major abdominal surgery

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