# Prehabilitation in Patients Undergoing Cardiac Procedures: A Systematic Review and Meta-Analysis

## TL;DR

This study finds that prehabilitation before cardiac procedures can improve patients' physical readiness and recovery, especially in women, but more research is needed.

## Contribution

The study provides a systematic review and meta-analysis of prehabilitation's effects on clinical outcomes in cardiac patients.

## Key findings

- Prehabilitation improved preprocedural functional capacity and recovery outcomes like 6-minute walk distance and hospital stay.
- Women appeared to benefit more from prehabilitation, with a significant association found in meta-regression analysis.
- Postprocedural pneumonia was less frequent in patients undergoing prehabilitation.

## Abstract

Evidence supporting prehabilitation before cardiac procedures is growing, but the efficacy of different components remains unclear.

The primary aim was to assess the efficacy of prehabilitation on clinical outcomes based on recent randomized controlled trials (RCTs). The secondary aim was to identify effective intervention and which patient subgroups benefit most.

We searched Medline, Web of Science, PsycINFO, Embase, Scopus, and Cochrane Central Register of Controlled Trials Library for RCTs comparing prehabilitation with standard care in cardiac patients up to August 2024. Trials were screened by 2 reviewers and meta-analyses were performed using random-effects models.

Forty-four RCTs including 3,925 patients were identified. Prehabilitation improved preprocedural functional capacity (6-minute walk distance) and recovery (in-hospital length of stay, intensive care unit stay, and occurrence of postprocedural pneumonia). Six trials (n = 600) showed improved 6-minute walk distance (mean difference [MD] 68.87 m; 95% CI: 12.76-124.98 m; P = 0.020). In 18 studies (n = 1,568), length of stay was shorter (MD -0.95 days; 95% CI: −1.77 to −0.13 days; P = 0.026) and meta-regression showed greater effect in studies including more women (P = 0.015). In 16 trials (n = 1,149), intensive care unit stay was reduced (MD −6.03 hours; 95% CI: −12.01 to −0.06 hours; P = 0.048). In 5 studies (n = 729), postprocedural pneumonia occurred less frequently (OR: 0.33; 95% CI: 0.15-0.72; P = 0.017). The analysis revealed substantial heterogeneity and risk of bias. Analysis of specific components showed no consistent effects.

Prehabilitation before cardiac procedures may enhance preprocedural functional capacity and postprocedural recovery, particularly in women. Further multicenter studies are needed.