Impact of exercise-based prehabilitation on cardiometabolic health in surgical patients with cancer: a systematic review and meta-analysis.

Abstract

Objective: This systematic review and meta-analysis aimed to establish the effects of exercise-based prehabilitation programs on cardiometabolic health in patients with cancer undergoing surgery.

Data source: A systematic search was conducted in MEDLINE (via PubMed) and Web of Science from inception to June 2023.

Study selection: The original systematic search retrieved 16,752 studies. After removal of duplicates and screening by title and abstract, 200 articles were eligible for full-text revision. Finally, a total of nine randomized controlled trials (RCTs), four controlled studies, and six uncontrolled before-and-after studies were included.

Outcome measures: Changes in blood pressure (systolic and diastolic), lipid metabolism (total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides levels), glycemic metabolism (fasting glucose, insulin, homeostatic model assessment for insulin resistance, and insulin-growth factor-1), and inflammatory biomarkers (i.e., interleukin-6, tumor necrosis factor-alpha, c-reactive protein, and vascular endothelial growth factor) were assessed.

Results: The total sample was composed of 651 participants (n = 311 intervention and n = 239 control from RCTs and controlled studies; n = 101 intervention from before-and-after studies), aged 64.90 ± 8.87 years (33.76% women). The meta-analyses of uncontrolled before-and-after studies revealed significant prehabilitation-induced reductions in systolic and diastolic blood pressure (d =  - 0.47 and - 0.57, respectively). However, no changes were noted in lipid and glycemic metabolism or inflammatory biomarkers in either controlled or uncontrolled before-and-after studies.

Limitations: These findings should be interpreted with caution. The small evidence base, inclusion of uncontrolled designs, substantial between-study heterogeneity, and the possibility of publication bias limit the robustness and generalizability of the conclusions.

Conclusions: Exercise-based prehabilitation programs seems to be effective at reducing blood pressure in patients with cancer undergoing surgery. No effects were noted in other cardiometabolic health outcomes included.