The effect of pre-operative exercise training on post-operative cognitive function: a systematic review

• Published in: European geriatric medicine 2024-10, Vol.15 (5), p.1259-1266
• Main Authors: Ekici, Hatice S., Collins, Jemima, Kafadar, Aysegul H., Yildirim, Mehmet C., Phillips, Bethan E., Gordon, Adam L.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Cognition - physiology; Exercise; Exercise Therapy - methods; Female; Geriatrics/Gerontology; Humans; Internal Medicine; Medicine; Medicine & Public Health; Postoperative Cognitive Complications - prevention & control; Postoperative Complications - prevention & control; Preoperative Exercise; Randomized Controlled Trials as Topic; Review
• ISSN: 1878-7649; 1878-7657; 1878-7657
• DOI: 10.1007/s41999-024-01028-4

Key summary points Aim To investigate the effect of pre-operative exercise training on post-operative cognition. Findings There are very few studies examining the effect of pre-operative exercise training on post-operative cognition. However, based on the results of previous studies, pre-operative exercise may increase post-operative cognition. More studies are needed to demonstrate the effect of pre-operative exercise training more clearly on post-operative cognition. Message Preoperative exercise training is a practice that may be effective on post-operative cognition, and studies are needed to examine its effect on older adults. Background With population aging and advances in surgical and anesthetic procedures, the incidence of surgery in patients over the age of 65 years is increasing. One post-operative complication often encountered by older surgical patients is post-operative cognitive dysfunction (POCD). Preoperative exercise training can improve the overall physiological resilience of older surgical patients, yet its impact on post-operative cognition is less well-established. Methods Six databases (Medline (OVID); EMBASE (OVID); EMCARE (OVID); CINAHL (EBSCOHost), the Cochrane Library, and PubMed) were searched for studies reporting the effect of pre-operative physical training on post-operative cognition. The quality of evidence was assessed using the Mixed Methods Assessment Tool. Results A total of 3983 studies were initially identified, three of which met the inclusion criteria for this review. Two studies were pilot randomized trials, and one was a prospective randomized trial. Two of the studies were high-quality. Each study used a different type of physical exercise and cognition assessment tool. Across the studies, post-operative cognition ( p  = 0.005) and attention ( p  = 0.04) were found to be better in the intervention groups compared to control, with one study reporting no difference between the groups. Conclusion Preoperative physical training may improve post-operative cognitive function, although more research with a consistent endpoint is required. Future studies should focus on patients at high risk of POCD, such as older adults, and explore the impact of different exercise regimes, including frequency, intensity, time, and type.