プレハビリテーションと心肺機能と術後回復

術前の運動（プレハビリテーション）による心肺機能と術後回復の効果に関する系統的レビューを紹介します。

Lemanu DP, Singh PP, Maccormick AD, Arroll B, Hill AG. Effect of Preoperative Exercise on Cardiorespiratory Function and Recovery After Surgery: a Systematic Review. World J Surg. 2013 Jan 5. [Epub ahead of print]

アウトカムに心肺機能も含んだプレハビリテーションのRCT8論文の系統的レビューです。手術は心臓外科手術3つ、一般外科手術3つ、整形外科手術2つです。結果ですが、心肺機能と術後回復（呼吸器合併症減少、入院期間短縮）がともに改善したのは1論文のみでした。

Hulzebos EH, Helders PJ, Favie NJ et al (2006) Preoperative
intensive inspiratory muscle training to prevent postoperative
pulmonary complications in high-risk patients undergoing CABG
surgery: a randomized clinical trial. JAMA 296:1851–1857

プレハビリテーションへのアドヒアランスは低く、対象者は高齢者が多く（平均年齢60歳以上）、プレハビリテーションのプログラムは多様でした。以上より、プレハビリテーションによる心肺機能と術後回復の効果に関するエビデンスは少なく、アドヒアランス改善も含めたさらなる研究が必要という結論です。

全患者にプレハビリテーションを行ってもおそらく有意な効果は出ませんので、どのような患者（サルコペニア、虚弱、低栄養など）に行うかの選定が重要です。また、運動のみでなく栄養改善、不安軽減、疼痛管理なども含めた包括的なプレハビリテーションプログラムのほうが望ましいと思います。

Abstract

BACKGROUND:

This systematic review aims to investigate the extent to which preoperative conditioning (PREHAB) improves physiologic function and whether it correlates with improved recovery after major surgery.

METHODS:

An electronic database search identified randomized controlled trials (RCTs) investigating the safety and efficacy of PREHAB. The outcomes studied were changes in cardiorespiratory physiologic function, clinical outcomes (including length of hospital stay and rates of postoperative complications), and measures of changes in functional capacity (physical and psychological).

RESULTS:

Eight low- to medium-quality RCTs were included in the final analysis. The patients were elderly (mean age >60 years), and the exercise programs were significantly varied. Adherence to PREHAB was low. Only one study found that PREHAB led to significant improvement in physiologic function correlating with improved clinical outcomes.

CONCLUSION:

There are only limited data to suggest that PREHAB confers any measured physiologic improvement with subsequent clinical benefit. Further data are required to investigate the efficacy and safety of PREHAB in younger patients and to identify interventions that may help improve adherence to PREHAB.