Prehabilitation Before Cardiac Surgery and Structural Heart Interventions: An Umbrella Review of Pooled Evidence

Hughes, EH ORCID: 0000-0003-3903-4657, Lotto, R ORCID: 0000-0002-4305-0513, Dawson, EA ORCID: 0000-0002-5958-267X, Saber, M, Richards, E ORCID: 0009-0001-6532-5178, Morris, A, Mayhew, D, Faraz, F, Ashrafi, R and Jones, JD ORCID: 0000-0003-3291-9938 (2026) Prehabilitation Before Cardiac Surgery and Structural Heart Interventions: An Umbrella Review of Pooled Evidence. Journal of Clinical Medicine, 15 (10). ISSN 2077-0383

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Abstract

Background: Prehabilitation aims to optimise patients before cardiac procedures through interventions including exercise training, respiratory conditioning, nutritional support, psychological preparation and multimodal lifestyle programmes. Evidence from systematic reviews and meta-analyses is increasing but remains heterogeneous due to variation in intervention design, patient populations and overlap of primary studies. Methods: We conducted an umbrella review of 17 systematic reviews and meta-analyses evaluating prehabilitation prior to cardiac surgery and structural heart interventions in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Methodological quality of included reviews was assessed using A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2). Outcomes of interest were postoperative pneumonia, hospital length of stay (LOS), and mortality. Results: Across pooled analyses, the most consistent finding was a reduction in postoperative pneumonia, particularly in studies incorporating inspiratory muscle training (IMT), with relative risk reductions of approximately 55–62%, corresponding to a modest absolute risk reduction. Reductions in hospital LOS were also reported, although effect sizes were smaller and more variable. In contrast, no consistent reduction in short-term mortality was demonstrated, likely reflecting low event rates. The evidence base was limited by substantial overlap between reviews and predominantly low or critically low methodological quality. Conclusions: Prehabilitation, particularly when incorporating IMT, is consistently associated with a reduction in postoperative pneumonia and may contribute to modest reductions in hospital LOS. However, the evidence base is constrained by heterogeneity, study overlap and low methodological quality. Further high-quality, adequately powered randomised trials are required to define the role of prehabilitation in contemporary cardiac surgical and structural intervention practice.

Item Type:	Article
Uncontrolled Keywords:	prehabilitation; cardiac interventions; cardiac surgery; exercise training; inspiratory muscle training; umbrella review; cardiac interventions; cardiac surgery; exercise training; inspiratory muscle training; prehabilitation; umbrella review; 1103 Clinical Sciences; 32 Biomedical and clinical sciences
Subjects:	R Medicine > RC Internal medicine > RC1200 Sports Medicine R Medicine > RT Nursing
Divisions:	Nursing and Advanced Practice Sport and Exercise Sciences
Publisher:	MDPI
Date of acceptance:	12 May 2026
Date of first compliant Open Access:	30 June 2026
Date Deposited:	30 Jun 2026 15:26
Last Modified:	30 Jun 2026 15:26
DOI or ID number:	10.3390/jcm15103821
URI:	https://researchonline.ljmu.ac.uk/id/eprint/28919

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