The benefit of a preoperative respiratory protocol and musculoskeletal exercise in patients undergoing cardiac surgery

INTRODUCTION: Loss of physical activity and pulmonary dysfunction with its associated complications represent two of the most important causes of morbidity and mortality following cardiac surgery. AIM: To evaluate whether a physiotherapy program based on respiratory training with or without musculoskeletal mobilization, started preoperatively, may provide a significant improvement in pulmonary and musculoskeletal recovery postoperatively in a sufficiently large sample of patients undergoing elective cardiac surgery. MATERIAL AND METHODS: One-hundred and two patients with similar baseline and preoperative characteristics were assigned to a preoperative respiratory physiotherapy protocol (group R, n = 34), a preoperative respiratory and motor physiotherapy protocol (group R + M, n = 34), or no preoperative specific physiotherapy protocol but only a simplified perioperative standard physiotherapy protocol (control group, C, n = 34). Data on 6-minute walking test, peak expiratory flow, and from blood gas analysis were retrospectively analyzed. RESULTS: As compared with group C, a statistically significant improvement was observed in the two preoperatively treated groups in terms of 1) better pre- (+0.7–0.8 Lt/min, p < 0.05) and postoperative (+1 Lt/min, p < 0.01) peak expiratory flow values; 2) longer pre- (+50–100 m, p < 0.01) and postoperative (+65–170 m, p < 0.01) distance traveled in the 6-minute walking test; 3) better PaO(2), SaO(2), pH value in postoperative blood gas measurements (p < 0.05, for all comparisons); 4) reduction of postoperative length of in-hospital stay (p < 0.05). CONCLUSIONS: A benefit of combined respiratory and motor physiotherapy protocols can be expected in the groups of patients preoperatively treated, especially with the respiratory one, either before or after cardiac surgery with a faster recovery of physical-functional activities. Specifically, the motor protocol is associated with greater autonomy of running before or after cardiac surgery.