Table S2.

Grading of recommendations, assessment, development, and evaluations

Certainty assessment							Patients, n		Effect		Certainty
Studies, n	Design	Risk of bias	Inconsistency	Indirectness	Imprecision	Other considerations	Preoperative exercise	Placebo	Relative (95% CI)	Absolute (95% CI)
PPCs
63–8	RCTa	Not serious	Not serious	Not serious	Seriousb	All plausible residual confounding would reduce the demonstrated effect	171	211	OR 0.35 (0.21–0.59)	190 fewer per 1,000 (from 108 fewer to 246 fewer)	⊕⊕⊕⊕ High
Pneumonia
53–7	RCTa	Not serious	Not serious	Seriousc	Serious	None	97	131	OR 0.45 (0.16–1.25)	67 fewer per 1,000 (from 27 more to 106 fewer)	⊕⊕⃝⃝ Low
Length of hospital stay
53–7	RCTa	Not serious	Not serious	Not serious	Very seriousd	None	97	134	–	SMD 1.02 lower (1.31 lower to 0.74 lower)	⊕⊕⃝⃝ Low
Days of chest-tube drainage
23,5	RCT	Not serious	Not serious	Not serious	Seriouse	None	21	17	–	MD 3.33 lower (5.35 lower to 1.3 lower)	⊕⊕⊕⃝ Moderate
PPCs of COPD patients
33,6,7	RCTa	Not seriousa	Not serious	Seriousf	Not serious	None	9/55 (16.4%)	27/92 (29.3%)		OR 0.44 (0.18–1.08)	⊕⊕⊕⃝ Moderate
Length of hospital stay in patients with COPD
23,7	RCTa	Seriousg	Not serious	Not serious	Very seriousd	None	31	68	–	MD 6.79 lower (9.69 lower to 3.89 lower)	⊕⃝⃝⃝ Very low
6MWD
34–6	RCT	Serious	Not serious	Not serious	Serioush	All plausible residual confounding would reduce the demonstrated effect	66	66	–	SMD 0.54 higher (0.19 higher to 0.88 higher)	⊕⊕⊕⊕ High
VO2 peak (reflecting physical performance)
28,9	RCT	Serious	Not serious	Not serious	Serioush	All plausible residual confounding would reduce the demonstrated effect	94	94	–	SMD 0.96 higher (0.66 higher to 1.27 higher)	⊕⊕⃝⃝ Low
Borg scores (representing dyspnea)
34,6,9	RCT	Not serious	Serious	Not serious	Serioush	All plausible residual confounding would reduce the demonstrated effect	74	74	–	SMD 0.54 higher (0.19 higher to 0.88 higher)	⊕⊕⃝⃝ Low

Note:

^aOne of the studies reported by Sekine et al¹⁶ was prospective;

^bPPCs were not defined clearly;

^cdetected by the clinical laboratory index;

^dlength of stay can be influenced by hospital conditions and other nonclinical problems;

^eduration of drainage was not consistent in different clinical institutes;

^fdifferent institutes had different definition of PPCs;

^gsmall sample of participants;

^hdistance walked influenced by many factors.

Abbreviations: MD, mean difference; PPCs, postoperative pulmonary complications; RCT, randomized controlled trial; SMD, standardized mean difference.