Summary of findings 1. Exercise compared to no exercise for adults with clinically diagnosed AAA deemed suitable for elective repair.
| Exercise compared to no exercise for adults with clinically diagnosed AAA deemed suitable for elective repair | ||||||
| Patient or population: adults with clinically diagnosed AAA deemed suitable for elective repair Setting: hospital Intervention: exercise Comparison: usual care (no exercise) | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with usual care (no exercise) | Risk with exercise | |||||
| 30‐day mortality Follow‐up: 30 days |
Study population | RR 1.33 (0.31 to 5.77) | 192 (3 RCTs) | ⊕⊝⊝⊝ VERY LOW a,b | ||
| 21 per 1000 | 28 per 1000 (6 to 120) | |||||
| Perioperative and postoperative complications: cardiac complications Follow‐up: 3 months |
Study population | RR 0.36 (0.14 to 0.92) | 124 (1 RCT) | ⊕⊕⊝⊝ LOW c,d | ||
| 226 per 1000 | 81 per 1000 (32 to 208) | |||||
| Perioperative and postoperative complications: pulmonary complications Follow‐up: 7 days ‐ 3 months |
Study population | RR 0.49 (0.26 to 0.92) | 144 (2 RCTs) | ⊕⊝⊝⊝ VERY LOW d,e | ||
| 292 per 1000 | 143 per 1000 (76 to 268) | |||||
| Perioperative and postoperative complications: renal complications Follow‐up: 3 months |
Study population | RR 0.31 (0.11 to 0.88) | 124 (1 RCT) | ⊕⊕⊝⊝ LOW c,d | ||
| 210 per 1000 | 65 per 1000 (23 to 185) | |||||
| Perioperative and postoperative: need for re‐intervention Follow‐up: 3 months |
Study population | RR 1.29 (0.33 to 4.96) | 144 (2 RCTs) | ⊕⊝⊝⊝ VERY LOW a,e | ||
| 42 per 1000 | 54 per 1000 (14 to 207) | |||||
| Perioperative and postoperative complications: postoperative bleeding Follow‐up: 72 hours |
Study population | RR 0.57 (0.18 to 1.80) | 124 (1 RCT) | ⊕⊝⊝⊝ VERY LOW a,c | ||
| 113 per 1000 | 64 per 1000 (20 to 203) | |||||
| Length of ICU stay (days) | See comments | ‐ | 147 (2 RCTs) |
⊕⊝⊝⊝ VERY LOW f,g | Two studies reported on length of ICU stay, but we could not evaluate this in a meta‐analysis. Neither of the studies found a clear difference between the exercise and usual care groups in length of ICU stay. | |
| Length of hospital stay (days) | See comments | ‐ | 212 (3 RCTs) |
⊕⊝⊝⊝ VERY LOWg,h | Three studies reported on length of hospital stay, but we could not evaluate this in a meta‐analysis. One study reported shorter hospital stay for the exercise group and two studies reported no clear difference between the exercise and usual care groups. | |
| Number of days on a ventilator | See comments | ‐ | ‐ | ‐ | No studies reported number of days on a ventilator | |
| QoL Follow‐up: 12 weeks |
See comments | ‐ | 53 (1 RCT) |
⊕⊕⊝⊝ LOWi | One study reported QoL. The study found little or no difference between the exercise and usual care group participants. | |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). AAA: abdominal aortic aneurysm;CI: confidence interval; ICU: intensive care unit; QoL: quality of life; RCT: randomised controlled trial;RR: risk ratio | ||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: we are moderately confident in the effect estimate. The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited. The true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate. The true effect is likely to be substantially different from the estimate of effect. | ||||||
aThe 95% CI includes no effect, and includes default values for appreciable harm (i.e. CI > 1.25), appreciable benefit (i.e. CI < 0.75), or both; the optimal information size was not met (i.e. sample size < 2000 participants); therefore, we downgraded the certainty of evidence by 2 levels for imprecision. bHigh overall risk of bias due to lack of blinding of outcome assessors, selective reporting, selection bias, attrition bias and/or other bias (Barakat 2016; Dronkers 2008; Tew 2017); therefore, we downgraded the certainty of evidence by 2 levels for methodological limitations. cStudy did not state whether outcome assessors were blinded, outcomes reported in protocol were not reported in study (risk of reporting bias) (Barakat 2016); therefore, we downgraded the certainty of evidence by 1 level for methodological limitations. dThe optimal information size was not met (i.e. sample size < 2000); therefore, we downgraded the certainty of evidence by 1 level for imprecision. eHigh overall risk of bias due to lack of blinding of outcome assessors, selective reporting, selection bias, attrition bias and/or other bias (Barakat 2016; Dronkers 2008); therefore, we downgraded the certainty of evidence by 2 levels for methodological limitations. fHigh overall risk of bias due to lack of blinding of outcome assessors, selective reporting, selection bias, and/or attrition bias (Barakat 2016; Richardson 2014); therefore, we downgraded the certainty of evidence by 2 levels for methodological limitations. gUnable to assess imprecision due to the way the studies report the outcome; therefore, we downgraded the certainty of evidence by 1 level. hHigh overall risk of bias due to lack of blinding of outcome assessors, selective reporting, selection bias, attrition bias and/or other bias (Barakat 2016; Richardson 2014; Tew 2017); therefore, we downgraded the certainty of evidence by 2 levels for methodological limitations. iHigh overall risk of bias due to selective reporting, attrition bias and other bias (Tew 2017); therefore, we downgraded the certainty of evidence by 2 levels for methodological limitations.