1. Summary of findings for subgroups.
| 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 |
Open surgical repair | RR 0.50 (0.05 to 5.29) | 78 (1 RCT) | ⊕⊝⊝⊝ VERY LOW a,b | ||
| 51 per 1000 | 26 per 1000 (3 to 271) | |||||
| Endovascular aneurysm repair | RR 3.00 (0.13 to 70.02) | 46 (1 RCT) | ⊕⊝⊝⊝ VERY LOW a,b | There were no deaths in the usual care (no exercise) group. | ||
| 0 per 1000 | 0 per 1000 (0 to 0) | |||||
| Any AAA repair | RR 3.00 (0.14 to 65.90) |
68 (2 RCTs) |
⊕⊝⊝⊝ VERY LOW b c | There were no deaths in the usual care (no exercise) group. | ||
| 0 per 1000 | 0 per 1000 (0 to 0) |
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| Perioperative and postoperative complications: cardiac complications Follow‐up: 3 months |
Open surgical repair | RR 0.36 (0.13 to 1.04) | 78 (1 RCT) | ⊕⊕⊝⊝ LOW a,d | ||
| 282 per 1000 | 102 per 1000 (37 to 293) | |||||
| Endovascular aneurysm repair | RR 0.33 (0.04 to 2.97) | 46 (1 RCT) | ⊕⊝⊝⊝ VERY LOW a,b | |||
| 130 per 1000 | 43 per 1000 (5 to 387) | |||||
| Perioperative and postoperative complications: pulmonary complications Follow‐up: 3 months |
Open surgical repair | RR 0.78 (0.32 to 1.88) | 78 (1 RCT) | ⊕⊝⊝⊝ VERY LOW a,b | ||
| 231 per 1000 | 180 per 1000 (74 to 434) | |||||
| Endovascular aneurysm repair | RR 0.11 (0.01 to 1.95) | 46 (1 RCT) | ⊕⊝⊝⊝ VERY LOW a,b | |||
| 174 per 1000 | 19 per 1000 (2 to 339) | |||||
| Any AAA repair | RR 0.38 (0.14 to 1.02) |
20 (1 RCT) |
⊕⊝⊝⊝ VERY LOW b e | |||
| 800 per 1000 | 304 per 1000 (112 to 816) |
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| Perioperative and postoperative complications: renal complications Follow‐up: 3 months |
Open surgical repair | RR 0.25 (0.08 to 0.82) | 78 (1 RCT) | ⊕⊕⊝⊝ LOW a,d | ||
| 308 per 1000 | 77 per 1000 (25 to 252) | |||||
| Endovascular aneurysm repair | RR 1.00 (0.07 to 15.04) | 46 (1 RCT) | ⊕⊝⊝⊝ VERY LOW a,b | |||
| 43 per 1000 | 43 per 1000 (3 to 654) | |||||
| Perioperative and postoperative complications: need for re‐intervention Follow‐up: 3 months |
Open surgical repair | RR 0.67 (0.12 to 3.77) | 78 (1 RCT) | ⊕⊝⊝⊝ VERY LOW a,b | ||
| 77 per 1000 | 52 per 1000 (9 to 290) | |||||
| Endovascular aneurysm repair | not estimable | 46 (1 RCT) |
⊕⊕⊝⊝ LOW a,d | There were no events in either of the arms. | ||
| See comments | ||||||
| Any AAA repair | RR 5.00 (0.27 to 92.62) |
20 (1 RCT) |
⊕⊝⊝⊝ VERY LOW b e | |||
| 0 per 1000 | 0 per 1000 (0 to 0) |
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| Perioperative and postoperative complications: postoperative bleeding Follow‐up: 72 hours |
Open surgical repair | RR 0.57 (0.18 to 1.80) | 78 (1 RCT) | ⊕⊝⊝⊝ VERY LOW a,b | ||
| 179 per 1000 | 102 per 1000 (32 to 323) | |||||
| Endovascular aneurysm repair | not estimable | 46 (1 RCT) | ⊕⊕⊝⊝ LOW a,d | There were no events in either of the arms. | ||
| See comments | ||||||
| Length of ICU stay (days) | Open surgical repair | ‐ | 101 (2 RCTs) | ⊕⊝⊝⊝ VERY LOW f g | Two studies reported on length of ICU stay in OSR participants, 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. | |
| See comments | ||||||
| Endovascular aneurysm repair | ‐ | 46 (1 RCT) |
⊕⊕⊝⊝ LOW a,d | One study reported no clear difference between the exercise and usual care group in EVAR participants (P = 0.21). | ||
| See comments | ||||||
| Length of hospital stay (days) | Open surgical repair | ‐ | 101 (2 RCTs) |
⊕⊝⊝⊝ VERY LOW f g | Two studies reported no clear difference in length of hospital stay between exercise and usual care groups. | |
| See comments | ||||||
| Endovascular aneurysm repair | ‐ | 46 (1 RCT) |
⊕⊝⊝⊝ VERY LOW a d | One study reported shorter hospital stay for the exercise group compared with the usual care group for EVAR participants (P = 0.013) | ||
| See comments | ||||||
| Any AAA repair | ‐ | 48 (1 RCT) |
⊕⊕⊝⊝ LOW h | One study reported no clear difference between exercise and usual care groups. | ||
| See comments | ||||||
| Number of days on a ventilator | See comments | ‐ | ‐ | ‐ | No studies reported number of days on a ventilator. | |
| QoL Follow‐up: 12 weeks |
Any AAA repair | ‐ | 53 (1 RCT) | ⊕⊕⊝⊝ LOWh | One study reported QoL. The study found little or no difference between the exercise and usual care group participants. | |
| See comments | ||||||
| *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; OSR: open surgical repair; 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. | ||||||
a Study 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. b The 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. c High overall risk of bias due to selective reporting, selection bias, attrition bias and/or other bias (Dronkers 2008; Tew 2017); therefore, we downgraded the certainty of evidence by 2 levels for methodological limitations. d The optimal information size was not met (i.e. sample size < 2000); therefore, we downgraded the certainty of evidence by 1 level for imprecision. e Risk of bias due to selection bias, attrition bias and other bias (Dronkers 2008); therefore, we downgraded the certainty of evidence by 2 levels for methodological limitations. f High 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. g Unable to assess imprecision due to the way the studies report the outcome; therefore, we downgraded the certainty of evidence by 1 level. h High 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.