Assessing impact of supervision in aerobic exercise training on fitness and clinical outcomes: a systematic review and meta-analysis.
Liu A, Baldi JC, Woodfield JC, Ledgard CF, Wong AYC, Clifford KA. Ā· British journal of anaesthesia Ā· 2026
Background: Study heterogeneity limits the certainty of evidence for exercise prehabilitation. This is contributed to by type of supervision because its impact on patient outcomes has yet to be elucidated. This review aimed to compare fitness and clinical outcomes of supervised and unsupervised aerobic exercise.
Methods: This review was prospectively registered on PROSPERO (CRD42023409883) and performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Included studies prospectively compared one primary outcome of supervised or unsupervised moderate-to-high-intensity exercise and controls among adult clinical populations. Primary outcomes were changes in peak oxygen consumption (VĖ O 2peak, ml min -1 kg -1 ) and 6-Minute Walk Test (6MWT, metres) distance and incidence of postoperative complications.
Results: Thirty supervised and 12 unsupervised studies, including 3157 and 1848 patients, respectively, were analysed. No study directly compared supervised and unsupervised exercise. Unsupervised exercise was only significantly associated with 6MWT distance (cumulative mean difference 0.51 m, 95% confidence interval [CI] 0.14-0.87 m, P=0.016). Supervised exercise was significantly associated with VĖ O 2peak (cumulative mean difference 0.88 ml min -1 kg -1 , 95% CI 0.49-1.27 ml min -1 kg -1 , P
Conclusions: Both supervised and unsupervised exercise improved 6MWT distance. Supervised high-intensity exercise programmes significantly reduced postoperative complications.
Findings: were limited by lack of direct comparisons between exercise groups, necessitating further research. Systematic review protocol PROSPERO (CRD42023409883).