Early Mobilization Prescription in Patients Undergoing Cardiac Surgery: Systematic Review

Borges, Mayara Gabrielle Barbosa; Borges, Daniel Lago; Ribeiro, Mariane Oliveira; Lima, Lara Susan Silva; Macedo, Karolina Carneiro Morais; Nina, Vinicius José da Silva

doi:10.21470/1678-9741-2021-0140

Mayara Gabrielle Barbosa Borges

Department of Physiotherapy, Hospital Universitário da Universidade Federal do Maranhão (UFMA), São Luís, Maranhão, Brazil.

Postgraduate Program in Health Sciences, Universidade Federal do Maranhão (UFMA), São Luís, Maranhão, Brazil.

https://orcid.org/0000-0002-3608-3974

Daniel Lago Borges

Department of Physiotherapy, Hospital Universitário da Universidade Federal do Maranhão (UFMA), São Luís, Maranhão, Brazil.

Mariane Oliveira Ribeiro

Faculty of Physiotherapy, Faculdade Pitágoras, São Luís, Maranhão, Brazil.

Lara Susan Silva Lima

Multiprofessional Residency Program, Hospital Universitário da Universidade Federal do Maranhão (UFMA), São Luís, Maranhão, Brazil.

Karolina Carneiro Morais Macedo

Department of Physiotherapy, Faculdade Pitágoras, São Luís, Maranhão, Brazil.

Vinicius José da Silva Nina

Postgraduate Program in Health Sciences, Universidade Federal do Maranhão (UFMA), São Luís, Maranhão, Brazil.

Correspondence Address: Mayara Gabrielle Barbosa Borges https://orcid.org/0000-0002-3608-3974 Hospital Universitário da Universidade Federal do Maranhão (HU-UFMA), Rua Barão de Itapary, 227, Centro, São Luís, MA, Brazil Zip Code: 65020-070 E-mail: mayaragabriellebs4@gmail.com

This study was carried out at the Hospital Universitário da Universidade Federal of Maranhão (UFMA), São Luís, Maranhão, Brazil.

No conflict of interest.

Author	Sample	Age (years)	Sample characteristic	Objective
Borges et al.[³⁷37 Borges DL, Silva MG, Silva LN, Fortes JV, Costa ET, Assunção RP, et al. Effects of aerobic exercise applied early after coronary artery bypass grafting on pulmonary function, respiratory muscle strength, and functional capacity: a randomized controlled trial. J Phys Act Health. 2016;13(9):946-51. doi:10.1123/jpah.2015-0614. https://doi.org/10.1123/jpah.2015-0614... ], 2016	34	62.7±15.6	Adults undergoing CABG	To evaluate whether the addition of aerobic exercise during hospitalization improves lung function, respiratory muscle strength, and functional capacity
Cacau et al.[⁷7 Cacau Lde A, Oliveira GU, Maynard LG, Araújo Filho AA, Silva WM Jr, Cerqueria Neto ML, et al. The use of the virtual reality as intervention tool in the postoperative of cardiac surgery. Rev Bras Cir Cardiovasc. 2013;28(2):281-9. doi:10.5935/1678-9741.20130039. https://doi.org/10.5935/1678-9741.201300... ], 2013	60	50.6±2.5	Adults under 75 years, undergoing CABG or valve surgeries	To evaluate the use of virtual reality in functional rehabilitation
Herdy et al.[³¹31 Herdy AH, Marcchi PLB, Vila A, Tavares C, Collaco J, Niebauer J, Ribeiro JP: Pre- and postoperative cardiopulmonary rehabilitation in hospitalized patients undergoing coronary artery bypass surgery: a randomized controlled trial. Am J Phys Med Rehabil. 2008;87(9):714-719. https://doi:10.1097/PHM.0b013e3181839152 https://doi:10.1097/PHM.0b013e3181839152... ], 2008	56	59.5±9.5	Adults in the preoperative period of CABG	To evaluate the effects of cardiopulmonary rehabilitation before and after surgery in postoperative outcomes
Hirschhorn et al.[¹⁸18 Hirschhorn AD, Richards D, Mungovan SF, Morris NR, Adams L. Supervised moderate intensity exercise improves distance walked at hospital discharge following coronary artery bypass graft surgery--a randomised controlled trial. Heart Lung Circ. 2008;17(2):129-38. doi:10.1016/j.hlc.2007.09.004. https://doi.org/10.1016/j.hlc.2007.09.00... ], 2007	88	62.9±8.9	Adults undergoing CABG	To assess whether a supervised walking program with or without musculoskeletal or respiratory exercises can improve walking capacity and other outcomes
Hojskov et al.[¹⁹19 Højskov IE, Moons P, Egerod I, Olsen PS, Thygesen LC, Hansen NV, et al. Early physical and psycho-educational rehabilitation in patients with coronary artery bypass grafting: a randomized controlled trial. J Rehabil Med. 2019;51(2):136-43. doi:10.2340/16501977-2499. https://doi.org/10.2340/16501977-2499... ], 2019	310	65±8.8	Adults undergoing CABG	To assess the impact of phases 1 and 2 of cardiovascular rehabilitation on functionality, physical and mental function, anxiety, depression, sleep, pain, and quality of life
Gama Lordello et al.[⁹9 Gama Lordello GG, Gonçalves Gama GG, Lago Rosier G, Viana PADC, Correia LC, Fonteles Ritt LE. Effects of cycle ergometer use in early mobilization following cardiac surgery: a randomized controlled trial. Clin Rehabil. 2020;34(4):450-9. doi:10.1177/0269215520901763. https://doi.org/10.1177/0269215520901763... ], 2020	228	57.7±13	Adults undergoing CABG and/or valve surgeries	To evaluate the effect of early use of cycle ergometer, compared with conventional therapy, on in-hospital mobility
Mendes et al.[³⁵35 Mendes RG, Simões RP, De Souza Melo Costa F, Pantoni CB, Di Thommazo L, Luzzi S, et al. Short-term supervised inpatient physiotherapy exercise protocol improves cardiac autonomic function after coronary artery bypass graft surgery--a randomised controlled trial. Disabil Rehabil. 2010;32(16):1320-7. doi:10.3109/09638280903483893. https://doi.org/10.3109/0963828090348389... ], 2010	47	59±8.5	Adults undergoing CABG	To determine whether a short exercise protocol during in-hospital cardiac rehabilitation can improve cardiac autonomic regulation
Pantoni et al.[¹⁴14 Pantoni CB, Di Thommazo-Luporini L, Mendes RG, Caruso FC, Mezzalira D, Arena R, et al. Continuous positive airway pressure during exercise improves walking time in patients undergoing inpatient cardiac rehabilitation after coronary artery bypass graft surgery: a RANDOMIZED CONTROLLED TRIAL. J Cardiopulm Rehabil Prev. 2016;36(1):20-7. doi:10.1097/HCR.0000000000000144. https://doi.org/10.1097/HCR.000000000000... ], 2016	27	57.85±7.3	Adults undergoing CABG	To evaluate the effectiveness of CPAP on the first day of walking
Silva et al.[¹⁵15 Silva LN, Marques MJS, Lima RS, Fortes JVS, Silva MGB, Baldez TEP, et al. Retirada precoce do leito no pós operatório de cirurgia cardíaca: Repercussões cardiorrespiratórias e efeitos na força muscular respiratória e periférica, na capacidade funcional e função pulmonar. ASSOBRAFIR Ciênc. 2017;8(2):25-39. doi:10.47066/2177-9333/ac.27867. https://doi.org/10.47066/2177-9333/ac.27... ], 2017	19	52±17	Adult undergoing elective cardiac surgery (corrections of congenital heart diseases, CABG, valve surgeries, and/or associated surgical procedures)	To check the cardiorespiratory repercussions of early sitting out of bed and its effects on muscle strength, functional capacity, and pulmonary function
Stein et al.[¹⁶16 Stein R, Maia CP, Silveira AD, Chiappa GR, Myers J, Ribeiro JP. Inspiratory muscle strength as a determinant of functional capacity early after coronary artery bypass graft surgery. Arch Phys Med Rehabil. 2009;90(10):1685-91. doi:10.1016/j.apmr.2009.05.010. https://doi.org/10.1016/j.apmr.2009.05.0... ], 2009	20	63.5 ± 6.5	Adults undergoing CABG	To evaluate the effect of a cardiopulmonary rehabilitation program on inspiratory muscle strength and its possible association with maximum and submaximal functional capacity
Tariq et al.[¹⁷17 Tariq MI, Khan AA, Khalid Z, Farheen H, Siddiqi FA, Amjad I. Effect of early ≤ 3 mets (metabolic equivalent of tasks) of physical activity on patient's outcome after cardiac surgery. J Coll Physicians Surg Pak. 2017;27(8):490-4.], 2017	174	51.9±13.8	Adults undergoing CABG or valve surgeries	To determine the effect of physical activities (≤ 3 METs) in the immediate postoperative period on respiratory and hemodynamic parameters
Ximenes et al.[²2 Ximenes NN, Borges DL, Lima RO, Barbosa e Silva MG, Silva LN, Costa Mde A, et al. Effects of resistance exercise applied early after coronary artery bypass grafting: a randomized controlled trial. Braz J Cardiovasc Surg. 2015;30(6):620-5. doi:10.5935/1678-9741.20150077. https://doi.org/10.5935/1678-9741.201500... ], 2015	34	60.9±6.8	Adults undergoing CABG	To evaluate the effects of early resistance exercise
Windmoller et al.[²³23 Windmöller P, Bodnar ET, Casagrande J, Dallazen F, Schneider J, Berwanger SA, et al. Physical exercise combined with CPAP in subjects who underwent surgical myocardial revascularization: a randomized clinical trial. Respir Care. 2020;65(2):150-7. doi:10.4187/respcare.06919. https://doi.org/10.4187/respcare.06919... ], 2020	31	60±7	Adults undergoing CABG	To evaluate the effectiveness of cycle ergometer with CPAP
Zanini et al.[²²22 Zanini M, Nery R, Lima J, Buhler R, Silveira R, Stein R. Effects of different rehabilitation protocols in inpatient cardiac rehabilitation after coronary artery bypass graft surgery: a randomized clinical trial. J Cardiopulm Rehabil Prev. 2019;39(6):19-25. http://doi:10.1097/HCR.0000000000000431 http://doi:10.1097/HCR.0000000000000431... ], 2019	40	58.5±6.25	Adults undergoing CABG	To evaluate the effect of different rehabilitation protocols on pulmonary function and functional capacity

Authors	Mode	Intensity	Frequency	Duration	Progression
Borges et al.[³⁷37 Borges DL, Silva MG, Silva LN, Fortes JV, Costa ET, Assunção RP, et al. Effects of aerobic exercise applied early after coronary artery bypass grafting on pulmonary function, respiratory muscle strength, and functional capacity: a randomized controlled trial. J Phys Act Health. 2016;13(9):946-51. doi:10.1123/jpah.2015-0614. https://doi.org/10.1123/jpah.2015-0614... ], 2016	Active and assisted exercises and progressive walking + active cycle ergometer	“As much as possible”	ICU: twice daily	1st and 2nd POD: 10 minutes	Time
		“As much as possible”	Ward: once daily	From the 3rd POD: 20 minutes	Time
Cacau et al.[⁷7 Cacau Lde A, Oliveira GU, Maynard LG, Araújo Filho AA, Silva WM Jr, Cerqueria Neto ML, et al. The use of the virtual reality as intervention tool in the postoperative of cardiac surgery. Rev Bras Cir Cardiovasc. 2013;28(2):281-9. doi:10.5935/1678-9741.20130039. https://doi.org/10.5935/1678-9741.201300... ], 2013	Metabolic exercises and mobilization using virtual reality	NR	NR	NR	Progressive METs
Herdy et al.[³¹31 Herdy AH, Marcchi PLB, Vila A, Tavares C, Collaco J, Niebauer J, Ribeiro JP: Pre- and postoperative cardiopulmonary rehabilitation in hospitalized patients undergoing coronary artery bypass surgery: a randomized controlled trial. Am J Phys Med Rehabil. 2008;87(9):714-719. https://doi:10.1097/PHM.0b013e3181839152 https://doi:10.1097/PHM.0b013e3181839152... ], 2008	Progressive exercises (passive, walking, and climbing stairs)	NR	Once daily	NR	2-4 METs
Hirschhorn et al.[¹⁸18 Hirschhorn AD, Richards D, Mungovan SF, Morris NR, Adams L. Supervised moderate intensity exercise improves distance walked at hospital discharge following coronary artery bypass graft surgery--a randomised controlled trial. Heart Lung Circ. 2008;17(2):129-38. doi:10.1016/j.hlc.2007.09.004. https://doi.org/10.1016/j.hlc.2007.09.00... ], 2007	1^st POD: marching on the spot (3 × 1 minute) and sitting out of bed	Borg: 3 a 4/10	Twice daily	Variable, depending on the patient’s condition	Increased walking distance and time
	2^nd POD: assisted walking (300 meters in the morning and 5 minutes in the afternoon)
	3^rd POD: assisted walking (at least 5 minutes in the morning and afternoon)
	4^th POD until discharge: supervised walking with increments of 2.5 minutes, as tolerated, up to 10 minutes
Hojskov et al.[¹⁹19 Højskov IE, Moons P, Egerod I, Olsen PS, Thygesen LC, Hansen NV, et al. Early physical and psycho-educational rehabilitation in patients with coronary artery bypass grafting: a randomized controlled trial. J Rehabil Med. 2019;51(2):136-43. doi:10.2340/16501977-2499. https://doi.org/10.2340/16501977-2499... ], 2019	1^st to 7^th POD: walking, shoulder and neck mobilization, and cycle ergometer	NR	NR	NR	NR
Gama Lordello et al.[⁹9 Gama Lordello GG, Gonçalves Gama GG, Lago Rosier G, Viana PADC, Correia LC, Fonteles Ritt LE. Effects of cycle ergometer use in early mobilization following cardiac surgery: a randomized controlled trial. Clin Rehabil. 2020;34(4):450-9. doi:10.1177/0269215520901763. https://doi.org/10.1177/0269215520901763... ], 2020	Cycle ergometer of upper and lower limbs. After drain removal, progressive activity for orthostatism, sitting on the chair, and walking in the ICU corridor	NR	Twice daily	10 minutes	NR
Mendes et al.[³⁵35 Mendes RG, Simões RP, De Souza Melo Costa F, Pantoni CB, Di Thommazo L, Luzzi S, et al. Short-term supervised inpatient physiotherapy exercise protocol improves cardiac autonomic function after coronary artery bypass graft surgery--a randomised controlled trial. Disabil Rehabil. 2010;32(16):1320-7. doi:10.3109/09638280903483893. https://doi.org/10.3109/0963828090348389... ], 2010	Active-assisted exercises	Exercise HR = HR rest + 20 bpm	Once daily	NR	2 to 4 METs
	STEP 1: 5 × 10 repetitions in Fowler’s position
	STEP 2: 2 × 15 repetitions in sitting position
	STEP 3: 3 × 15 repetitions in sitting position
	STEP 4: 3 × 15 repetitions in sitting position + 10 minutes of walking
	STEP 5: 3 × 15 repetitions in orthostatism + 10 minutes of walking + climbing 4 floor of stairs
Pantoni et al.[¹⁴14 Pantoni CB, Di Thommazo-Luporini L, Mendes RG, Caruso FC, Mezzalira D, Arena R, et al. Continuous positive airway pressure during exercise improves walking time in patients undergoing inpatient cardiac rehabilitation after coronary artery bypass graft surgery: a RANDOMIZED CONTROLLED TRIAL. J Cardiopulm Rehabil Prev. 2016;36(1):20-7. doi:10.1097/HCR.0000000000000144. https://doi.org/10.1097/HCR.000000000000... ], 2016	CPAP (10-12 cmH2O) during exercises	Exercise HR = HR rest + 20 bpm	Twice daily	NR	2 to 4 METs
	1^st POD: upper and lower extremity exercises
	3^rd POD: active exercises and 5 minutes of walking
	4th POD: active exercises and 10 minutes of walking
	5th POD: 10 minutes of walking and stair training
Silva et al.[¹⁵15 Silva LN, Marques MJS, Lima RS, Fortes JVS, Silva MGB, Baldez TEP, et al. Retirada precoce do leito no pós operatório de cirurgia cardíaca: Repercussões cardiorrespiratórias e efeitos na força muscular respiratória e periférica, na capacidade funcional e função pulmonar. ASSOBRAFIR Ciênc. 2017;8(2):25-39. doi:10.47066/2177-9333/ac.27867. https://doi.org/10.47066/2177-9333/ac.27... ], 2017	Sitting out of bed at 1st POD, active exercises, and progressive walking	NR	NR	30 minutes	NR
Stein et al.[¹⁶16 Stein R, Maia CP, Silveira AD, Chiappa GR, Myers J, Ribeiro JP. Inspiratory muscle strength as a determinant of functional capacity early after coronary artery bypass graft surgery. Arch Phys Med Rehabil. 2009;90(10):1685-91. doi:10.1016/j.apmr.2009.05.010. https://doi.org/10.1016/j.apmr.2009.05.0... ], 2009	1^st POD: hip and knee flexion (2 × 15 repetitions), upper limbs active exercises (flexion and abduction up 90° - 2 × 10 repetitions), knees and wrist flexion and extension (3 minutes each)	NR	NR	NR	Walked distance
	2^nd POD: marching on the spot after mediastinal drain removal (3 × 1 to 3 minutes)
	3^rd POD: walking - 100 to 200 meters
	4^th POD: walking - 200 to 300 meters
	5^th POD: walking - 300 to 400 meters and climbing 15 steps
	6^th POD: walking - 500 to 600 meters and climbing 15 steps
Tariq et al.[¹⁷17 Tariq MI, Khan AA, Khalid Z, Farheen H, Siddiqi FA, Amjad I. Effect of early ≤ 3 mets (metabolic equivalent of tasks) of physical activity on patient's outcome after cardiac surgery. J Coll Physicians Surg Pak. 2017;27(8):490-4.], 2017	Immediate postoperative period: sitting on the edge of bed (assisted by the physiotherapist) for 5 minutes. Orthostatism (1-2 minutes), marching on the spot (10 steps), and sitting on the chair (90 minutes)	NR	NR	NR	≤ 3 METs
Ximenes et al.[²2 Ximenes NN, Borges DL, Lima RO, Barbosa e Silva MG, Silva LN, Costa Mde A, et al. Effects of resistance exercise applied early after coronary artery bypass grafting: a randomized controlled trial. Braz J Cardiovasc Surg. 2015;30(6):620-5. doi:10.5935/1678-9741.20150077. https://doi.org/10.5935/1678-9741.201500... ], 2015	Resistance exercises and progressive walking	Borg (does not specify value)	ICU: twice daily Ward: once daily	30 minutes	Positioning (45° on bed, sitting on the edge of bed and orthostatism)
Windmoller et al.[²³23 Windmöller P, Bodnar ET, Casagrande J, Dallazen F, Schneider J, Berwanger SA, et al. Physical exercise combined with CPAP in subjects who underwent surgical myocardial revascularization: a randomized clinical trial. Respir Care. 2020;65(2):150-7. doi:10.4187/respcare.06919. https://doi.org/10.4187/respcare.06919... ], 2020	Cycle ergometer with CPAP (10 cmH2O) (once daily, from 2nd to 4th POD) + exercises:	Resting HR + 30 bpm	Twice daily	20 to 30 minutes	2-6 METs
	STEP 1: supine - active exercises
	STEP 2: sitting - active exercises
	STEP 3: orthostatism - passive stretching of lower limbs and walking (35 to 60 meters)
	STEP 4: orthostatism - passive stretching of lower limbs and active stretching of upper limbs, walking (60 to 100 meters), and climbing 1 floor of stairs
	STEP 5: orthostatism - active stretching of upper and lower limbs, active exercises, walking (100 to 150 meters), and climbing up/down 1 floor of stairs
	STEP 6: orthostatism - active stretching of upper and lower limbs, active exercises, walking (150 to 200 meters), and climbing up/down 2 floors of stairs
	STEP 7: orthostatism - active stretching of upper and lower limbs, active exercises, walking (> 200 meters), and climbing up/down 3 floors of stairs
Zanini et al.[²²22 Zanini M, Nery R, Lima J, Buhler R, Silveira R, Stein R. Effects of different rehabilitation protocols in inpatient cardiac rehabilitation after coronary artery bypass graft surgery: a randomized clinical trial. J Cardiopulm Rehabil Prev. 2019;39(6):19-25. http://doi:10.1097/HCR.0000000000000431 http://doi:10.1097/HCR.0000000000000431... ],2019	Group 1: active exercises (shoulders, hips, knees, and ankle flexions), IMT, progressive walking, and conventional therapy	Borg: 11/20	Twice daily	NR	Active mobilization: series and repetition Walking: distance
	Group 2: active exercises (shoulders, hips, knees, and ankle flexions), progressive walking, and conventional therapy
	Group 3: IMT and conventional therapy

Author	Main outcomes
Borges et al.[¹³13 Mendes RG, Simões RP, De Souza Melo Costa F, Pantoni CB, Di Thommazo L, Luzzi S, et al. Short-term supervised inpatient physiotherapy exercise protocol improves cardiac autonomic function after coronary artery bypass graft surgery--a randomised controlled trial. Disabil Rehabil. 2010;32(16):1320-7. doi:10.3109/09638280903483893. https://doi.org/10.3109/0963828090348389... ], 2016	Functional capacity was maintained in the intervention group. A significant difference in functional capacity was also found in intergroup analyses at hospital discharge.
Cacau et al.[⁷7 Cacau Lde A, Oliveira GU, Maynard LG, Araújo Filho AA, Silva WM Jr, Cerqueria Neto ML, et al. The use of the virtual reality as intervention tool in the postoperative of cardiac surgery. Rev Bras Cir Cardiovasc. 2013;28(2):281-9. doi:10.5935/1678-9741.20130039. https://doi.org/10.5935/1678-9741.201300... ], 2013	Intervention group showed lower reduction in functional performance, decreased pain score, higher energy level, shorter hospital length of stay, and higher 6MWT distance.
Herdy et al.[¹⁴14 Pantoni CB, Di Thommazo-Luporini L, Mendes RG, Caruso FC, Mezzalira D, Arena R, et al. Continuous positive airway pressure during exercise improves walking time in patients undergoing inpatient cardiac rehabilitation after coronary artery bypass graft surgery: a RANDOMIZED CONTROLLED TRIAL. J Cardiopulm Rehabil Prev. 2016;36(1):20-7. doi:10.1097/HCR.0000000000000144. https://doi.org/10.1097/HCR.000000000000... ], 2008	Intervention group had shorter time to endotracheal extubation, decreased incidence of pleural effusion, atelectasis, pneumonia, and atrial fibrillation or flutter, and reduced hospital length of stay.
Hirschhorn et al.[¹⁵15 Silva LN, Marques MJS, Lima RS, Fortes JVS, Silva MGB, Baldez TEP, et al. Retirada precoce do leito no pós operatório de cirurgia cardíaca: Repercussões cardiorrespiratórias e efeitos na força muscular respiratória e periférica, na capacidade funcional e função pulmonar. ASSOBRAFIR Ciênc. 2017;8(2):25-39. doi:10.47066/2177-9333/ac.27867. https://doi.org/10.47066/2177-9333/ac.27... ], 2007	Intervention group had significantly higher 6MWT distance at hospital discharge.
Hojskov et al.[¹⁶16 Stein R, Maia CP, Silveira AD, Chiappa GR, Myers J, Ribeiro JP. Inspiratory muscle strength as a determinant of functional capacity early after coronary artery bypass graft surgery. Arch Phys Med Rehabil. 2009;90(10):1685-91. doi:10.1016/j.apmr.2009.05.010. https://doi.org/10.1016/j.apmr.2009.05.0... ], 2019	No significant differences between groups in 6MWT. Anxiety and depression were decreased in intervention group.
Lordello et al.[⁹9 Gama Lordello GG, Gonçalves Gama GG, Lago Rosier G, Viana PADC, Correia LC, Fonteles Ritt LE. Effects of cycle ergometer use in early mobilization following cardiac surgery: a randomized controlled trial. Clin Rehabil. 2020;34(4):450-9. doi:10.1177/0269215520901763. https://doi.org/10.1177/0269215520901763... ], 2020	No significant difference was found in the total number of steps between the groups. However, self-reports indicated better motivation in the intervention group.
Mendes et al.[¹⁷17 Tariq MI, Khan AA, Khalid Z, Farheen H, Siddiqi FA, Amjad I. Effect of early ≤ 3 mets (metabolic equivalent of tasks) of physical activity on patient's outcome after cardiac surgery. J Coll Physicians Surg Pak. 2017;27(8):490-4.], 2010	Intervention group presented significantly higher parasympathetic HRV values, global power, non-linear HRV indexes and mean RR. Higher values of mean HR, LF (sympathetic activity), and the LF/HF (global sympathovagal balance) were found in control group.
Pantoni et al.[¹⁴14 Pantoni CB, Di Thommazo-Luporini L, Mendes RG, Caruso FC, Mezzalira D, Arena R, et al. Continuous positive airway pressure during exercise improves walking time in patients undergoing inpatient cardiac rehabilitation after coronary artery bypass graft surgery: a RANDOMIZED CONTROLLED TRIAL. J Cardiopulm Rehabil Prev. 2016;36(1):20-7. doi:10.1097/HCR.0000000000000144. https://doi.org/10.1097/HCR.000000000000... ], 2016	Intervention group had increased exercise time, better thoracoabdominal coordination, increased ventilation during walking, increased SpO2 values at the end of walking, and reduced dyspnea rate.
Silva et al.[¹⁵15 Silva LN, Marques MJS, Lima RS, Fortes JVS, Silva MGB, Baldez TEP, et al. Retirada precoce do leito no pós operatório de cirurgia cardíaca: Repercussões cardiorrespiratórias e efeitos na força muscular respiratória e periférica, na capacidade funcional e função pulmonar. ASSOBRAFIR Ciênc. 2017;8(2):25-39. doi:10.47066/2177-9333/ac.27867. https://doi.org/10.47066/2177-9333/ac.27... ], 2017	Reduction of MIP in both groups, while the maximum expiratory pressure did not reduce in the intervention group. There was no change in the MRC and decrease in spirometry values in both groups at hospital discharge.
Stein et al.[¹⁶16 Stein R, Maia CP, Silveira AD, Chiappa GR, Myers J, Ribeiro JP. Inspiratory muscle strength as a determinant of functional capacity early after coronary artery bypass graft surgery. Arch Phys Med Rehabil. 2009;90(10):1685-91. doi:10.1016/j.apmr.2009.05.010. https://doi.org/10.1016/j.apmr.2009.05.0... ], 2009	Intervention group maintained MIP measured at 7 and 30 days postoperatively, while it was significantly reduced in the control group. 6MWT distance was higher 7 days after cardiac surgery in intervention group. VO2 peak at day 30 was also higher in the intervention group.
Tariq et al.[¹⁷17 Tariq MI, Khan AA, Khalid Z, Farheen H, Siddiqi FA, Amjad I. Effect of early ≤ 3 mets (metabolic equivalent of tasks) of physical activity on patient's outcome after cardiac surgery. J Coll Physicians Surg Pak. 2017;27(8):490-4.], 2017	In the intervention group, there was an improvement in dyspnea, respiratory rate, and oxygen saturation.
Ximenes et al.[²2 Ximenes NN, Borges DL, Lima RO, Barbosa e Silva MG, Silva LN, Costa Mde A, et al. Effects of resistance exercise applied early after coronary artery bypass grafting: a randomized controlled trial. Braz J Cardiovasc Surg. 2015;30(6):620-5. doi:10.5935/1678-9741.20150077. https://doi.org/10.5935/1678-9741.201500... ], 2015	Intervention group maintained functional capacity at hospital discharge measured by 6MWT, while control group had a significant decrease.
Windmoller et al.[²³23 Windmöller P, Bodnar ET, Casagrande J, Dallazen F, Schneider J, Berwanger SA, et al. Physical exercise combined with CPAP in subjects who underwent surgical myocardial revascularization: a randomized clinical trial. Respir Care. 2020;65(2):150-7. doi:10.4187/respcare.06919. https://doi.org/10.4187/respcare.06919... ], 2020	Functional capacity decreased in both groups, without significant difference in the intervention group. ICU length of stay was lower in the intervention group. In both groups there was a decrease in maximal inspiratory and expiratory pressures, as well as in the 1-min sit-to-stand test on the fourth postoperative day compared to the preoperative period.
Zanini et al.[²²22 Zanini M, Nery R, Lima J, Buhler R, Silveira R, Stein R. Effects of different rehabilitation protocols in inpatient cardiac rehabilitation after coronary artery bypass graft surgery: a randomized clinical trial. J Cardiopulm Rehabil Prev. 2019;39(6):19-25. http://doi:10.1097/HCR.0000000000000431 http://doi:10.1097/HCR.0000000000000431... ], 2019	The 6MWT distance on the sixth postoperative day was significantly higher in groups which included early ambulation and upper and lower limbs exercise, remaining higher at 30 days post-discharge. Peak VO2 on day 30 was also higher in in the same groups. All groups achieved similar recovery of lung function

[1] Correspondence Address: Mayara Gabrielle Barbosa Borges https://orcid.org/0000-0002-3608-3974 Hospital Universitário da Universidade Federal do Maranhão (HU-UFMA), Rua Barão de Itapary, 227, Centro, São Luís, MA, Brazil Zip Code: 65020-070 E-mail: mayaragabriellebs4@gmail.com

6MWT	= 6-minute walk test	METs	= Metabolic equivalent of task
CABG	= Coronary artery bypass grafting	MIP	= Maximal inspiratory pressure
CPAP	= Continuous positive airway pressure	MRC	= Medical Research Council
HF	= High frequency	NR	= Not reported
HR	= Heart rate	POD	= Postoperative day
HRV	= Heart rate variability	RR	= R-R intervals
ICU	= Intensive care unit	SpO₂	= Saturation of peripheral oxygen
IMT	= Inspiratory muscle training	VO₂	= Oxygen uptake
LF	= Low frequency

#1	(“Intensive care” OR “Critical care” OR “Intensive care unit” OR “Critical illness” OR “Care, Critical” OR “Care, Intensive” OR “Surgical Intensive Care” OR “Care, Surgical Intensive” OR “Intensive Care, Surgical”)
#2	(“Early Ambulation” OR “Accelerated Ambulation” OR “Ambulation, Accelerated” OR “Ambulation, Early” OR “Early Mobilization” OR “Mobilization, Early” OR “Exercise” OR “Physical Activity” OR “Activities, Physical” OR “Activity, Physical” OR “Physical Activities” OR “Exercise, Physical” OR “Exercises, Physical” OR “Physical Exercise” OR “Physical Exercises” OR “Acute Exercise” OR “Acute Exercises” OR “Exercise, Acute” OR “Exercises, Acute” OR “Exercise, Isometric” OR “Exercises, Isometric” OR “Isometric Exercises” OR “Isometric Exercise” OR “Exercise, Aerobic” OR “Aerobic Exercise” OR “Aerobic Exercises” OR “Exercises, Aerobic” OR “Exercise Training” OR “Exercise Trainings” OR “Training, Exercise” OR “Trainings, Exercise” OR “Motion Therapy, Continuous Passive” OR “Movement Therapy, Continuous Passive” OR “Passive Movement Therapy, Continuous” OR “Continuous Passive Motion Therapy” OR “Passive Motion Therapy, Continuous” OR “Continuous Passive Movement Therapy” OR “CPM Therapy” OR “CPM Therapies” OR “Therapies, CPM” OR “Therapy, CPM” OR “Resistance Training”)
#3	(“Procedure, Cardiac Surgical” OR “Procedures, Cardiac Surgical” OR “Surgical Procedure, Cardiac” OR “Surgical Procedures, Cardiac” OR “Surgical Procedures, Heart” OR “Cardiac Surgical Procedure” OR “Heart Surgical Procedures” OR “Procedure, Heart Surgical” OR “Procedures, Heart Surgical” OR “Surgical Procedure, Heart” OR “Heart Surgical Procedure” OR “Cardiac Surgery”)
#4	#1 AND #2 AND #3 AND

MGBB	Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published
DLB	Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published
MOR	Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published
LSSL	Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published
KCMM	Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published
VJSN	Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published

Brasil

Brasil

Early Mobilization Prescription in Patients Undergoing Cardiac Surgery: Systematic Review

ABSTRACT

Introduction:

Methods:

Results:

Conclusion: