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Perioperative respiratory-focused exercise reduces pneumonia and atelectasis risk in patients undergoing cardiac surgeryRespiratory exercises may reduce complications after heart surgery

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Key Takeaway
Consider perioperative respiratory-focused exercise to reduce pneumonia and atelectasis risk in cardiac surgery patients.

This meta-analysis evaluated the impact of perioperative respiratory-focused exercise interventions, including inspiratory muscle training, incentive spirometry, and deep breathing exercises, on outcomes for patients undergoing cardiac surgery. The analysis included 11 randomized controlled trials. The primary findings indicate that these interventions significantly reduced the risk of pneumonia (RR 0.56; 95% CI: 0.38 to 0.83) and atelectasis (RR 0.39; 95% CI: 0.24 to 0.64). Additionally, a significant reduction was observed for PPC grade 2 or higher (RR 0.47; 95% CI: 0.33 to 0.67).

Secondary outcomes showed significant reductions in mechanical ventilation duration (SMD -0.70; 95% CI: -1.04 to -0.37), ICU length of stay (SMD -1.09; 95% CI: -1.81 to -0.36), and hospital length of stay (SMD -0.70; 95% CI: -0.97 to -0.44). No statistically significant effects were observed for pleural effusion, respiratory failure, hypoxemia episodes, or re-intubation. Improvements in maximal inspiratory pressure (MIP) and 6-minute walk distance (6MWD) were not statistically significant.

The authors noted several limitations, including substantial variation in intervention type, timing, and duration, as well as risk of bias and heterogeneity for some outcomes. The certainty of evidence ranges from moderate to very low. While these interventions may reduce specific pulmonary complications and improve some short-term recovery metrics, the evidence is currently insufficient to determine an optimal exercise protocol or to establish consistent improvements in respiratory muscle strength or functional capacity.

Recovering from heart surgery is a grueling process where breathing often becomes a major hurdle. Patients frequently face lung complications, such as pneumonia or fluid buildup, which can stall their recovery and keep them in the hospital longer.

A review of 11 trials found that specific respiratory-focused exercises—including breathing techniques, incentive spirometry, and muscle training—can significantly reduce the risk of pneumonia and other lung issues. These interventions also showed a link to shorter stays in the intensive care unit and less time spent on a ventilator.

While these results are promising, the evidence is not perfect. Because the studies varied so much in how they timed and delivered the exercises, the overall certainty of the findings is moderate to low. Researchers cannot yet say which specific routine is best, but the data suggests these movements are a helpful tool for recovery.

What this means for you:
Respiratory exercises can reduce lung complications and shorten hospital stays for heart surgery patients.

Common questions

What kind of exercises help after heart surgery?

The study looked at several types of respiratory-focused exercises. These included inspiratory muscle training, incentive spirometry, deep breathing exercises, and surgical respiratory re-education. These methods aim to help patients manage their breathing more effectively during the recovery period following heart surgery.

Can these exercises help patients get home faster?

Yes, the data showed that these respiratory exercises were linked to a reduction in the length of stay in the intensive care unit and a reduction in the total time spent in the hospital. They also helped reduce the amount of time patients needed to stay on a mechanical ventilator.

Are these exercises effective at preventing lung infections?

The findings showed a significant reduction in pneumonia and other lung complications, such as atelectasis. However, the study did not find a significant effect on other issues like pleural effusion, respiratory failure, or hypoxemia episodes. Talk to your doctor about the best plan for your recovery.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedNov 2026
View Original Abstract ↓
BackgroundPostoperative pulmonary complications (PPCs) increase morbidity and hospital stay after cardiac surgery. Perioperative respiratory-focused exercise interventions, including inspiratory muscle training (IMT), incentive spirometry, and breathing exercises, may reduce PPCs, but the effects of these heterogeneous interventions in cardiac surgery patients remain uncertain.MethodsA systematic review and meta-analysis were conducted using PRISMA guidelines and included 11 randomized controlled trials (RCTs) evaluating perioperative exercise or respiratory-focused interventions administered before and/or after cardiac surgery. The principal components of the interventions included IMT, incentive spirometry, deep breathing exercises, and surgical respiratory re-education exercises. The analysis was conducted using RevMan 5.4, with Rayyan used to assist in the screening and selection of studies.ResultsPerioperative exercise or respiratory-focused interventions significantly reduced selected pulmonary outcomes, including PPC grade ≥2 (RR = 0.47, 95% CI: 0.33–0.67), pneumonia (RR = 0.56, 95% CI: 0.38–0.83), and atelectasis (RR = 0.39, 95% CI: 0.24–0.64). No statistically significant effects were observed for pleural effusion, respiratory failure, hypoxemia episodes, or re-intubation. Mechanical ventilation duration (SMD = −0.70, 95% CI: −1.04 to −0.37), ICU length of stay (SMD = −1.09, 95% CI: −1.81 to −0.36; I2 = 85%), and hospital length of stay (SMD = −0.70, 95% CI: −0.97 to −0.44; I2 = 40%) showed reductions. MIP (SMD = 0.89, 95% CI: −0.08 to 1.86; I2 = 94%) and 6MWD (SMD = 0.13, 95% CI: −0.31 to 0.57; I2 = 34%) did not demonstrate statistically significant improvement when analyzed as separate outcomes. Certainty of evidence ranged from moderate to very low.ConclusionsPerioperative respiratory-focused exercise interventions may reduce selected postoperative pulmonary complications and may improve some short-term recovery outcomes in patients undergoing cardiac surgery. However, substantial variation in intervention type, timing, and duration, together with risk of bias and heterogeneity for some outcomes, resulted in moderate to very low certainty of evidence and limits the generalizability of the findings. The available evidence remains insufficient to determine an optimal exercise protocol or to establish consistent improvements in respiratory muscle strength or functional exercise capacity.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420261294365, identifier CRD420261294365.
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