OBJECTIVE: To compare the postoperative outcomes of preoperative respiratory muscle training with a device (RMT) to preoperative aerobic exercise training (AET) in patients undergoing thoracic surgeries (cardiac and lung). DATA SOURCES: PubMed, Embase, Cochrane, and Web of Science were comprehensively searched upon inception to 9/2020. STUDY SELECTION: All randomized control studies, including preoperative RMT and preoperative AET compared to a non-training control group, were included. DATA EXTRACTION: The meta-analysis was performed for outcomes including postoperative pulmonary complications (PPC), pneumonia, postoperative respiratory failure (PRF), hospital length of stay (HLOS), and mortality. We performed a network meta-analysis based on Bayesian random-effects regression models. DATA SYNTHESIS: A total of 25 studies, 2070 patients were included in this meta-analysis. Pooled data for the patients who performed RMT with a device showed a reduction in PPCs, pneumonia, PRF with OR (Odds ratio) of 0.35 (p-value 0.006), 0.38 (p-value 0.002), and 0.22 (p-value 0.008), respectively. Pooled data for the patients who performed AET showed reduction in PPC, pneumonia with a OR of 0.33 (p-value < 0.00001) and OR of 0.54 (p-value 0.01) respectively. HLOS was decreased by 1.69 days (p-value < 0.00001) by performing RMT and 1.79 days (p-value 0.0008) by performing AET compared to the usual group. No significant difference in all-cause mortality compared to usual care in both RMT and AET intervention groups. No significant difference in the incidence of PRF compared to usual group in RMT plus AET and AET alone intervention groups (OR 0.32, p = 0.21, OR 0.94, p = 0.87). Based on rank probability plots analysis, on network meta-analysis, RMT and AET ranked similarly on the primary outcome of PPC and secondary outcomes of pneumonia, PRF and HLOS. CONCLUSION: In thoracic surgeries, preoperative RMT is comparable to preoperative AET to prevent PPC, pneumonia, and PRF and reduce HLOS. It can be considered in patients in resource-limited settings.

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