Objective To systematically assess postoperative changes in physical activity (PA) and their influence on clinical outcomes among elderly patients after transcatheter aortic valve replacement (TAVR), providing an evidence-based framework for risk stratification and the design of personalized cardiac rehabilitation programs. Methods A systematic search was conducted in CNKI, Wanfang, SinoMed, PubMed, Web of Science, and the Cochrane Library for relevant literature published from April 16, 2002 to January 1, 2026. Eligible studies included patients with a mean age of ≥65 years who underwent TAVR, with assessments of PA both pre- and postoperatively, and reported clinical outcomes stratified by the trajectory of PA change. Two reviewers independently performed study selection, data extraction, and quality appraisal using the Newcastle-Ottawa Scale (NOS) for cohort studies and the Cochrane Risk-of-Bias tool for randomized controlled trials. ResultsFour studies, all assessed as high-quality (three cohort studies with an NOS score of 8 and one randomized controlled trial with "some concerns" for risk of bias) encompassing 1 278 patients were included. The mean age was (82.2±7.3) years, and 52.0% were female. The results demonstrated a strong association between postoperative PA trajectories and clinical outcomes. Patients with persistently low or declining PA exhibited significantly higher risks of all-cause mortality, composite cardiovascular events, and rehospitalization compared to those whose PA improved or remained stable. A notable "protective effect of functional improvement" was observed: patients with low baseline PA who achieved significant postoperative improvement had prognosis comparable to those with normal baseline PA. Multivariable analyses identified advanced age, female sex, comorbidities such as chronic obstructive pulmonary disease, and cognitive impairment as independent predictors of impaired postoperative PA recovery. Conclusion Dynamic postoperative PA trajectories are a key predictor of clinical outcomes in the elderly TAVR population. This allows for risk stratification to identify a "low-benefit" high-risk cohort, for whom targeted, individualized cardiac rehabilitation interventions are crucial to optimize long-term survival and enhance quality of life.
