title: Impact of physical activity on fatigue and quality of life in people with advanced lung cancer: a randomized controlled trial Systematic short-term pulmonary rehabilitation before lung cancer lobectomy: a randomized trial. Short-term preoperative exercise therapy does not improve long-term outcome after lung cancer surgery: a randomized controlled study† Preoperative pulmonary rehabilitation in patients undergoing lung resection for non-small cell lung cancer. Do patients with lung cancer benefit from physical exercise? Perioperative rehabilitation in operation for lung cancer (PROLUCA) – rationale and design Strength and endurance training in the treatment of lung cancer patients in stages IIIA/IIIB/IV Randomised controlled trial on the effectiveness of home-based walking exercise on anxiety, depression and cancer-related symptoms in patients with lung cancer Effect of aerobic exercise and relaxation training on fatigue and physical performance of cancer patients after surgery. A randomised controlled trial Effects of exercise training on exercise capacity in patients with non-small cell lung cancer receiving targeted therapy Cancer Type Does Not Affect Exercise-Mediated Improvements in Cardiorespiratory Function and Fatigue Comparison of the effects of pulmonary rehabilitation with chest physical therapy on the levels of fibrinogen and albumin in patients with lung cancer awaiting lung resection: a randomized clinical trial Pulmonary rehabilitation programme for patients undergoing curative lung cancer surgery. POSITIVE study: physical exercise program in non-operable lung cancer patients undergoing palliative treatment Evaluation of an early exercise intervention after thoracotomy for non-small cell lung cancer (NSCLC), effects on quality of life, muscle strength and exercise tolerance: randomised controlled trial. High-intensity training following lung cancer surgery: a randomised controlled trial Should we exclude elderly patients with chronic obstructive pulmonary disease from a long-time ambulatory pulmonary rehabilitation programme? Preoperative Exercise Vo2 Measurement for Lung Resection Candidates: Results of Cancer and Leukemia Group B Protocol 9238 Short-term high-intensity rehabilitation in radically treated lung cancer: a three-armed randomized controlled trial. Systemic Therapy for Stage IV Non-Small-Cell Lung Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update. Physical exercise for cancer patients with advanced disease: a randomized controlled trial. Rehabilitation in patients with radically treated respiratory cancer: A randomised controlled trial comparing two training modalities. The effect of neoadjuvant chemotherapy on physical fitness and survival in patients undergoing oesophagogastric cancer surgery. Preoperative exercise training prevents functional decline after lung resection surgery: a randomized, single-blind controlled trial The effects of preoperative short-term intense physical therapy in lung cancer patients: a randomized controlled trial. Endurance training in patients with chronic obstructive pulmonary disease: a comparison of high versus moderate intensity. Changes in Hope and Power in Lung Cancer Patients who Exercise Inspiratory Muscle Training May Increase Peak Inspiratory Flow in Chronic Obstructive Pulmonary Disease [Impact and Effect of Preoperative Short-term Pulmonary Rehabilitation Training on  Lung Cancer Patients with Mild to Moderate Chronic Obstructive Pulmonary Disease:  A Randomized Trial]. Effect of walking on circadian rhythms and sleep quality of patients with lung cancer: a randomised controlled trial Preoperative pulmonary rehabilitation before lung cancer resection: results from two randomized studies. Effect of postoperative physical training on activity after curative surgery for non-small cell lung cancer: a multicentre randomised controlled trial. High-intensity training and cardiopulmonary exercise testing in patients with chronic obstructive pulmonary disease and non-small-cell lung cancer undergoing lobectomy. PEDro. A database of randomized trials and systematic reviews in physiotherapy. A Randomized Controlled Trial of Postthoracotomy Pulmonary Rehabilitation in Patients with Resectable Lung Cancer The Impact of a Multidimensional Exercise Intervention on Physical and Functional Capacity, Anxiety, and Depression in Patients With Advanced-Stage Lung Cancer Undergoing Chemotherapy Exercise in patients with non-small cell lung cancer. Randomized Controlled Study to Evaluate the Efficacy of a Preoperative Respiratory Rehabilitation Program to Prevent Postoperative Pulmonary Complications after Esophagectomy Too Sick Not to Exercise: Using a 6-Week, Home-Based Exercise Intervention for Cancer-Related Fatigue Self-management for Postsurgical Non–Small Cell Lung Cancer Patients Short‐Term Preoperative High‐Intensity Interval Training in Patients Awaiting Lung Cancer Surgery: A Randomized Controlled Trial Combined aerobic exercise and high-intensity respiratory muscle training in patients surgically treated for non-small cell lung cancer: a pilot randomized clinical trial. Seven-day intensive preoperative rehabilitation for elderly patients with lung cancer: a randomized controlled trial.
abstract: Background Physical activity ( PA )  improves fatigue and quality of life ( QOL ) in cancer survivors . Our aim was to assess whether a 2-month PA intervention  improves fatigue and QOL for people with advanced lung cancer . Methods Participants with advanced lung cancer , Eastern Cooperative Oncology Group performance status ( PS ) ≤2 , > 6 months life expectancy , and ability to complete six-min walk test , were stratified ( disease stage , PS 0 - 1 versus 2 , centre ) and r and omized ( 1:1 ) in an open-label study to usual care ( UC ) ( nutrition and PA education material s ) or experimental intervention ( EX ) : UC plus 2-month supervised weekly PA and behaviour change sessions . Assessment s occurred at baseline , 2 , 4 , and 6 months . The primary endpoint was fatigue [ Functional Assessment of Cancer Therapy-Fatigue ( FACT-F ) question naire ] at 2 months . The study was design ed to detect a difference in mean FACT-F subscale score of 6 . Analysis was intention-to-treat using linear mixed models . Results We recruited 112 patients : 56 ( 50.4 % ) were r and omized to EX , 55(49.5 % ) to UC ; 1 ineligible . Male 55 % ; median age 64 years ( 34 - 80 ) ; 106 ( 96 % ) non-small cell lung cancer ; 106 ( 95.5 % ) stage IV . At 2 , 4 and 6 months , 90 , 73 and 62 participants were assessed , respectively , with no difference in attrition between groups . There were no significant differences in fatigue between the groups at 2 , 4 or 6 months : mean scores at 2 months EX 37.5 , UC 36.4 ( difference 1.2 , 95 % CI - 3.5 , 5.8 , P = 0.62 ) . There were no significant differences in QOL , symptoms , physical or functional status , or survival . Conclusions Adherence to the intervention was good but the intervention group did not increase their PA enough compared to the control group , and no difference was seen in fatigue or QOL . Trial Registration Australian New Zeal and Clinical Trials Registry No. ACTRN12609000971235 OBJECTIVES The goal of this study was to assess the impact of a preoperative 1-week , systematic , high-intensity inpatient exercise regimen on patients with lung cancer who had risk factors for postoperative pulmonary complications ( PPCs ) . METHODS We conducted a r and omized controlled trial with 101 subjects of a preoperative , 7-day systematic , integrated , high-intensity pulmonary exercise regimen .  The control group received st and ard preoperative care . We analysed the occurrence of PPCs in both groups as the primary outcome ; other outcomes included changes in blood gas , quality of life , peak expiratory flow rate , the 6-min walk distance and others . RESULTS The 6-min walk distance showed an increase of 22.9 ± 25.9 m in the intervention group compared with 4.2 ± 9.2 m in the control group , giving a between-group difference of 18.7 m ( 95 % confidence interval : 8.8 - 28.6 ; P < 0.001 ) ; the peak expiratory flow increased by 25.2 ± 24.6 l/min , compared with 4.2 ± 7.7 l/min ( between-group difference : 21.0 m , 95 % confidence interval : 7.2 - 34.8 ; P = 0.003 ) . The intervention group had a shorter average total ( 15.6 ± 3.6 vs 17.7 ± 5.3 days , P = 0.023 ) and postoperative length of stay ( 6.1 ± 3.0 vs 8.7 ± 4.6 days , P = 0.001 ) than the control group ; the incidence of PPCs ( 9.8 % , 5/51 vs 28.0 % , 14/50 , P = 0.019 ) was significantly lower . A multivariable analysis of the risk of PPCs identified short-term rehabilitation intervention to be an independent risk factor ( odds ratio = 0.156 , 95 % confidence interval : 0.037 - 0.649 , P = 0.011 ) . CONCLUSIONS The study results suggested that a systematic , high-intensity pulmonary exercise programme was a practical strategy when performed preoperatively in patients with lung cancer with risk factors for PPCs . CLINICAL TRIAL REGISTRATION ChiCTR-IOR-16008109 OBJECTIVES Poor aerobic fitness is a potential modifiable risk factor for long-term survival and quality of life in patients with lung cancer . This r and omized trial evaluates the impact of adding rehabilitation ( Rehab ) with high-intensity interval training ( HIIT ) before lung cancer surgery to enhance cardiorespiratory fitness and improve long-term postoperative outcome . METHODS Patients with operable lung cancer were r and omly assigned to  usual care ( UC , n = 77 ) or to intervention group ( Rehab  , n = 74 ) that entailed HIIT that was implemented only preoperatively .  Cardiopulmonary exercise testing ( CPET ) and pulmonary functional tests ( PFTs ) including forced vital capacity ( FVC ) , forced expiratory volume ( FEV 1 ) and carbon monoxide transfer factor ( KCO ) were performed before and 1 year after surgery . RESULTS During the preoperative waiting time ( median 25 days ) , Rehab patients participated to a median of 8 HIIT sessions ( interquartile [ IQ ] 25 - 75 % , 7 - 10 ) . At 1 year follow-up , 91 % UC patients and 93 % Rehab patients were still alive ( P = 0.506 ) . Pulmonary functional changes were non-significant and comparable in both groups ( FEV 1 mean -7.5 % , 95 % CI , -3.6 to -12.9 and in KCO mean 5.8 % 95 % CI 0.8 - 11.8 ) Compared with preoperative CPET results , both groups demonstrated similar reduction in peak oxygen uptake ( mean -12.2 % 95 % CI -4.8 to -18.2 ) and in peak work rate ( mean -11.1 % 95 % CI -4.2 to -17.4 ) . CONCLUSIONS Short-term preoperative rehabilitation with HIIT does not improve pulmonary function and aerobic capacity measured at 1 year after lung cancer resection . TRIAL REGISTRY Clinical Trials.gov ; No. NCT01258478 ; www . clinical trials.gov BACKGROUND The impact of short-term preoperative pulmonary rehabilitation on exercise capacity of patients with chronic obstructive pulmonary disease undergoing lobectomy for non-small cell lung cancer is evaluated . METHODS A prospect i ve observational study was design ed . Inclusion criteria consisted of an indication to lung resection because of a clinical stage I or II non-small cell lung cancer and a chronic obstructive disease on preoperative pulmonary function test . In such conditions , maximal oxygen consumption by a cardio-pulmonary exercise test was evaluated ; when this result ed as being < or = 15 ml/kg/min a pulmonary rehabilitation programme lasting 4 weeks was considered . Twelve patients fulfilled inclusion criteria , completed the preoperative rehabilitation programme and underwent a new functional evaluation prior to surgery . The postoperative record of these patients was collected . RESULTS On completion of pulmonary rehabilitation , the resting pulmonary function test and diffuse lung capacity of patients was unchanged , whereas the exercise performance was found to have significantly improved ; the mean increase in maximal oxygen consumption proved to be at 2.8 ml/kg/min ( p<0.01 ) . Eleven patients underwent lobectomy ; no postoperative mortality was noted and mean hospital stay was 17 days . Postoperative pulmonary complication was recorded in 8 patients . CONCLUSIONS Short-term preoperative pulmonary rehabilitation could improve the exercise capacity of patients with chronic obstructive pulmonary disease who are c and i date s for lung resection for non-small cell lung cancer Abstract Background . Patients with lung cancer are often burdened by dyspnoea , fatigue , decreased physical ability and loss of weight . Earlier studies of physical exercise of patients with COPD have shown promising results . The aim of this study was to investigate , if a well-documented COPD rehabilitation protocol can improve physical fitness and quality of life ( QoL ) in patients with lung cancer . Material and methods . Forty-five patients , with a minimum walking distance of 50 meters , absence of cognitive deficits or severe heart disease and motivated for physical training were invited to an exercise intervention .  The intervention consisted of seven weeks of twice weekly training , focusing on walking training , circuit training , h and ling of dyspnoea and instructions in daily diary-based training at home . Prior to , and after the intervention , Incremental- and Endurance Shuttle Walk Test ( ISWT and ESWT ) were performed , and pulmonary function as well as self-reported QoL ( EORTC-QLQ-C30 and LC13 ) were measured . Results . Fourteen subjects dropped out before commencement of the intervention . Seven were excluded after physiotherapeutic evaluation . Of the remaining 24 , three were excluded because of insufficient attendance ( < 65 % of scheduled exercise sessions ) thus 21 patients completed the intervention . For 17 patients with complete pre- and post intervention data , ISWT increased 9 % ( −77 to 39 % ) ( median and range ) ( p = 0.021 ) , while ESWT increased 109 % ( −70 to 432 % ) ( p = 0.002 ) . Twelve of 17 improved in ISWT , while 15 improved in ESWT . No changes in pulmonary function and improvements in QoL were observed . Conclusion . Patients with pulmonary cancer can achieve significant improvements in physical fitness measured with ISWT and ESWT after completion of the intervention program . No changes in pulmonary function and QoL were observed . In addition , we found that a large number of patients dropped out before intervention and that the patients , who succeeded , often discontinued training at home Background The purpose of the PROLUCA study is to investigate the efficacy of preoperative and early postoperative rehabilitation in a non-hospital setting in patients with operable lung cancer with special focus on exercise . Methods Using a 2x2 factorial design with continuous effect endpoint ( Maximal Oxygen Uptake ( VO2peak ) ) , 380 patients with non-small cell lung cancer ( NSCLC ) stage I-IIIa referred for surgical resection will be r and omly assigned to one of four groups : ( 1 ) preoperative and early postoperative rehabilitation ( starting two weeks after surgery ) ; ( 2 ) preoperative and late postoperative rehabilitation ( starting six weeks after surgery ) ; ( 3 ) early postoperative rehabilitation alone ; ( 4 ) today ’s st and ard care which is postoperative rehabilitation initiated six weeks after surgery . The preoperative rehabilitation program consists of an individually design ed , 30-minute home-based exercise program performed daily . The postoperative rehabilitation program consists of a supervised group exercise program comprising cardiovascular and resistance training two-hour weekly for 12 weeks combined with individual counseling . The primary study endpoint is VO2peak and secondary endpoints include : Six-minute walk distance ( 6MWD ) , one-repetition-maximum ( 1RM ) , pulmonary function , patient-reported outcomes ( PROs ) on health-related quality of life ( HRQoL ) , symptoms and side effects of the cancer disease and the treatment of the disease , anxiety , depression , wellbeing , lifestyle , hospitalization time , sick leave , work status , postoperative complications ( up to 30 days after surgery ) and survival . Endpoints will be assessed at baseline , the day before surgery , pre-intervention , post-intervention , six months after surgery and one year after surgery . Discussion The results of the PROLUCA study may potentially contribute to the identification of the optimal perioperative rehabilitation for operable lung cancer patients focusing on exercise initiated immediately after diagnosis and rehabilitation shortly after surgery . Trial Registration Purpose This r and omized controlled trial tested the effects of a specially design ed strength and endurance training on the independence and quality of life in lung cancer patients in stages IIIA/IIIB/IV during palliative chemotherapy . Methods Between August 2010 and December 2011 , 46 patients were r and omized into two groups receiving either conventional physiotherapy or special physiotherapeutic training . The Barthel Index served as primary endpoint . The secondary endpoints were the European Organization for Research and Treatment of Cancer Quality of Life Question naire Core-30 ( EORTC QLQ C-30/LC-13 ) question naire , the 6-Minute Walk Test ( 6MWT ) , stair walking , the Modified Borg Scale , and muscle strength . Nonparametrical data were analyzed with the Wilcoxon and Mann – Whitney U test . For parametric , data student t tests were used . A p value of ≤.05 was accepted . Results Twenty-nine patients completed the trial ( Intervention group ( IG ) , n = 18 ; control group ( CG ) , n = 11 ) . Significant differences were detectable in the Barthel Index ( IGmean = 92.08 ; CGmean = 81.67 ; p = .041 ) , in single scores of the EORTC QLQ C-30/LC-13 question naire ( physical functioning , p = .025 ; hemoptysis , p = .019 ; pain in arms or shoulder , p = .048 ; peripheral neuropathy , p = .050 ; cognitive functioning , p = .050 ) , in the 6MWT , stair walking , strength capacity , and in the patient ’s dyspnoea perception during submaximal walking activities ( IG > CG ) . Conclusion According to these findings , lung cancer patients should receive enhanced physical activity intervention during palliative chemotherapy Background : Although exercise has been addressed as an adjuvant treatment for anxiety , depression and cancer-related symptoms , limited studies have evaluated the effectiveness of exercise in patients with lung cancer . Methods : We recruited 116 patients from a medical centre in northern Taiwan , and r and omly assigned them to either a walking-exercise group ( n=58 ) or a usual-care group ( n=58 ) . We conducted a 12-week exercise programme that comprised home-based , moderate-intensity walking for 40 min per day , 3 days per week , and weekly exercise counselling . The outcome measures included the Hospital Anxiety and Depression Scale and the Taiwanese version of the MD And erson Symptom Inventory . Results : We analysed the effects of the exercise programme on anxiety , depression and cancer-related symptoms by using a generalised estimating equation method . The exercise group patients exhibited significant improvements in their anxiety levels over time ( P=0.009 and 0.006 in the third and sixth months , respectively ) and depression ( P=0.00006 and 0.004 in the third and sixth months , respectively ) than did the usual-care group patients . Conclusions : The home-based walking exercise programme is a feasible and effective intervention method for managing anxiety and depression in lung cancer survivors and can be considered as an essential component of lung cancer rehabilitation Fatigue is a frequent problem after surgical treatment of solid tumours . Aerobic exercise and psychosocial interventions have been shown to reduce the severity of this symptom in cancer patients . Therefore , we compared the effect of the two therapies on fatigue in a r and omised controlled study . Seventy-two patients who underwent surgery for lung ( n=27 ) or gastrointestinal tumours ( n=42 ) were assigned to an aerobic exercise group ( stationary biking 30 min five times weekly ) or a progressive relaxation training group ( 45 min three times per week ) . Both interventions were carried out for 3 weeks . At the beginning and the end of the study , we evaluated physical , cognitive and emotional status and somatic complaints with the European Organization for Research and Treatment of Cancer Quality of Life Question naire Core Module ( EORTC-QLQ-30 ) question naire , and maximal physical performance with an ergometric stress test . Physical performance of the training group improved significantly during the programme ( 9.4±20 watts , p=0.01 ) but remained unchanged in the relaxation group ( 1.5±14.8 watts , p=0.37 ) . Fatigue and global health scores improved in both groups during the intervention ( fatigue : training group 21 % , relaxation group 19 % ; global health of both groups 19 % , p for all ≤0.01 ) ; however , there was no significant difference between changes in the scores of both groups ( p=0.67 ) . We conclude that a structured aerobic training programme improves the physical performance of patients recovering from surgery for solid tumours . However , exercise is not better than progressive relaxation training for the treatment of fatigue in this setting Purpose Peak oxygen consumption ( VO2peak ) is an important predictive factor for long-term prognosis in patients with non-small cell lung cancer ( NSCLC ) . The purpose of this study was to investigate whether 8 weeks of exercise training improves exercise capacity , as assessed by VO2peak , and other related factors in patients with NSCLC receiving targeted therapy . Methods A total of 24 participants with adenocarcinoma were r and omly assigned to either the control group ( n = 11 ) or the exercise group ( n = 13 ) . Subjects in the exercise group participated in individualized , high-intensity aerobic interval training of exercise . The outcome measures assessed at baseline and after 8 weeks were as follows : VO2peak and the percentage of predicted VO2peak ( % predVO2peak ) , muscle strength and endurance of the right quadriceps , muscle oxygenation during exercise , insulin resistance as calculated by the homeostasis model , high-sensitivity C-reactive protein , and quality of life ( QoL ) question naire inventory . Results No exercise-related adverse events were reported . After exercise training , VO2peak and % predVO2peak increased by 1.6 mL kg−1 min−1 and 5.3 % ( p < 0.005 ) , respectively ; these changes were associated with improvements in circulatory , respiratory , and muscular functions at peak exercise ( all p = 0.001 ) . The exercise group also had less dyspnea ( p = 0.01 ) and favorably lower fatigue ( p = 0.05 ) than baseline . Conclusions Patients with NSCLC receiving targeted therapy have quite a low exercise capacity , even with a relatively high QoL. Exercise training appears to improve exercise capacity and alleviate some cancer-related symptoms Purpose . Despite mounting evidence indicating that exercise training has a positive effect on cancer recovery , the influence of cancer type on the response to exercise training remains uncharacterized . Therefore , the adaptations to exercise training were compared between groups composed of 7 different forms of cancer . Methods . A total of 319 cancer survivors completed fatigue inventories and participated in assessment s of cardiorespiratory function , which encompassed aerobic capacity ( VO2peak ) , pulmonary function ( forced vital capacity [ FVC ] and forced expiratory volume in 1 second [ FEV1 ] ) , and resting blood pressure and heart rate . Participants were divided into 7 groups based on cancer type , including breast cancer ( BC , n = 170 ) , prostate cancer and other male urogenital neoplasia ( PC , n = 38 ) , hematological malignancies ( HM , n = 34 ) , colorectal cancer ( CC , n = 25 ) , gynecological cancers ( GC , n = 20 ) , gl and ular and epithelial neoplasms ( GEN , n = 20 ) , and lung cancer ( LC , n = 12 ) . All participants completed an individualized , multimodal exercise intervention consisting of cardiorespiratory , flexibility , balance , and muscular strength training 3 days per week for 3 months . Following the intervention , all subjects were reassessed . Generalized Estimating Equations with exchangeable working correlation structure was used to model each response ; the group by time interaction effect represented the effect of cancer type on exercise-associated improvements . Results . No significant ( P > .05 ) group by time interaction effects were observed between different types of cancer for any parameter . Pre- to postexercise contrasts revealed significant improvements in VO2peak in BC , PC , HM , and GEN at the Bonferroni adjusted significance level ( .00714 ) . Heart rate was significantly lowered in the BC and CC groups . Mean fatigue indices decreased by at least 17 % in all groups , but these changes were only significant in the BC , HM , CC , and GC groups . Systolic blood pressure decreased significantly in BC and GC , and diastolic blood pressure decreased significantly only in the BC group while pulmonary function remained unchanged in all cancer types . Conclusion . Although trends toward improved cardiorespiratory and fatigue parameters only reached significance in some groups , there were no significant differences between cancer types . This suggests that cardiorespiratory and fatigue improvements following rehabilitative exercise are not dependent on cancer type . Further research investigating alternative physiological parameters are needed to confirm the relationship between cancer type and exercise-mediated rehabilitation Background Systemic inflammation plays an important role in the initiation , promotion , and progression of lung carcinogenesis . In patients with non-small cell lung cancer ( NSCLC ) , fibrinogen levels correlate with neoplasia . Here we compared the effects of pulmonary rehabilitation ( PR ) with chest physical therapy ( CPT ) on fibrinogen and albumin levels in patients with LC and previous inflammatory lung disease awaiting lung resection . Methods We conducted a r and omized clinical trial with 24 patients who were r and omly assigned to Pulmonary Rehabilitation ( PR ) and Chest Physical Therapy ( CPT ) groups . Each group underwent training 5 days weekly for 4 weeks . All patients were assessed before and after four weeks of training through clinical assessment , measurement of fibrinogen and albumin levels , spirometry , 6-minute Walk Test ( 6MWT ) , quality of life survey , and anxiety and depression scale . PR involved strength and endurance training , and CPT involved lung expansion techniques . Both groups attended educational classes . Results A mixed between-within subjects analysis of variance ( ANOVA ) revealed a significant interaction between time ( before and after intervention ) and group ( PR vs. CPT ) on fibrinogen levels ( F(1 , 22 ) = 0.57 , p < 0.0001 ) and a significant main effect of time ( F(1 , 22 ) = 0.68 , p = 0.004 ) . Changes in albumin levels were not statistically significant relative to the interaction effect between time and group ( F(1 , 22 ) = 0.96 , p = 0.37 ) nor the main effects of time ( F(1 , 22 ) = 1.00 , p = 1.00 ) and group ( F(1 , 22 ) = 0.59 , p = 0.45 ) . A mixed between-within subjects ANOVA revealed significant interaction effects between time and group for the peak work rate of the unsupported upper limb exercise ( F(1 , 22 ) = 0.77 , p = 0.02 ) , endurance time ( F(1 , 22 ) = 0.60 , p = 0.001 ) , levels of anxiety ( F(1 , 22 ) = 0.60 , p = 0.002 ) and depression ( F(1 , 22 ) = 0.74 , p = 0.02 ) , and the SF-36 physical component summary ( F(1 , 22 ) = 0.83 , p = 0.07 ) . Conclusion PR reduced serum fibrinogen levels , improved functional parameters , and quality of life of patients with LC and inflammatory lung disease awaiting lung resection . Trial registration Current Controlled Trials RBR-3nm5bv OBJECTIVES The aim of the study was to develop a multistr and ed pragmatic rehabilitation programme for operable lung cancer patients , that looks into feasibility , process indicators , outcome measures , local adaptability , compliance and potential cost benefit . METHODS An outpatient-based complex intervention , rehabilitation for operated lung cancer ( ROC ) programme , was developed to optimize physical status , prepare for the inpatient journey and support through recovery after surgery . It includes exercise classes , smoking cessation , dietary advice and patient education and was tested in an enriched cohort study within a regional thoracic unit over 18 months . RESULTS A multistr and ed pragmatic rehabilitation programme pre- and post-surgery is feasible . Fifty-eight patients received the intervention and 305 received st and ard care . Both groups were matched for age , lung function comorbidity and type of surgery . Patients in the intervention group attended exercise classes twice a week until surgery , which was not delayed . Patients attended four sessions presurgery ( range 1 - 15 ) , result ing in an improvement of 20 m ( range -73 - 195 , P = 0.001 ) in a 6-min walk test and 0.66 l in forced expiratory volume in 1 s ( range -1.85 from 1.11 , P = 0.009 ) from baseline to presurgery . Fifty-four percentage of smokers in the intervention group stopped smoking . Sixteen percentage of patients were identified as being at risk of malnourishment and received nutritional intervention . There was a trend in patients in the intervention group towards experiencing fewer postoperative pulmonary complications than those in the non-intervention group ( 9 vs 16 % , respectively , P = 0.21 ) and fewer readmissions to hospital because of complications ( 5 vs 14 % respectively , P = 0.12 ) . CONCLUSION Chronic obstructive pulmonary disease-type pulmonary rehabilitation before and after lung cancer surgery is viable , and preliminary results suggest improvement in physical measures . A multicentre , r and omized controlled trial is warranted to confirm clinical efficacy . IS RCT N REGISTRATION NUMBER IS RCT N00061628 Background Patients with advanced stage non-small cell lung cancer ( NSCLC ) or small cell lung cancer ( SCLC ) often experience multidimensional impairments , affecting quality of life during their course of disease . In lung cancer patients with operable disease , several studies have shown that exercise has a positive impact on quality of life and physical functioning . There is limited evidence regarding efficacy for advanced lung cancer patients undergoing palliative treatment . Therefore , the POSITIVE study aims to evaluate the benefit of a 24-week exercise intervention during palliative treatment in a r and omized controlled setting . Methods / design The POSITIVE study is a r and omized , controlled trial investigating the effects of a 24-week exercise intervention during palliative treatment on quality of life , physical performance and immune function in advanced , non-operable lung cancer patients . 250 patients will be recruited in the Clinic for Thoracic Diseases in Heidelberg , enrolment begun in November 2013 . Main inclusion criterion is histologically confirmed NSCLC ( stage IIIa , IIIb , IV ) or SCLC ( Limited Disease-SCLC , Extensive Disease-SCLC ) not amenable to surgery . Patients are r and omized into two groups . Both groups receive weekly care management phone calls ( CMPCs ) with the goal to assess symptoms and side effects . Additionally , one group receives a combined resistance and endurance training ( 3x/week ) . Primary endpoints are quality of life assessed by the Functional Assessment of Cancer Therapy for patients with lung cancer ( FACT-L , subcategory Physical Well-Being ) and General Fatigue measured by the Multidimensional Fatigue Inventory ( MFI-20 ) . Secondary endpoints are physical performance ( maximal voluntary isometric contraction , 6-min walk distance ) , psychosocial ( depression and anxiety ) and immunological parameters and overall survival . Discussion The aim of the POSITIVE trial is the evaluation of effects of a 24-week structured and guided exercise intervention during palliative treatment stages . Analysis of various outcomes ( such as quality of life , physical performance , self-efficacy , psychosocial and immunological parameters ) will contribute to a better underst and ing of the potential of exercise in advanced lung cancer patients . In contrast to other studies with advanced oncological patients the POSITIVE trial provides weekly phone calls to support patients both in the intervention and control group and to segregate the impact of physical activity on quality of life . Trial registration Clinical Trials.gov NCT02055508 ( Date : December 12 , 2013 Deterioration in exercise tolerance and impairment in quality of life ( QoL ) are common consequences of lobectomy . This study evaluates additional exercise and strength training after lung resection on QoL , exercise tolerance and muscle strength .  Fifty-three ( 28 male ) patients attending thoracotomy for lung cancer , mean age , range 64 ( 32 - 82 ) years ; mean pack years ( SD ) 31.9 ( 26.8 ) ; BMI 25.6 ( 4.2 ) ; FEV1 2.0 ( 0.7 ) l were r and omised to control ( usual care ) or intervention ( twice daily training plus usual care ) . After discharge the intervention group received monthly home visits and weekly telephone calls , the control group received monthly telephone calls up to 12 weeks . Assessment pre-operatively , 5 day and 12 weeks post-operatively consisted of quadriceps strength using magnetic stimulation , 6 Minute Walking Distance ( 6MWD ) and QoL-EORTC-QLQ-LC13 . QoL was unchanged over 12 weeks ; 6MWD showed significant deterioration at 5 days post-operatively compared with pre-operatively , mean difference (SD)-131.6 ( 101.8 ) m and -128.0 ( 90.7 ) m in active and control groups respectively ( p=0.89 between groups ) which returned to pre-operative levels by 12 weeks in both groups . Quadriceps strength over the 5 day in-patient period showed a decrease of -8.3 ( 11.3 ) kg in the control group compared to increase of 4.0 ( 21.2 ) kg in the intervention group ( p=0.04 between groups ) . Strength training after thoracotomy successfully prevented the fall in quadriceps strength seen in controls , however , there was no effect on 6MWD or QoL. 6MWD returned to pre-operative levels by 12 weeks regardless of additional support offered Background Many patients with lung cancer are deconditioned with poor physical fitness . Lung resection reduces physical fitness further , impairing the patient 's ability to function in daily life . Methods We conducted a single-blind r and omised controlled trial of high-intensity endurance and strength training ( 60 min , three times a week , 20 weeks ) , starting 5–7 weeks after surgery . The control group received st and ard postoperative care . The primary outcome was the change in peak oxygen uptake measured directly during walking until exhaustion . Other outcomes included changes in pulmonary function , muscular strength by one-repetition maximum ( 1RM ) , total muscle mass measured by dual energy X-ray absorptiometry , daily physical functioning and quality of life ( QoL ) . Results The intention-to-treat analysis of the 61 r and omised patients showed that the exercise group had a greater increase in peak oxygen uptake ( 3.4 mL/kg/min between-group difference , p=0.002 ) , carbon monoxide transfer factor ( Tlco ) ( 5.2 % predicted , p=0.007 ) , 1RM leg press ( 29.5 kg , p<0.001 ) , chair st and ( 2.1 times p<0.001 ) , stair run ( 4.3 steps , p=0.002 ) and total muscle mass ( 1.36 kg , p=0.012 ) compared with the controls . The mean±SD QoL ( SF-36 ) physical component summary score was 51.8±5.5 and 43.3±11.3 ( p=0.006 ) , and the mental component summary score was 55.5±5.3 and 46.6±14.0 ( p=0.015 ) in the exercise and control groups , respectively . Conclusions In patients recently operated for lung cancer , high-intensity endurance and strength training was well tolerated and induced clinical ly significant improvements in peak oxygen uptake , Tlco , muscular strength , total muscle mass , functional fitness and QoL. This study may provide a basis for exercise therapy after lung cancer surgery . Trial registration number NCT01748981 OBJECTIVE To assess the outcomes of a 6-month comprehensive multidisciplinary outpatient pulmonary rehabilitation programme in patients with chronic obstructive pulmonary disease according to age . DESIGN Prospect i ve cohort study . PATIENTS A total of 140 patients with chronic obstructive pulmonary disease ( Global Initiative for Chronic Obstructive Lung Disease ( GOLD ) 3 - 4 ) admitted to our centre for pulmonary rehabilitation . METHODS Patients were divided into 3 groups : group A ( < 65 years ) , group B ( 65 - 74 years ) and group C ( ≥ 75 years ) . All the patients received an education and individualized training programme . Pulmonary rehabilitation  efficacy was evaluated at 6 months of treatment and 12 months post-treatment . RESULTS A total of 116 patients completed the pulmonary rehabilitation programme  : 59 in group A ( 85.5 % ) , 40 in group B ( 80 % ) and 17 in group C ( 80.9 % ) . All the parameters studied ( number of sessions , 6-min walking distance , isometric quadriceps strength , health-related quality of life , maximal load , peak oxygen uptake , maximal inspiratory and expiratory pressures ) were significantly improved in each of the groups at 3 and 6 months compared with baseline . Moreover , percentage changes from baseline at 6 months for all of the parameters studied were not significantly different between age-groups . CONCLUSION Pulmonary rehabilitation is efficient in elderly patients with severe and very severe chronic obstructive pulmonary disease , and their compliance with pulmonary rehabilitation was similar to that seen in younger groups . Therefore , elderly patients with chronic obstructive pulmonary disease should not be denied pulmonary rehabilitation Introduction : A stepwise approach to the functional assessment of lung resection c and i date s is widely accepted , and this approach incorporates the measurement of exercise peak Vo2 when spirometry and radionuclear studies suggest medical inoperability . A new functional operability ( FO ) algorithm incorporates peak exercise Vo2 earlier in the preoperative assessment to determine which patients require preoperative radionuclear studies . This algorithm has not been studied in a multicenter study . Methods : The CALGB ( Cancer and Leukemia Group B ) performed a prospect i ve multi-institutional study to investigate the use of primary exercise Vo2 measurement for the prediction of surgical risk . Patients with known or suspected resectable non-small cell lung cancer ( NSCLC ) were eligible .  Exercise testing including measurement of peak oxygen uptake ( Vo2 ) , spirometry , and single breath diffusion capacity ( DLCO ) was performed on each patient . Nuclear perfusion scans were obtained on selected high-risk patients . After surgery , morbidity and mortality data were collected and correlated with preoperative data . Mortality and morbidity were retrospectively compared by algorithm-based risk groups . Results : Three hundred forty-six patients with suspected lung cancer from nine institutions underwent thoracotomy with or without resection ; 57 study patients did not undergo thoracotomy .  Patients who underwent surgery had a median survival time of 30.9 months , whereas patients who did not undergo surgery had a median survival time of 15.6 months . Among the 346 patients who underwent thoracotomy , 15 patients died postoperatively ( 4 % ) , and 138 patients ( 39 % ) exhibited at least one cardiorespiratory complication postoperatively . We found that patients who had a peak exercise Vo2 of < 65 % of predicted ( or a peak Vo2/kg < 16 ml/min/kg ) were more likely to suffer complications ( p = 0.0001 ) and were also more likely to have a poor outcome ( respiratory failure or death ) if the peak Vo2 was < 15 ml/min/kg ( p = 0.0356 ) . We also found a subset of 58 patients who did not meet FO algorithm criteria for operability , but who still tolerated lung resection with a 2 % mortality rate . Conclusions : Our data provide multicenter validation for the use of exercise Vo2 for preoperative assessment of lung cancer patients , and we encourage an aggressive approach when evaluating these patients for surgery BACKGROUND The feasibility and practicality of preoperative rehabilitation ( PR ) programs remains quite controversial in the treatment of lung cancer ( LC ) . This study explored whether a short-term high-intensity rehabilitation program could improve postoperative outcomes compared to those achieved with conventional inspiratory muscle training ( IMT ) . METHODS A three-armed r and omized controlled trial comparing the two training modalities and routine care was conducted in surgical LC patients . Patient groups received one of three treatment regimens : ( I ) high-intensity pulmonary rehabilitation ( PR ) that combined IMT with conventional resistance training ( CRT ) ( combined PR group ) ; ( II ) conventional PR ( single IMT group ) ; or ( III ) routine preoperative preparation ( control group ) . The primary endpoint was a change in the occurrence of post-operative pulmonary complications ( PPCs ) that occurred within 30 days after surgery , while secondary endpoints included changes in length of hospital stay , quality of life ( QoL ) scores , 6-min walk distance ( 6-MWD ) and peak expiratory flow ( PEF ) . RESULTS A total of 90 enrolled patients were r and omized into three groups with a computer-based 1:1:1 ratio . The intention-to-treat analysis of the study revealed that , compared with the Control Group , the Combined PR Group had a significant increase in ∆6-MWD ( by 32.67 m , P=0.002 ) , ∆PEF ( by 14.3 L/min , P=0.001 ) , ∆global scores ( by 3.7 , P=0.035 ) ; and a reduced ∆average total hospital stay ( by 3.2 d , P=0.001 ) and ∆postoperative stay ( by 3.6 d , P=0.001 ) . With regard to PPC rate , the Combined PR Group had a somewhat lower PPC severity ( grade II-V ) compared to the Control Group . CONCLUSIONS This hospital-based short-term program of PR combining high-intensity IMT with CRT was significantly superior to the conventional IMT program , indicating that this approach would be a feasible strategy for treating LC patients , especially those waiting operations with surgery-related risk factors Purpose To provide evidence -based recommendations to up date the American Society of Clinical Oncology guideline on systemic therapy for stage IV non – small-cell lung cancer ( NSCLC ) . Methods An Up date Committee of the American Society of Clinical Oncology NSCLC Expert Panel based recommendations on a systematic review of r and omized controlled trials from January 2007 to February 2014 . Results This guideline up date reflects changes in evidence since the previous guideline . Recommendations There is no cure for patients with stage IV NSCLC . For patients with performance status ( PS ) 0 to 1 ( and appropriate patient cases with PS 2 ) and without an EGFR-sensitizing mutation or ALK gene rearrangement , combination cytotoxic chemotherapy is recommended , guided by histology , with early concurrent palliative care . Recommendations for patients in the first-line setting include platinum-doublet therapy for those with PS 0 to 1 ( bevacizumab may be added to carboplatin plus paclitaxel if no contraindications ) ; combination or single-agent chemotherapy or palliative care alone for those with PS 2 ; afatinib , erlotinib , or gefitinib for those with sensitizing EGFR mutations ; crizotinib for those with ALK or ROS1 gene rearrangement ; and following first-line recommendations or using platinum plus etoposide for those with large-cell neuroendocrine carcinoma . Maintenance therapy includes pemetrexed continuation for patients with stable disease or response to first-line pemetrexed-containing regimens , alternative chemotherapy , or a chemotherapy break . In the second-line setting , recommendations include docetaxel , erlotinib , gefitinib , or pemetrexed for patients with nonsquamous cell carcinoma ; docetaxel , erlotinib , or gefitinib for those with squamous cell carcinoma ; and chemotherapy or ceritinib for those with ALK rearrangement who experience progression after crizotinib . In the third-line setting , for patients who have not received erlotinib or gefitinib , treatment with erlotinib is recommended . There are insufficient data to recommend routine third-line cytotoxic therapy . Decisions regarding systemic therapy should not be made based on age alone . Additional information can be found at http://www.asco.org/ guidelines /nsclc and http://www.asco.org/ guidelines wiki . J Clin Oncol 33:3488 - 3515 . © 2015 by American Society of Clinical BACKGROUND Physical exercise can improve cancer patients ' functioning and reduce their symptom levels . A r and omized , controlled trial was launched to test the hypothesis that physical exercise reduces fatigue and improves physical performance in cancer patients with advanced and incurable disease . METHODS Cancer patients ( n = 231 ) with a life expectancy ≤2 years were r and omized to a physical exercise group ( PEG , n = 121 ) or a control usual care group ( UCG , n = 110 ) . The PEG exercised under supervision 60 minutes twice a week for 8 weeks . Assessment s were performed before and after the intervention . The primary outcome was physical fatigue ( PF ) measured by the Fatigue Question naire . Physical performance was a secondary outcome measured by the Shuttle Walk Test ( SWT ) and h and grip strength ( HGS ) test . Analyses were performed after multiple imputations for missing data . The trial is registered with Clinical Trials.gov ( identifier , NCT00397774 ) . FINDINGS Thirty-six percent of the PEG were lost to follow-up compared with 23 % of the UCG , primarily as a result of disease progression . Seventy-eight PEG and 85 UCG patients completed the intervention . Analyses showed no significant between-group effects in PF . However , clinical ly and statistically significant between-group effects were found for the SWT and HGS test . INTERPRETATION Fatigue was not reduced but physical performance ( SWT and HGS test ) was significantly improved after 8 weeks of physical exercise . Physical exercise might therefore be a suitable approach for maintaining physical capacity in cancer patients with incurable and advanced disease INTRODUCTION The evidence on the effectiveness of rehabilitation in lung cancer patients is limited . Whole body vibration ( WBV ) has been proposed as an alternative to conventional resistance training ( CRT ) . METHODS We investigated the effect of radical treatment ( RT ) and of two rehabilitation programmes in lung cancer patients . The primary endpoint was a change in 6-min walking distance ( 6MWD ) after rehabilitation .  Patients were r and omised after RT to either CRT , WBVT or st and ard follow-up ( CON ) . Patients were evaluated before , after RT and after 12 weeks of intervention . RESULTS Of 121 included patients , 70 were r and omised to either CON ( 24 ) , CRT ( 24 ) or WBVT ( 22 ) . After RT , 6MWD decreased with a mean of 38 m ( 95 % CI 22 - 54 ) and increased with a mean of 95 m ( 95 % CI 58 - 132 ) in CRT ( p<0.0001 ) , 37 m ( 95 % CI -1 - 76 ) in WBVT ( p=0.06 ) and 1 m ( 95 % CI -34 - 36 ) in CON ( p=0.95 ) , respectively . Surgical treatment , magnitude of decrease in 6MWD by RT and allocation to either CRT or WBVT were prognostic for reaching the minimally clinical ly important difference of 54 m increase in 6MWD after intervention . CONCLUSIONS RT of lung cancer significantly impairs patients ' exercise capacity .  CRT significantly improves and restores functional exercise capacity , whereas WBVT does not fully substitute for CRT BACKGROUND Neoadjuvant chemotherapy ( NAC ) followed by surgery for resectable oesophageal or gastric cancer improves outcome when compared with surgery alone . However NAC has adverse effects . We assess here whether NAC adversely affects physical fitness and whether such an effect is associated with impaired survival following surgery . METHODS We prospect ively studied 116 patients with oesophageal or gastric cancer to assess the effect of NAC on physical fitness , of whom 89 underwent cardiopulmonary exercise testing ( CPET ) before NAC and proceeded to surgery . 39 patients were tested after all cycles of NAC but prior to surgery . Physical fitness was assessed by measuring oxygen uptake ( VO₂ in ml kg(-1 ) min(-1 ) ) at the estimated lactate threshold ( θL ) and at peak exercise ( VO₂ peak in ml kg(-1 ) min(-1 ) ) . RESULTS VO₂ at θL and at peak were significantly lower after NAC compared to pre-NAC values : VO₂ at θL 14.5 ± 3.8 ( baseline ) vs. 12.3 ± 3.0 ( post-NAC ) ml kg(-1 ) min(-1 ) ; p ≤ 0.001 ; VO₂ peak 20.8 ± 6.0 vs. 18.3 ± 5.1 ml kg(-1 ) min(-1 ) ; p ≤ 0.001 ; absolute VO₂ ( ml min(-1 ) ) at θL and peak were also lower post-NAC ; p ≤ 0.001 . Decreased baseline VO₂ at θL and peak were associated with increased one year mortality in patients who completed a full course of NAC and had surgery ; p = 0.014 . CONCLUSION NAC before cancer surgery significantly reduced physical fitness in the overall cohort . Lower baseline fitness was associated with reduced one-year-survival in patients completing NAC and surgery , but not in patients who did not complete NAC . It is possible that in some patients the harms of NAC may outweigh the benefits . Trials Registry Number : NCT01335555 Objectives : To investigate the effects of a preoperative pulmonary rehabilitation programme in patients with lung cancer undergoing video-assisted thoracic surgery .  Design : R and omized , single-blind controlled trial . Setting : Teaching hospital . Subjects : Patients with suspected or confirmed lung cancer undergoing video-assisted thoracic surgery .  Intervention : Participants were r and omized  to either a prehabilitation group or a control group .  Participants in the prehabilitation group underwent a combination of moderate endurance and resistance training plus breathing exercises three to five times per week . Main measures : The primary outcome of the study was exercise capacity . Secondary outcomes were muscle strength ( Senior Fitness Test ) , health-related quality of life ( Short-Form 36 ) and the postoperative outcomes . Patients were evaluated at baseline ( before r and omization ) , presurgery ( only the prehabilitation group ) , after surgery and three months post-operatively . Results : A total of 40 patients were r and omized and 22 finished the study ( 10 in the prehabilitation group and 12 in the control group ) . Three patients were lost to follow-up at three months . After the training , there was a statistically significant improvement in exercise tolerance ( + 397 seconds , p = 0.0001 ) , the physical summary component of the SF-36 ( + 4.4 points , p = 0.008 ) and muscle strength ( p < 0.01 ) . There were no significant differences between groups after surgery . However , three months postoperatively , significant differences were found in the mean change of exercise capacity ( p = 0.005 ) , physical summary component ( p = 0.001 ) and upper and lower body strength ( p = 0.045 and p = 0.002 ) . Conclusions : A pulmonary rehabilitation programme before video-assisted thoracic surgery seems to improve patients ’ preoperative condition and may prevent functional decline after surgery . Clinical Registration Number : NCT01963923 ( Registration date 10/10/2013 BACKGROUND We planned to investigate the effect of preoperative short period intensive physical therapy on lung functions , gas-exchange , and capacity of diffusion , and ventilation-perfusion distribution of patients with non-small cell lung cancer . METHODS Sixty patients with lung cancer , who were deemed operable , were r and omly allocated into two groups . Intensive physical therapy was performed in patients in the study group before operation . Both groups received routine physical therapy after operation . RESULTS There was no difference in pulmonary function tests between the two groups . Intensive physical therapy statistically significantly increased peripheral blood oxygen saturation . At least one complication was noted in 5 patients ( 16.7 % ) in the control group , and 2 ( 6.7 % ) , in the study group . However , there was no statistically significant difference ( p = 0,4 ) . The hospital stay has been found to be statistically significantly shortened by intensive physical therapy ( p < 0.001 ) . Ventilation-perfusion distribution was found to be significantly effected by intensive physical therapy . The change was prominent in the the contralateral lung ( p < 0.001 ) . CONCLUSIONS Intensive physical therapy appeared to increase oxygen saturation , reduce hospital stay , and change the ventilation/perfusion distribution . It had a significant , positive effect on the exercise capacity of patients PURPOSE To create a maximum tolerated 45-minute aerobic training program for patients with chronic obstructive pulmonary disease ( COPD ) and to compare its outcomes with those of commonly prescribed moderate exercise . DESIGN Prospect i ve , r and omized trial . SETTING A work physiology laboratory . PATIENTS AND METHODS The maximum exercise intensities that 7 COPD patients could sustain for 45 minutes were determined on a bilevel exercise ergometer . The patients then exercised 45 minutes daily , 5 days a week for 6 weeks , working 2.03+/-0.4 kJ/kg per session . They were matched with 6 COPD patients who pushed an O2 cart for 45 minutes daily , 5 days a week for 6 weeks , working 1.44+/-.35 kJ/kg per session . RESULTS A 45 minute maximal regimen was established by alternating 1-minute peak exercise at peak VO2-levels with 4 minutes at the ventilatory anaerobic threshold or at 40 % of peak VO2 . Maximal bilevel training significantly decreased dyspnea at rest ( p < or = .01 ) and the blood lactate level during submaximal exercise ( p<.001 ) , and increased peak VO2 and total physical work ( p<.01 ) , maximum inspiratory and expiratory pressures ( p<.01 ) , and grip and forearm strength and endurance ( p<.01 ) . The training also increased maximum voluntary ventilation while decreasing the ventilatory equivalent during exercise ( p<.001 ) . The O2 cart pushers significantly improved only on the 12-minute walk ( p<.05 ) . CONCLUSIONS A maximally intense anaerobic exercise program can be created for most COPD patients that can significantly improve both skeletal and respiratory muscle strength and endurance as well as dyspnea and physiologic parameters Using Rogers ’ science of unitary human beings , changes in hope and power among 104 lung cancer patients were examined in relation to participation in a preoperative exercise program . Participants were r and omly assigned to exercise or no-exercise and a repeated measures ANOVA was employed . The exercise group ’s power increased while the no-exercise group ’s power decreased . No differences in hope emerged . Positive correlations between hope and power were observed . Findings suggest that exercise is a form of knowing participation in change and illustrate a relation between one ’s ability to envision a better future and one ’s potential to actualize options through choice Background : When choosing a specific inhalation device for a chronic obstructive pulmonary disease ( COPD ) patient , the internal airflow resistance and the ability of the patient to overcome it and to create an optimal inspiratory flow are essential . Objectives : The purpose of the present study was to investigate : ( 1 ) the peak inspiratory flow ( PIF ) that a patient with COPD can generate while breathing through two dry powder inhalers and ( 2 ) whether in patients with low PIF  specific inspiratory muscle training ( SIMT ) will increase the PIF and exceed the minimal PIF that is considered necessary to guarantee optimal lung deposition of the drug . Methods : Inspiratory muscle strength and PIFs were measured in 60 patients with COPD . Then 28 patients with severe COPD and low PIF were r and omized to receive SIMT or to a control group . Results : With the Turbuhaler , 12 patients ( 20 % ) could not generate the optimal flow of 60 l/min . PIF correlated very well with maximal inspiratory mouth pressure ( PImax ) for the Diskus and the Turbuhaler , as well as for both males and females ( p < 0.001 ) . Following the training period , there was a statistically significant increase in the PImax in the training group . This increase was associated with a significant increase in the PIF . All patients overcame the minimal threshold PIF following the training . Conclusions : Some patients with severe COPD are not able to generate adequate flow to secure optimal lung deposition of the inhalation with the Turbuhaler . SIMT improves inspiratory muscle strength as well as PIF . Following 8 weeks of training , the optimal PIF enabling adequate lung deposition of the drug was attained in all the trained patients BACKGROUND Pulmonary rehabilitation ( PR ) is proposed as an effective strategy to decrease surgical morbidity . However , appropriate rehabilitation plan , initiation time , and optimal duration of PR remain unclear . Lung cancer patients with chronic obstructive pulmonary disease ( COPD ) are considered high-risk population for postoperative pulmonary complications ( PPCs ) because of poor lung fitness and cardiopulmonary endurance . This study aims to assess the impact of a one-week , systematic and highly-intensive rehabilitation on surgical lung cancer patients with mild to moderate COPD . METHODS A r and omized controlled trial with 48 subjects was conducted ( 24 patients each for the intervention and groups ) . The intervention group received seven days of systematic , integrated and highly-intensive PR before surgical treatment , including : pharmacotherapy with atomizing terbutaline , pulmicort and infusion of ambroxol ; and physical rehabilitation with respiratory training and endurance training . The control group underwent st and ard preoperative care . RESULTS For the intervention group , the postoperative length of stay was shorter [ ( 6.17±2.91 ) d vs ( 8.08±2.21 ) d ; P=0.013 ] ; likewise for the duration of antibiotics use [ ( 3.61±2.53 ) d vs ( 5.36±3.12 ) d ; P=0.032 ] . No significant difference was found between the groups in total in-hospital cost [ ( 46,455.6±5,080.9 ) ¥ vs ( 45,536.0±4,195.8 ) ¥ , P=0.498 ] , medicine cost [ ( 7,760.3±2,366.0 ) vs ( 6,993.0±2,022.5 ) , P=0.223 ] , and material cost [ ( 21,155.5±10,512.1 ) ¥ vs ( 21,488.8±3,470.6 ) ¥ , P=0.883 ] . In the intervention group , peak expiratory flow [ ( 268.40±123.94 ) L/min vs ( 343.71±123.92 ) L/min ; P<0.001 ] , 6-min walk distance ( 6-MWD ) [ ( 595.42±106.74 ) m vs ( 620.90±99.27 ) m ; P=0.004 ] , and energy consumption [ ( 59.93±10.61 ) kcal vs ( 61.03±10.47 ) kcal ; P=0.004 ] were statistically different after the seven-day exercise , compared with those on the first day . Finally , for the intervention group the incidence of PPCs ( 8.3 % , 2/24 vs 20.8 % , 5/24 , 20.8 % ; P=0.416 ) were lower . CONCLUSIONS The systematic and highly-intensive pulmonary rehabilitation combining abdominal respiration training , respiratory exercise with incentive spirometry , and aerobic exercise could improve the cardiorespiratory endurance of lung cancer patients with mild to moderate COPD . The proposed program may be a practicable preoperative strategy . Background : Sleep disturbances and poor rest-activity rhythms , which can reduce the quality of life , are highly prevalent among patients with lung cancer . Methods : This trial investigated the effects of a 12-week exercise intervention including home-based walking exercise training and weekly exercise counseling on 111 lung cancer patients . Participants were r and omly allocated to receive the intervention or usual-care . Outcomes included objective sleep ( total sleep time , TST ; sleep efficiency , SE ; sleep onset latency , SOL ; and wake after sleep onset , WASO ) , subjective sleep ( Pittsburgh Sleep Quality Index , PSQI ) , and rest-activity rhythms ( r24 and I < O ) . Outcomes were assessed at baseline and 3 and 6 months after intervention . Results : The PSQI ( Wald χ2=15.16 , P=0.001 ) and TST ( Wald χ2=7.59 , P=0.023 ) of the patients in the exercise group significantly improved 3 and 6 months after intervention . The moderating effect of I < O on TST was significant ( β of group × I < O=3.70 , P=0.032 ) . Conclusions : The walking program is an effective intervention for improving the subjective and objective sleep quality of lung cancer patients and can be considered an optional component of lung cancer rehabilitation Complete surgical resection is the most effective curative treatment for lung cancer . However , many patients with lung cancer also have severe COPD which increases their risk of postoperative complications and their likelihood of being considered " inoperable . " Preoperative pulmonary rehabilitation ( PR ) has been proposed as an intervention to decrease surgical morbidity but there is no established protocol and no r and omized study has been published to date . We tested two preoperative PR interventions in patients undergoing lung cancer resection and with moderate-severe COPD in a r and omized single blinded design . Outcomes were length of hospital stay and postoperative complications . The first study tested 4 weeks of guideline -based PR vs. usual care : that study proved to be very difficult to recruit as patients and providers were reluctant to delay surgery . Nine patients were r and omized and no differences were found between arms . The second study tested ten preoperative PR sessions using a customized protocol with nonst and ard components ( exercise prescription based on self efficacy , inspiratory muscle training , and the practice of slow breathing ) ( n=10 ) vs. usual care ( n=9 ) . The PR arm had shorter length of hospital stay by 3 days ( p=0.058 ) , fewer prolonged chest tubes ( 11 % vs. 63 % , p=0.03 ) and fewer days needing a chest tube ( 8.8 vs. 4.3 days p=0.04 ) compared to the controlled arm . A ten-session preoperative PR intervention may improve post operative lung reexpansion evidence d by shorter chest tube times and decrease the length of hospital stay , a crude estimator of post operative morbidity and costs . Our results suggest the potential for short term preoperative pulmonary rehabilitation interventions in patients with moderate-severe COPD undergoing curative lung resection . 4 weeks of conventional preoperative PR seems non feasible OBJECTIVE To evaluate the effect of a combined hospital plus home exercise programme following curative surgery for non-small cell lung cancer ( NSCLC ) . DESIGN R and omised controlled trial . SETTING Teaching hospital . PARTICIPANTS One hundred and thirty-one subjects with NSCLC admitted for curative surgery . INTERVENTIONS Participants were r and omised to usual care or a hospital plus home exercise programme . OUTCOMES The primary outcome was the between-group difference in physical activity 4 weeks after surgery . Secondary outcomes were the difference in quadriceps strength , exercise tolerance and quality of life [ Short Form-36 ( SF-36 ) and European Organisation for Research and Treatment of Cancer ( EORTC ) QLQ-LC13 ] from pre-operatively ( baseline ) to 4 weeks after surgery . RESULTS The participants ( n=131 ) had a mean age of 68 [ st and ard deviation ( SD ) 11 ] years and mean forced expiratory volume in 1 second of 2.4 ( SD 1.1)l . There were no significant differences in physical activity between the groups 4 weeks after surgery [ mean difference adjusted for baseline 12minutes/day , 95 % confidence interval ( CI ) -20.2 to 44.1 ] . In addition , there were no significant differences in total SF-36 or EORTC QLQ-LC13 scores from baseline to 4 weeks after surgery . Both groups had recovered their pre-operative walking distance 4 weeks after surgery , and there were no differences between the groups ( mean difference in Incremental Shuttle Walk Test from baseline to 4 weeks after surgery ( -26 m , 95 % CI -94.2 to 42.3 ) . CONCLUSIONS A hospital plus home exercise programme showed little benefit in unselected patients with NSCLC following surgery . Regardless of group allocation , the patients had recovered their pre-operative exercise tolerance levels by 4 weeks after surgery OBJECTIVES Peak VO2 , as measure of physical performance is central to a correct preoperative evaluation in patients with both non-small-cell lung cancer ( NSCLC ) and chronic obstructive pulmonary disease ( COPD ) because it is closely related both to operability criteria and the rate of postoperative complications . Strategies to improve peak VO2 , as a preoperative pulmonary rehabilitation programme ( PRP ) , should be considered favourably in these patients . In order to clarify the role of pulmonary rehabilitation , we have evaluated the effects of 3-week preoperative high-intensity training on physical performance and respiratory function in a group of patients with both NSCLC and COPD who underwent lobectomy . METHODS We studied 40 patients with both NSCLC and COPD , age < 75 years , TNM stages I-II , who underwent lobectomy . Patients were r and omly divided into two groups ( R and S ) : Group R underwent an intensive preoperative PRP , while Group S underwent only lobectomy . We evaluated peak VO2 in all patients at Time 0 ( T0 ) , after PRP/before surgery in Group R/S ( T1 ) and 60 days after surgery , respectively , in both groups ( T2 ) . RESULTS There was no difference between groups in peak VO2 at T0 , while a significant difference was observed both at T1 and T2 . In Group R , peak VO2 improves significantly from T0 to T1 : 14.9 ± 2.3 - 17.8 ± 2.1 ml/kg/min ± st and ard deviation ( SD ) , P < 0.001 ( 64.5 ± 16.5 - 76.1 ± 14.9 % predicted ± SD , P < 0.05 ) and deteriorates from T1 to T2 : 17.8 ± 2.1 - 15.1 ± 2.4 , P < 0.001 ( 76.1 ± 14.9 - 64.6 ± 15.5 , P < 0.05 ) , reverting to a similar value to that at T0 , while in Group S peak VO2 did not change from T0 to T1 and significantly deteriorates from T1 to T2 : 14.5 ± 1.2 - 11.4 ± 1.2 ml/kg/min ± SD , P < 0.00001 ( 60.6 ± 8.4 - 47.4 ± 6.9 % predicted ± SD , P < 0.00001 ) . CONCLUSIONS PRP was a valid preoperative strategy to improve physical performance in patients with  both NSCLC and COPD and this advantage was also maintained after surgery This paper describes PEDro , the Physiotherapy Evidence Data base . PEDro is a web-based data base of r and omized controlled trials and systematic review s in physiotherapy . It can be accessed free of charge at http://ptwww.cchs.usyd.edu.au/pedro . The data base contains bibliographic details and abstract s of most English- language r and omized trials and systematic review s in physiotherapy , and of many trials and review s in other language s. Trials on the data base are rated on the basis of their method ological quality so that users of the data base can quickly identify trials of high quality . Trials and systematic review s are extensively indexed to facilitate search ing . PEDro provides an important information re source to support evidence -based clinical practice Introduction : Little is known about the effects of rehabilitation for patients with lung cancer after thoracotomy . The primary objective of this study was to evaluate the effect of a multidisciplinary rehabilitation program on quality of life ( QOL ) and secondary objectives were to determine its effects on pain and exercise capacity and the feasibility of combining rehabilitation with adjuvant chemotherapy . Methods : Patients who had undergone a thoracotomy for lung cancer were r and omized between rehabilitation and usual care .  Rehabilitation consisted of twice-weekly training for 12 weeks starting 1 month after hospital discharge , scheduled visits to pain specialists , and medical social work . QOL and pain were measured with vali date d question naires at baseline and after 1 , 3 , 6 , and 12 months . Exercise tolerance was assessed at baseline and after 3 months with a 6-minute walking distance test . Results : The study closed prematurely because of the introduction of video-assisted thoracoscopic surgery .  Of 57 r and omized patients , 49 patients ( 23 active and 26 control ) were analyzed .  QOL was not significantly different between groups , although , the active group reported more pain after 3 and 6 months and more limitations because of physical problems after 3 months . In the active group , 6-minute walking distance improved by 35 m from preoperative baseline , as opposed to the control group that showed a decline by 59 m ( p = 0.024 for difference ) . Patients treated with adjuvant chemotherapy showed decreased attendance at training sessions . Conclusion : Rehabilitation did not result in a better QOL . Exercise tolerance improved at the cost of more pain and more limitations because of physical problems . We suggest that rehabilitation is better postponed for 3 to 4 months after hospital discharge Introduction . Patients with advanced-stage lung cancer face poor survival and experience co-occurring chronic physical and psychosocial symptoms . Despite several years of research in exercise oncology , few exercise studies have targeted advanced lung cancer patients undergoing chemotherapy . The aim of the present study was to investigate the benefits of a 6-week supervised group exercise intervention and to outline the effect on aerobic capacity , strength , health-related quality of life ( HRQoL ) , anxiety , and depression . Methods . VO2peak was assessed using an incremental exercise test .  Muscle strength  was measured with one repetition maximum test ( 1RM ) . HRQoL , anxiety , and depression were assessed using Functional Assessment of Cancer Therapy – Lung ( FACT-L ) scale and the Hospital Anxiety and Depression Scale ( HADS ) . Results . One hundred and forthteen patients with advanced stage lung cancer were recruited . Forty-three patients dropped out . No serious adverse events were reported . Exercise adherence in the group training was 68 % . Improvements in VO2peak ( P < .001 ) and 6-minute walk distance ( P < .001 ) and muscle strength measurements ( P < .05 ) were seen . There was a reduction in anxiety level ( P = .0007 ) and improvement in the emotional well-being parameter ( FACT-L ) but no statistically significant changes in HRQoL were observed . Conclusion . The results of the present study show that during a 6-week hospital-based supervised , structured , and group-based exercise program , patients with advanced-stage lung cancer ( NSCLC IIIb-IV , ED-SCLC ) improve their physical capacity ( VO2peak , 1RM ) , functional capacity , anxiety level , and emotional well-being , but not their overall HRQoL. A r and omized controlled trial testing the intervention including 216 patients is currently being carried out PURPOSE This study aim ed to evaluate the safety , feasibility , and effects of an 8-wk combined resistance and endurance exercise program in patients with advanced non-small cell lung cancer ( NSCLC ) during in- and outpatient care . METHODS In this intervention study , 40 patients with predominantly advanced NSCLC receiving simultaneous or sequential radiochemotherapy or chemotherapy alone were enrolled . For a period of 8 wk , patients were instructed to exercise at least five times per week during the inpatient setting and at least three times per week in the outpatient setting . Physical performance status ( endurance capacity : 6-min walk test ; strength capacity : h and held dynamometry ) , quality -of-life ( Functional Assessment of Cancer Therapy-Lung ) , fatigue ( Multidimensional Fatigue Inventory ) , and depression ( Patient Health Question naire ) were assessed at baseline ( T0 ) , after the exercise intervention ( T1 ) , and at a follow-up time point 8 wk later ( T2 ) . The primary end point was adequate adherence ( feasibility ) defined as completing at least two training sessions per week during a minimum of 6 wk . RESULTS Of 40 patients , 31 ( 77.5 % ) completed the postexercise assessment ( T1 ) and 22 ( 55 % ) completed follow-up ( T2 ) . The stages were IIA ( 5 % ) , IIIA ( 8 % ) , IIIB ( 20 % ) , and IV ( 67 % ) , and the median age was 63 yr ( range = 22 - 75 yr ) . Overall , adherence was 82 % for those patients who completed T1 , and 55 % of the 40 participating patients fulfilled the adequate adherence criterion . Those who completed the intervention showed a significant improvement in the 6-min walk distance and in knee , elbow , and hip muscle strength after the intervention ( T1 ) . Quality of life , fatigue , and depression scores remained stable or declined slightly . Significant improvements in knee-muscle strength were also observed at T2 . CONCLUSIONS Exercise training is feasible in advanced and metastatic NSCLC patients during anticancer treatment . In this pilot study , endurance and strength capacity improved over time , indicating the rehabilitative importance of the applied intervention . To investigate the potential impact of exercise training in this patient group , a larger r and omized trial is warranted Background / Aims : Patients with postoperative pulmonary complications after esophagectomy often have increased mortality . The purpose of the study was to examine the efficacy of preventing postoperative pulmonary complications by an intensive preoperative respiratory rehabilitation ( PR ) program for esophageal cancer patients . Methods : This study was a prospect i ve r and omized controlled study . Thirty patients in the PR group and 30 patients in the no preoperative respiratory rehabilitation ( NPR ) group were included . The PR group received preoperative rehabilitation for more than 7 days , while the NPR group did not receive any preoperative rehabilitation . All patients underwent postoperative rehabilitation from the first postoperative day . The postoperative pulmonary complications were evaluated using the Clavien-Dindo classification ( CDC ) and the Utrecht Pneumonia Scoring System ( UPSS ) . Results : The CDC grade in the PR group was significantly lower than that in the NPR group ( p = 0.014 ) . The UPSS score in the PR group was significantly lower than that in the NPR group at postoperative day 1 ( p = 0.031 ) . In the multivariate analysis , NPR was an independent risk factor for postoperative pulmonary complications greater than CDC grade II ( OR : 3.99 , 95 % CI : 1.28 - 12.4 , p = 0.017 ) . Conclusions : This study showed that the intensive PR program was capable of reducing the postoperative pulmonary complications in esophageal cancer patients Background : Two prevalent unmet supportive care needs reported by the non – small cell lung cancer ( NSCLC ) population include the need to manage fatigue and attain adequate exercise to meet the physical dem and s of daily living . Yet , there are no guidelines for routine rehabilitative support to address fatigue and exercise for persons with NSCLC during the critical transition from hospital to home after thoracotomy . Objective : The objective of this study was to evaluate the feasibility , acceptability , safety , and changes in study end points of a home-based exercise intervention to enhance perceived self-efficacy for cancer-related fatigue ( CRF ) self-management for persons after thoracotomy for NSCLC transitioning from hospital to home . Interventions / Methods : Guided by the principles of the Transitional Care Model and the Theory of Symptom Self-management , a single-arm design composed of 7 participants with early-stage NSCLC performed light-intensity walking and balance exercises in a virtual reality environment with the Nintendo Wii Fit Plus . Exercise started the first week after hospitalization for thoracotomy and continued for 6 weeks . Results : The intervention positively impacted end points such as CRF severity ; perceived self-efficacy for fatigue self-management , walking , and balance ; CRF self-management behaviors ( walking and balance exercises ) ; and functional performance ( number of steps taken per day ) . Conclusions : A home-based , light-intensity exercise intervention for patients after thoracotomy for NSCLC is feasible , safe , well tolerated , and highly acceptable showing positive changes in CRF self-management . Implication s for Practice : Beginning evidence suggests that a light-intensity in-home walking and balance intervention after hospitalization for thoracotomy for NSCLC is a potentially effective rehabilitative CRF self-management intervention . Next steps include testing of this health-promoting self-management intervention in a larger-scale r and omized controlled trial Introduction : Impairment in aerobic fitness is a potential modifiable risk factor for postoperative complications . In this r and omized controlled trial , we hypothesized that a high‐intensity interval training ( HIIT ) program enhances cardiorespiratory fitness before lung cancer surgery and therefore reduces the risk of postoperative complications . Methods : Patients with operable lung cancer were r and omly assigned to usual care ( UC ) ( n = 77 ) or preoperative rehabilitation based on HIIT ( Rehab ) ( n = 74 ) .  Maximal cardiopulmonary exercise testing and the 6‐minute walk test were performed twice before surgery . The primary outcome measure was a composite of death and in‐hospital postoperative complications . Results : The groups were well balanced in terms of patient characteristics . During the preoperative waiting period ( median 25 days ) , the peak oxygen consumption and the 6‐minute walking distance increased ( median + 15 % , interquartile range , 25th to 75 percentile [ IQR25%–75 % , % ] = + 9 % to + 22 % , p = 0.003 and + 15 % , IQR25%–75 % = + 8 % to + 28 % , p < 0.001 , respectively ) in the Rehab group , whereas peak oxygen consumption declined in the UC group ( median –8 % , IQR25%–75 % = –16 % to 0 % ] , p = 0.005 ) . The primary end point did not differ significantly between the two groups : at least one postoperative complication developed in 27 of the 74 patients ( 35.5 % ) in the Rehab group and 39 of 77 patients ( 50.6 % ) in the UC group ( p = 0.080 ) . Notably , the incidence of pulmonary complications was lower in the Rehab compared with in the UC group ( 23 % versus 44 % , p = 0.018 ) , owing to a significant reduction in atelectasis ( 12.2 % versus 36.4 % , p < 0.001 ) , and this decrease was accompanied by a shorter length of stay in the postanesthesia care unit ( median –7 hours , IQR25%–75 % = –4 to –10 ) . Conclusions : In this r and omized controlled trial , preoperative HIIT result ed in significant improvement in aerobic performances but failed to reduce early complications after lung cancer resection BACKGROUND Lung resection surgery further decreases exercise capacity and negatively affects respiratory muscle function in patients with non-small cell lung cancer ( NSCLC ) . The best design for exercise interventions in these patients has not been determined yet . AIM To assess the impact of aerobic exercise and high-intensity respiratory muscle training on patient outcomes following lung cancer resection surgery . DESIGN Prospect i ve , single-blind , pilot r and omized controlled trial . SETTING Outpatient cardiopulmonary rehabilitation unit of two university hospitals . POPULATION Thirty-seven patients with NSCLC after tumor resection . METHODS Patients were r and omly assigned to exercise training or usual post-operative care . The training program consisted of aerobic exercises and high-intensity respiratory muscle training ( 24 supervised sessions , 3 per week , 8 weeks ) . Primary outcome was exercise capacity assessed with peak oxygen uptake ( VO2peak ) during cardiopulmonary exercise test . Secondary outcomes included changes in respiratory muscle strength , levels of serum insulin growth factor I ( IGF-I ) and IGF binding protein 3 ( IGFBP-3 ) , and quality of life assessed with the European Organization for Research and Treatment of Cancer ( EORTC QLQ-C30 ) question naire . RESULTS The 8-week training program was associated with significant improvement in VO2peak ( 2.13 mL/Kg/min [ 95%CI 0.06 to 4.20 ] ) , maximal inspiratory and expiratory pressures ( 18.96 cmH2O [ 95 % CI 2.7 to 24.1 ] and 18.58 cmH2O [ 95 % CI 4.0 to 33.1 ] , respectively ) and IGFBP-3 ( 0.61 µg/mL [ % 95 CI 0.1 to 1.12 ] ) . No significant differences were observed in the EORTC QLQ-C30 . CONCLUSIONS An 8-week exercise program consisting of aerobic exercise and high-intensity respiratory muscle training improved exercise capacity , respiratory muscle strength , and serum IGFBP-3 levels in NSCLC patients after lung resection . There was no impact on the other outcomes assessed . CLINICAL REHABILITATION IMPACT A combination of aerobic exercise and respiratory muscle training could be included in the rehabilitation program of deconditioned patients with NSCLC after lung resection surgery BACKGROUND As a newly developed treatment , preoperative pulmonary rehabilitation ( PR ) has been studied in depth . However , few studies have assessed the relationship between advanced age and a shorter term intensive pattern of preoperative PR in patients with lung cancer ( LC ) and especially those patients waiting for therapeutic LC surgeries . This study investigated short-term preoperative PR combined with inspiratory muscle training ( IMT ) and aerobic endurance training in elderly patients scheduled to undergo LC lobectomy . METHODS A prospect i ve r and omized controlled trial with a total of 60 subjects aged ≥70 y was conducted . The intervention group ( PR group ) was treated for 1 wk with systematic and highly intensive preoperative PR training before lobectomy , and the control group ( NPR group ) was treated with conventional preoperative respiratory management . We analyzed the 6-min walking distance ( 6-MWD ) , the peak expiratory flow ( PEF ) , and quality -of-life scores before and after the rehabilitation regimen as well as the incidence of postoperative pulmonary complications ( PPCs ) . RESULTS In total , 30 patients ( PR group ) completely executed the 7-d intensive preoperative PR , and 30 patients ( NPR group ) served as the control group . The two groups were comparable at baseline . During the preoperative PR , a significantly longer 6-MWD ( increase : 28.6 ± 18.2 versus 9.4 ± 27.0 m ; between-groups difference : 19.2 m , P = 0.029 ) and an increased PEF ( increase : 26.2 ± 22.5 versus 8.2 ± 10.3 L/min ; between-groups difference : 18.0 L/min , P < 0.001 ) were noted in the PR group compared with the NPR group . After LC surgery , the mean postoperative length of stay ( 6.9 ± 4.4 versus 10.7 ± 6.4 d , P = 0.010 ) and total hospital stay ( 16.0 ± 4.5 versus 19.7 ± 6.5 d , P = 0.012 ) were significantly reduced in the PR group . Thirty-day PPCs were noted in four ( 13.3 % ) patients in the PR group and 11 ( 36.7 % ) patients in the NPR group , with a significant difference between the two groups ( P = 0.037 ) . CONCLUSIONS For elderly LC patients scheduled to undergo surgery in China , a 7-d intensive pattern of preoperative PR combined with IMT and aerobic endurance training may be a feasible rehabilitation strategy with positive physical and psychological effects
target: For the functional capacity and medical care parameters , preoperative combined aerobic , resistance , and inspiratory muscle training was shown to be effective if comprising one to four weeks , performing 1 - 3 sessions per week , with moderate intensity ( 50 % for endurance capacity ) .
background: Preoperative physical exercise protocol s prior to cancer surgery increased in popularity over recent years ; however , the beneficial effect of such protocol s is not well established , with conflicting results reported .
  We conducted a systematic review and meta- analysis of r and omized controlled trials ( RCTs ) to assess the effects of different modalities or combinations of preoperative exercise interventions and /or prehabilitation multicomponent training in patients with non-small-cell lung cancer ( NSCLC ) after surgery on the outcomes related to functional capacity , mental wellness and medical care .