title: Low physical activity levels and functional decline in individuals with lung cancer. Postoperative pulmonary complications following thoracic surgery: are there any modifiable risk factors? 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. The effect of incentive spirometry and inspiratory muscle training on pulmonary function after lung resection. Long-term impact of developing a postoperative pulmonary complication after lung surgery Does physiotherapy reduce the incidence of postoperative pulmonary complications following pulmonary resection via open thoracotomy? A preliminary randomised single-blind clinical trial. [Effects of a progressive walking program on physical activity, exercise tolerance, recovery, and post-operative complications in patients with a lung resection]. Preoperative Exercise Vo2 Measurement for Lung Resection Candidates: Results of Cancer and Leukemia Group B Protocol 9238 Influence of major pulmonary resection on postoperative daily ambulatory activity of the patients. Preoperative pulmonary rehabilitation versus chest physical therapy in patients undergoing lung cancer resection: a pilot randomized controlled trial. The effects of preoperative short-term intense physical therapy in lung cancer patients: a randomized controlled trial. Preoperative pulmonary rehabilitation before lung cancer resection: results from two randomized studies. Peak oxygen consumption during cardiopulmonary exercise test improves risk stratification in candidates to major lung resection. High-intensity training and cardiopulmonary exercise testing in patients with chronic obstructive pulmonary disease and non-small-cell lung cancer undergoing lobectomy. Physical activity and survival after cancer diagnosis in men. Seven-day intensive preoperative rehabilitation for elderly patients with lung cancer: a randomized controlled trial. Perioperative Rehabilitation in Operable Lung Cancer Patients (PROLUCA)
abstract: OBJECTIVES Physical activity has been infrequently measured objective ly in non-small cell lung cancer ( NSCLC ) . We aim ed to investigate levels of physical activity , functional and patient reported outcomes at diagnosis and over six months in participants with recently diagnosed NSCLC and compare results with both physical activity guidelines and outcomes of similar-aged healthy individuals . METHODS This prospect i ve observational study assessed 50 individuals from three Australian tertiary hospitals with stage I-IIIB NSCLC at diagnosis , then 10 weeks and six months later . Thirty five healthy individuals without cancer were assessed once . Outcome measures included  tri-axial accelerometery ( number of steps per day ) , six minute walk distance ( 6MWD ) , muscle strength and question naires including health-related quality of life ( HRQoL ) . RESULTS Individuals with NSCLC were engaged in significantly less physical activity than similar-aged healthy individuals , with 60 % not meeting physical activity guidelines . At diagnosis they had worse quadriceps strength , nutritional status and HRQoL. Over six months , participants with NSCLC experienced decline in self-reported physical activity , 6MWD and muscle strength , and worsening symptoms . CONCLUSION At diagnosis individuals with NSCLC engage in less physical activity , are weaker and more depressed than healthy individuals and their self-reported physical activity declines over six months . Future studies are required to investigate the efficacy of interventions to increase physical activity Background Postoperative pulmonary complications ( PPC ) are the most frequently observed complications following lung resection , of which pneumonia and atelectasis are the most common . PPCs have a significant clinical and economic impact associated with increased observed number of deaths , morbidity , length of stay and associated cost . The aim of this study was to assess the incidence and impact of PPCs and to identify potentially modifiable independent risk factors . Methods A prospect i ve observational study was carried out on all patients following lung resection via thoracotomy in a regional thoracic centre over 13 months .  PPC was assessed using a scoring system based on chest x-ray , raised white cell count , fever , microbiology , purulent sputum and oxygen saturations . Results Thirty-four of 234 subjects ( 14.5 % ) had clinical evidence of PPC . The PPC patient group had a significantly longer length of stay ( LOS ) in hospital , high dependency unit ( HDU ) LOS , higher frequency of intensive care unit ( ITU ) admission and a higher number of hospital deaths . Older patients , body mass index ( BMI ) ≥30 kg/m2 , preoperative activity < 400 m , American Society of Anesthesiologists ( ASA ) score ≥3 , smoking history , chronic obstructive pulmonary disease ( COPD ) , lower preoperative forced expiratory volume in 1 s ( FEV1 ) and predicted postoperative ( PPO ) FEV1 were all significantly ( p<0.05 ) associated with PPC on univariate analysis . Multivariate analysis confirmed that age > 75 years , BMI ≥30 kg/m2 , ASA ≥3 , smoking history and COPD were significant independent risk factors in the development of PPC ( p<0.05 ) . Conclusion The clinical impact of PPCs is marked . Significant independent preoperative risk factors have been identified in current clinical practice . Potentially modifiable risk factors include BMI , smoking status and COPD . The impact of targeted therapy requires further evaluation 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 A predicted postoperative forced expiratory volume in 1 second ( FEV1 ) of less than 800 ml or 40 % of predicted is a common criterion for exclusion of patients from lung resection for cancer . Usually , the predicted postoperative lung function is calculated according to a formula based on the number of lung segments that will be resected . Incentive spirometry and specific inspiratory muscle training are two maneuvers that have been used to enhance lung expansion and inspiratory muscle strength in patients with chronic obstructive pulmonary disease and after lung operation . METHODS Thirty-two patients with chronic obstructive pulmonary disease who were c and i date s for lung resection were r and omized into two groups : 17 patients received specific inspiratory muscle training and incentive spirometry , 1 hour per day , six times a week , for 2 weeks before and 3 months after lung resection ( group A ) and 15 patients were assigned to the control group and received no training ( group B ) . RESULTS Inspiratory muscle strength increased significantly in the training group , both before and 3 months after the operation . In group B , the predicted postoperative FEV1 value consistently underestimated the actual postoperative FEV1 by approximately 70 ml in the lobectomy subgroup and by 110 ml in the pneumonectomy subgroup . In group A , the actual postoperative FEV1 was higher than the predicted postoperative FEV1 by 570 ml in the lobectomy subgroup and by 680 ml in the pneumonectomy subgroup of patients . CONCLUSIONS In patients undergoing lung resection the simple calculation of predicted postoperative FEV1 underestimates the actual postoperative FEV1 by a small fraction . Lung functions can be increased significantly when incentive spirometry and specific inspiratory muscle training are used before and after operation Introduction Postoperative pulmonary complications ( PPC ) such as atelectasis and pneumonia are common following lung resection . PPCs have a significant clinical impact on postoperative morbidity and mortality . We studied the long-term effects of PPCs and sought to identify independent risk factors . Methods A prospect i ve observational study involved all patients following lung resection in a regional thoracic centre over 4 years .  PPCs were assessed daily in hospital using the Melbourne group scale based on chest X-ray , white cell count , fever , purulent sputum , microbiology , oxygen saturations , physician diagnosis and intensive therapy unit (ITU)/high-dependency unit readmission . Follow-up included hospital length of stay ( LOS ) , 30-day readmissions , and mortality . Results 86 of 670 patients ( 13 % ) who had undergone a lung resection developed a PPC . Those patients had a significantly longer hospital LOS in days ( 13 , 95 % CI 10.5–14.9 vs 6.3 , 95 % CI 5.9 to 6.7 ; p<0.001 ) and higher rates of ITU admissions ( 28 % vs 1.9 % ; p<0.001 ) and 30-day hospital readmissions ( 20.7 % vs 11.9 % ; p<0.05 ) . Significant independent risk factors for development of PPCs were COPD and smoking ( p<0.05 ) , not age . Excluding early postoperative deaths , developing a PPC result ed in a significantly reduced overall survival in months ( 40 , 95 % CI 34 to 44 vs 46 , 95 % CI 44 to 47 ; p=0.006 ) . Those who developed a PPC had a higher rate of non-cancer-related deaths ( 11 % vs 5 % ; p=0.020 ) . PPC is a significant independent risk factor for late deaths in non-small cell lung cancer patients ( HR 2.0 , 95 % CI 1.9 to 3.2 ; p=0.006 ) . Conclusions Developing a PPC after thoracic surgery is common and is associated with a poorer long-term outcome OBJECTIVE This study investigates whether targeted postoperative respiratory physiotherapy decreased the incidence of postoperative pulmonary complications and length of stay for patients undergoing elective pulmonary resection via open thoracotomy . METHODS Seventy-six patients participated in a prospect i ve , single-blind , parallel-group , r and omised trial with concealed allocation , assessor blinding and intention-to-treat analysis . Treatment group participants received daily respiratory physiotherapy interventions until discharge . Control group participants received st and ard medical/nursing care involving a clinical pathway . The presence of postoperative pulmonary complications was assessed on a daily basis during hospitalisation using a st and ardised diagnostic tool . Length of stay was recorded . RESULTS Postoperative pulmonary complications developed in two participants ( 4.8 % ) in the treatment group and in one participant ( 2.9 % ) in the control group ; the difference ( treatment minus control ) was 1.8 % ( 95 % confidence interval ( CI ) -10.6 % to 13.1 % ) ( p=1.00 ) . No significant difference was found between groups for length of stay ( treatment group , median 6.0 days ; control group 6.0 days ) ( p=0.87 ) . A preoperative forced expiratory volume in 1s of 1.5l or less ( p=0.005 ) and a history of chronic obstructive pulmonary disease ( p=0.008 ) were associated with a greater number of criteria for a postoperative pulmonary complication being met . CONCLUSIONS In this patient population , given the low incidence of postoperative pulmonary complications , targeted respiratory physiotherapy may not be required in addition to st and ard care involving a clinical pathway following pulmonary resection via open thoracotomy . These results should be extrapolated with caution to those patients undergoing pulmonary resection with poor preoperative lung function PURPOSE The purpose of this study was to identify the effects of a Progressive Walking program ( PW ) on physical activity , exercise tolerance , recovery , and post-operative complications for patients with a lung resection . METHODS A nonequivalent control group non-synchronized design was utilized and 37 participants with a lung resection ( 22 for control group , 15 for experimental group ) were recruited at A university hospital from December 2012 to August 2013 .  The PW consisted of preoperative education , goal setting , and feedback , provided to the experimental group , and usual care to the control group . Data were analyzed using the SPSS WIN 18.0 . RESULTS A higher proportion of patients in the experimental group showed adequate levels of physical activity ( p=.001 ) , shorter period of chest tube retention ( ≤ 7 days ; p=.011 ) , and shorter stay in the hospital ( ≤ 10 days ; p=.036 ) than patients in the control group . Patients in the experimental group reported longer 6-minute walking distance ( p=.032 ) and lower levels of dyspnea ( p=.049 ) than patients in the control group . The PW  did not influence the occurrence of pulmonary complications . CONCLUSION The findings of this study suggest that the PW could be a useful strategy for improving patients ' post-operative health and reducing cost after lung resection 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 To describe and compare the daily ambulatory activity  of the patients before and one month after major lung resection .  Daily activity was measured using a pedometer ( OMROM Walking Style PRO ) given preoperatively in a prospect i ve way to a series of 21 consecutive cases scheduled for lobectomy or pneumonectomy .  Analyzed variables were age , pulmonary function , mean number of total and aerobic steps per day , walked distance and mean daily time of aerobic activity . Activity variables were analyzed individually and as a new differential variable DELTA . Wilcoxon and Mann-Whitney nonparametric tests were used for comparison between groups . General series data : 19 male . Age : 63+/-10.9 years . FEV(1)% : 88.4+/-22.7 . DLCO : 86.2+/-21.6 . Eleven cases had COPD criteria . Type of surgery : 3 pneumonectomy/18 lobectomy . Activity data : all patients showed a global decrease of their activity one month after surgery but , patients in the pneumonectomy group are unable to keep aerobic activity meanwhile patients that undergone lobectomy showed only a 25 % reduction in the measured variables . Major pulmonary resection decreases the time and the quality of the daily ambulatory activity of the patients during the first postoperative month . Despite limitations , the chosen pedometer OMRON Walking Style Pro is an efficient tool to evaluate the perioperative daily ambulatory activity of patients OBJECTIVE To evaluate the effect of 4 weeks of pulmonary rehabilitation ( PR ) versus chest physical therapy ( CPT ) on the preoperative functional capacity and postoperative respiratory morbidity of patients undergoing lung cancer resection . DESIGN R and omized single-blinded study . SETTING A teaching hospital . PARTICIPANTS Patients undergoing lung cancer resection ( N=24 ) . INTERVENTIONS Patients were r and omly assigned to receive PR ( strength and endurance training ) versus CPT ( breathing exercises for lung expansion ) . Both groups received educational classes . MAIN OUTCOME MEASURES Functional parameters assessed before and after 4 weeks of PR or CPT ( phase 1 ) , and pulmonary complications assessed after lung cancer resection ( phase 2 ) . RESULTS Twelve patients were r and omly assigned to the PR arm and 12 to the CPT arm . Three patients in the CPT arm were not su bmi tted to lung resection because of inoperable cancer . During phase 1 evaluation , most functional parameters in the PR group improved from baseline to 1 month : forced vital capacity ( FVC ) ( 1.47L [ 1.27 - 2.33L ] vs 1.71L [ 1.65 - 2.80L ] , respectively ; P=.02 ) ; percentage of predicted FVC ( FVC% ; 62.5 % [ 49%-71 % ] vs 76 % [ 65%-79.7 % ] , respectively ; P<.05 ) ; 6-minute walk test ( 425.5±85.3 m vs 475±86.5 m , respectively ; P<.05 ) ; maximal inspiratory pressure ( 90±45.9cmH(2)O vs 117.5±36.5cmH(2)O , respectively ; P<.05 ) ; and maximal expiratory pressure ( 79.7±17.1cmH(2)O vs 92.9±21.4cmH(2)O , respectively ; P<.05 ) . During phase 2 evaluation , the PR group had a lower incidence of postoperative respiratory morbidity ( P=.01 ) , a shorter length of postoperative stay ( 12.2±3.6d vs 7.8±4.8d , respectively ; P=.04 ) , and required a chest tube for fewer days ( 7.4±2.6d vs 4.5±2.9d , respectively ; P=.03 ) compared with the CPT arm . CONCLUSIONS These findings suggest that 4 weeks of PR before lung cancer resection improves preoperative functional capacity and decreases the postoperative respiratory morbidity 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 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 BACKGROUND The objective of this investigation was to assess the association of peak oxygen consumption ( Vo(2 ) ) with postoperative outcome in a prospect i ve cohort of patients undergoing major lung resection for the treatment of lung cancer . METHODS Preoperative symptom-limited cardiopulmonary exercise testing ( CPET ) performed using cycle ergometry was conducted in 204 consecutive patients who had undergone pulmonary lobectomy or pneumonectomy .  Peak Vo(2 ) was tested for possible association with postoperative cardiopulmonary complications and mortality . Logistic regression analysis , vali date d by a bootstrap analysis , was used to adjust for the effect of other perioperative factors . The role of peak Vo(2 ) in stratifying the surgical risk was further assessed in different groups of patients subdivided according to their cardiorespiratory status . RESULTS Logistic regression showed that peak Vo(2 ) was an independent and reliable predictor of pulmonary complications ( p = 0.04 ) . All six deaths occurred in patients with a peak Vo(2 ) of < 20 mL/kg/min ( four deaths in patients with a peak Vo(2 ) of < 12 mL/kg/min ) . The mortality rate in this high-risk group was 10-fold higher ( 4 of 30 patients ; 13 % ) compared to those with higher peak Vo(2 ) ( p = 0.006 ) . Compared to patients with a peak Vo(2 ) of > 20 mL/kg/min , those with a peak Vo(2 ) of < 12 mL/kg/min had 5-fold , 8-fold , 5-fold , and 13-fold higher rates , respectively , of total cardiopulmonary complications pulmonary complications , cardiac complications , and mortality . CONCLUSIONS The present study supports a more liberal use of CPET before lung resection compared to the current guidelines since this test can help in stratifying the surgical risk and optimizing perioperative care 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 BACKGROUND The number of cancer survivors is increasing rapidly ; however , little is known about whether engaging in physical activity after a cancer diagnosis is associated with lower mortality rates in men . METHODS We conducted a prospect i ve cohort study of 1021 men ( mean age , 71.3 years ) who were diagnosed with cancer ( other than nonmelanoma skin cancer ) . Men reported their physical activities ( walking , stair climbing , and participation in sports and recreational activities ) on question naires in 1988 , a median of 6 years after their cancer diagnosis .  Physical activity was up date d in 1993 and men were followed until 2008 , with mortality follow-up > 99 % complete , during which 777 men died ( 337 from cancer , 190 from cardiovascular disease ) . RESULTS In multivariate analyses , the relative risks for all-cause mortality associated with expending < 2100 , 2100 - 4199 , 4200 - 8399 , 8400 - 12,599 , and ≥ 12,600 kJ/week in physical activity were 1.00 ( referent ) , 0.77 , 0.74 , 0.76 , and 0.52 , respectively ( P-trend < 0.0001 ) . Higher levels of physical activity also were associated with lower rates of death from cancer and cardiovascular disease ( P- trend = 0.01 and 0.002 , respectively ) . CONCLUSIONS Engaging in physical activity after cancer diagnosis is associated with better survival among men 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 Introduction . Surgical resection in patients with non – small cell lung cancer ( NSCLC ) may be associated with significant morbidity , functional limitations , and decreased quality of life . Objectives . The safety and feasibility of a preoperative and early postoperative rehabilitation program in patients operated for NSCLC was determined in a nonhospital setting , with focus on high-intensity interval exercise . Methods . Forty patients with biopsy-proven NSCLC stages I to IIIa referred for surgical resection at the Department of Cardiothoracic Surgery RT , Rigshospitalet , University of Copenhagen , were r and omly assigned to 1 of 4 groups ( 3 intervention groups and 1 control group ) . The preoperative intervention consisted of a home-based exercise program , while the postoperative exercise program comprised a supervised group exercise program involving resistance and high-intensity interval cardiorespiratory exercise 2 hours weekly for 12 weeks combined with individual counseling . The study endpoints were inclusion rate , adherence , and number of adverse events . Results . Forty patients ( of 124 screened ; 32 % ) were included and r and omized into the 4 groups . The postoperative exercise was completed by 73 % of the patients r and omized to this intervention . No adverse events were observed , indicating that the early postoperative exercise program is safe . The preoperative home-based exercise program was not feasible due to interfering diagnostic procedures and fast-track surgery that left only 1 to 2 weeks between diagnosis and surgery . Conclusion . The early postoperative exercise program for patients with NSCLC was safe and feasible , but in a fast-track set up , a preoperative home-based exercise program was not feasible for this population
target: Preoperative exercise training may reduce the risk of developing a postoperative pulmonary complication , the duration of intercostal catheter use , postoperative length of hospital stay , and improve both exercise capacity and FVC in people undergoing lung resection for NSCLC .
background: BACKGROUND Surgical resection for early stage non-small cell lung cancer ( NSCLC ) offers the best chance of cure , but is associated with a risk of postoperative pulmonary complications ( i.e. pneumonia ( new infiltrate coupled with either fever ( > 38º C ) and purulent secretions , or fever and white cell count > 11,000 ) , bronchopleural fistula , severe atelectasis that requires chest physiotherapy or bronchoscopy , and prolonged mechanical ventilation ( > 48 hours ) ) .
  It is currently unclear if preoperative exercise training , and the potential result ant improvement in exercise capacity , may also improve postoperative outcomes , such as the risk of developing postoperative pulmonary complications , the length of postoperative intercostal drainage , or the length of hospital stay .
  OBJECTIVES The primary aims of this study were to determine the effect of preoperative exercise training on postoperative outcomes , such as risk of developing a postoperative pulmonary complication , and postoperative duration of intercostal catheter use in adults scheduled to undergo lung resection for NSCLC .
  The secondary aims of this study were to determine the effect of preoperative exercise training  on length of hospital stay , fatigue , dyspnoea , exercise capacity , lung function , and postoperative mortality .