title: A postoperative shoulder exercise program improves function and decreases pain following open thoracotomy: a randomised trial. Do patients with lung cancer benefit from physical exercise? 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 Post-operative rehabilitation for surgically resected non-small cell lung cancer patients: serial pulmonary functional analysis. [Effects of a progressive walking program on physical activity, exercise tolerance, recovery, and post-operative complications in patients with a lung resection]. The effect of resistance inspiratory muscle training in the management of breathlessness in patients with thoracic malignancies: a feasibility randomised trial Initial clinical outcomes after completion of training in a Canadian Royal College thoracic surgery program. Preoperative pulmonary rehabilitation versus chest physical therapy in patients undergoing lung cancer resection: a pilot randomized controlled trial. 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. A Randomized Controlled Trial of Postthoracotomy Pulmonary Rehabilitation in Patients with Resectable Lung Cancer
abstract: QUESTION Does a postoperative physiotherapy exercise program incorporating shoulder exercises improve shoulder function , pain , range of motion , muscle strength , and health-related quality of life in patients undergoing elective pulmonary resection via open thoracotomy ? DESIGN R and omised trial with concealed allocation , assessor blinding , and intention-to-treat analysis . PARTICIPANTS 76 patients who underwent pulmonary resection via open thoracotomy . INTERVENTION All participants received st and ard medical and nursing care involving a clinical pathway . The experimental group also received physiotherapy interventions that included daily supervised , progressive exercises until discharge and a postoperative exercise booklet on discharge . OUTCOME MEASURES Preoperatively and up to 3 months postoperatively pain was measured with a numerical rating scale , shoulder function with the Shoulder Pain and Disability Index , and quality of life with the Short Form-36 . Shoulder range of motion and muscle strength were measured in a subgroup . RESULTS The experimental group had 1.3 units ( 95 % CI 0.3 to 2.2 ) less shoulder pain ( scored /10 ) and 2.2 units ( 95 % CI 0.2 to 4.3 ) less total pain ( scored /30 ) at discharge , and 7.6 % ( 95 % CI 1.7 to 13.6 ) better function at 3 months . The Short Form-36 physical component score was 4.8 points ( 95 % CI -0.3 to 10.0 ) better for the experimental group than the control group at 3 months . Differences between groups in all range of motion and strength measures were small and statistically non-significant . CONCLUSION A physiotherapist-directed postoperative exercise program result ed in significant benefits in pain and shoulder function over usual care for patients following open thoracotomy . TRIAL REGISTRATION ANZCTRN 12605000201673 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 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 INTRODUCTION Post-operative pulmonary rehabilitation in patients who have undergone surgery for lung cancer is a subject of open debate . Clinical practice in this setting is based on the results of observational trials , such as the one described here . Prospect i ve r and omized controlled trials have been registered and recruitment is ongoing . METHODS From 2005 to 2008 , 110 patients with surgical non-small cell lung cancer were entered into a post-operative inpatient pulmonary rehabilitation programme for 3 weeks . All patients were evaluated for pulmonary function after surgery ( time 0 ; T0 ) and at the end of pulmonary rehabilitation programme ( time 1 ; T1 ) . Statistical analysis focused on improvement in pulmonary function parameters and physical performance in the 6-min walking test ( 6MWT ) . Mixed models multiple linear regression was used to identify parameters related to the primary end-points of this research . RESULTS Patients ' mean age was 70.1 years ( st and ard deviation ( SD ) 8.5 years ) ; male/female ratio 73/37 . A total of 94 patients underwent lobectomy , 8 underwent pneumonectomy , and the remaining 8 underwent bilobectomy . Among the analysed parameters a significant improvement could be detected only with regards to the 6MWT ( 257.4 ( SD 112.2 ) at T0 and 382.8 ( SD 11.09 ) at T1 ) . CONCLUSION Post-operative pulmonary rehabilitation in patients with surgical non-small cell lung cancer is effective in terms of exercise tolerance 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 Objectives Breathlessness in patients with lung cancer is a common and distressing symptom affecting 50–70 % of patients , rising to some 90 % for those with advanced lung cancer . The aim of the current study was to assess how feasible inspiratory muscle training ( IMT ) is in the lung cancer population and explore changes in outcome variables . Material s and methods A pilot feasibility r and omised trial was conducted in patients with clinical ly stable lung cancer . The experimental group received training using a pressure threshold device . Patients were instructed to carry out five IMT sessions weekly for 12 weeks for a total of 30 mins/day . Patients in the control group received st and ard care . Outcome measures were completed at baseline and monthly for 3 months , and included : physiological parameters ( FEV1 , FVC ) ; perceived severity of breathlessness using six 10-point NRS ; modified Borg Scale ; quality of life using the short form Chronic Respiratory Disease Question naire ; Hospital Anxiety and Depression Scale , and safety .  Results Forty-six patients ( M = 37 , F = 9 ) at a mean age of 69.5 years old and a mean of 16 months post-diagnosis who were not currently receiving chemotherapy and /or radiotherapy were recruited . Seventy-percent had NSCLC and advanced disease . Statistical ( area under the curve-AUC ) and clinical ly important differences were seen with regard to distress from breathlessness ( p = 0.03 ) , ability to cope with breathlessness ( p = 0.01 ) , satisfaction with breathlessness management ( p = 0.001 ) , fatigue ( p = 0.005 ) , emotional function ( p = 0.011 ) , breathlessness mastery ( p = 0.015 ) and depression ( p = 0.028 ) . The m-Borg difference between the two groups at 3 months was 0.80 , which is borderline clinical ly significant . Changes were more evident in the 3-month assessment where the effect of the intervention came to its peak . Conclusion This trial shows the IMT is feasible and potentially effective in patients with lung cancer . These findings warrant a fully powered larger r and omised controlled trial BACKGROUND Thoracic procedures are currently performed by general and thoracic surgeons . Initial clinical outcome after training is a good measure of the quality of the surgical training received . METHODS We examined the morbidity and mortality for  pneumonectomy , lobectomy and esophagectomy  during one surgeon 's first 2 years of practice ; we collected data prospect ively . The results were based on the experience of the only dedicated thoracic surgeon ( 5 years of general surgery and 3 years of thoracic surgery training with certification from the Royal College of Physicians and Surgeons of Canada ) at the largest tertiary care hospital of Brown University School of Medicine . RESULTS During the 2-year period , 154 major pulmonary resections ( 20 pneumonectomies , 134 lobectomies ) and 25 esophagectomies ( 18 transhiatal , 4 Ivor-Lewis , 2 thoracoabdominal , one 3-incision ) were performed . Mortality for major lung resection was 1.9 % ( pneumonectomy 5 % , lobectomy 1.5 % ) , and morbidity was 27 % ( pneumonectomy 35 % , lobectomy 26 % ) . Mortality for esophagectomy was 4 % , and morbidity was 36 % ( anastamotic leak 12 % ) . CONCLUSIONS These results compare favourably with clinical outcomes published from several large series . Thoracic surgical training in Canada is adequate and prepares surgeons well to perform major thoracic procedures . A data base of the initial results from all graduates of thoracic surgery training in Canada is needed . Such a data base could be used to compare the initial results of thoracic procedures performed by general and thoracic surgery graduates from Canada and the United States 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 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 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
target: There was no difference between the effect of late- and early-initiated exercise intervention .
  Exercise has a small-to-moderate effect at short-term follow-up on exercise capacity and the physical component of health-related quality of life in patients operated for lung cancer .
  The long-term effects of exercise capacity are unknown .
  Early-initiated exercise programmes ( 2 weeks post-operation ) did not show an effect on exercise capacity .
background: OBJECTIVE To review the evidence concerning the effects of  postoperative exercise interventions  on exercise capacity and health-related quality of life  following resection for non-small cell lung cancer , and to review whether different initiation times of exercise produce different effects on exercise capacity .