title: 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. Perioperative rehabilitation in operation for lung cancer (PROLUCA) – rationale and design Perioperative rehabilitation and physiotherapy for lung cancer patients with chronic obstructive pulmonary disease. POSITIVE study: physical exercise program in non-operable lung cancer patients undergoing palliative treatment The effect of incentive spirometry and inspiratory muscle training on pulmonary function after lung resection. High-intensity training following lung cancer surgery: a randomised controlled trial Preoperative Exercise Vo2 Measurement for Lung Resection Candidates: Results of Cancer and Leukemia Group B Protocol 9238 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. [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]. Preoperative pulmonary rehabilitation before lung cancer resection: results from two randomized studies. Preoperative Pulmonary Rehabilitation for Lung Transplant: Effects on Pulmonary Function, Exercise Capacity, and Quality of Life; First Results in Turkey. Preoperative Maximal Oxygen Uptake and Exercise-induced Changes in Pulse Oximetry Predict Early Postoperative Respiratory Complications in Lung Cancer Patients High-intensity training and cardiopulmonary exercise testing in patients with chronic obstructive pulmonary disease and non-small-cell lung cancer undergoing lobectomy. Effects of an early postoperative walking exercise programme on health status in lung cancer patients recovering from lung lobectomy. Perioperative Rehabilitation in Operable Lung Cancer Patients (PROLUCA)
abstract: 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 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 OBJECTIVE The purpose of this study was to investigate the impact of pulmonary rehabilitation on surgical morbidity and lung function in lung cancer patients with chronic obstructive pulmonary disease ( COPD ) . METHODS Prospect ively , 22 lung cancer patients with COPD who underwent lobectomy between 2000 and 2003 were enrolled for this study as a rehabilitation group (  Rehab . Group ) . The criteria of COPD were preoperative forced expiratory volume in 1 second (FEV1)/forced vital capacity ( FVC ) < or = 70 % and more than 50 % of low attenuation area in a computed tomography . Preoperatively patients performed aggressive pulmonary exercise for two weeks and received chest physiotherapy postoperatively .  As a historical control , 60 patients with lung cancer who fulfilled the same criteria but did not receive rehabilitation between 1995 and 1999 ( control group ) were entered in this study . RESULTS Patient background s were all equivalent between the two groups . However , FEV1 and FEV1/FVC were significantly lower in the Rehab . Group ( p < 0.05 ) . Prolonged oxygen supplement and tracheostomy tended to be more frequent in the control group . The ratio of actual postoperative to predicted postoperative FEV1 was significantly better in the Rehab . Group ( p = 0.047 ) . Furthermore , postoperative hospital stay was significantly longer in the control group ( p = 0.0003 ) . CONCLUSION Despite lower FEV1 and FEV1/FVC in the Rehab . Group , postoperative pulmonary complications and long hospital stay could be effectively prevented and FEV1 was well preserved by rehabilitation and physiotherapy 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 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 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 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 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 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 . 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 OBJECTIVES The frequency and success rates of lung transplant in patients with end-stage lung disease are increasing . In our study , we investigated the effects of preoperative pulmonary rehabilitation on pulmonary function , exercise capacity , and quality of life in patients who are c and i date s for lung transplant . MATERIAL S AND METHODS This prospect i ve study included 39 consecutive patients who were c and i date s for lung transplant . All patients underwent preoperative pulmonary rehabilitation for at least 3 weeks . RESULTS Our patient group included 25 male and 14 female patients with a mean age of 36 years ( range , 15 -68 y ) . Although no significant improvement was shown in the forced expiratory volume in 1 second after pulmonary rehabilitation , significant improvements were observed in the Modified Medical Research Council dyspnea scores ( P = .001 ) and 6-minute walk distance ( P = .001 ) . We also observed statistically significant improvements in the Short-Form 36 Quality of Life Question naire 's physical function ( P = .01 ) and emotional role ( P = .02 ) subparameters . We also found a significant improvement in the Beck Depression Inventory score ( P = .004 ) . There was no correlation between Beck Depression Inventory scores before and after rehabilitation and 6-minute walk distance , Short-Form 36 , and Modified Medical Research Council dyspnea scores . CONCLUSIONS Our results suggest that preoperative pulmonary rehabilitation improves exercise capacity , reduces the sensation of dyspnea and muscle strength loss , and has a positive effect on the psychologic state of patients who are c and i date s for lung transplant Background : Postoperative respiratory complications often arise in lung cancer patients after lung resection , although these are often difficult to predict . We sought to identify reliable predictors of early-onset postoperative respiratory complications in lung cancer patients who had moderate-to-severe preoperative respiratory impairment . Methods : This was a prospect i ve observational study that included 107 consecutive lung cancer patients with forced expiratory volume in 1 s < 60 % of predicted who were scheduled for thoracotomy and lung resection .  Preoperative functional assessment s included pulmonary function testing by spirometry , single breath diffusion capacity of lung for carbon monoxide , and cardiopulmonary exercise testing . Risk factors for early-onset postoperative respiratory complications that occurred within 30 days postoperatively were sought from among these pulmonary function testing and cardiopulmonary exercise testing results . Results : By multivariable logistic regression , peak oxygen uptake ( V′O2max% ; p < 0.001 ) and the transcutaneous pulse oxygen saturation difference during load exercise ( ΔSPO2 % ; p < 0.001 ) were independent predictors of postoperative respiratory complications . A receiver operating characteristic curve had an area under the curve of 0.846 for the combination of V′O2max% and ΔSPO2 % , while the area under the curve with V′O2max% only was 0.726 . From this , the probability of postoperative respiratory complications was P complication = e ( 2 . 58 − 0 . 08 V ′ O 2 max % + 0 . 56 Δ SP O 2 % ) / [ 1 + e ( 2 . 58 − 0 . 08 V ′ O 2 max % + 0 . 56 Δ SP O 2 % ) ] . Pcomplication ≥ 0.202 for postoperative respiratory complications had a sensitivity of 80.8 % and a specificity of 81.5 % . Conclusions : For lung cancer patients with forced expiratory volume in 1 s < 60 % of predicted , in addition to common preoperative tests , V′O2max% and ΔSPO2 % may be an aid for predicting early-onset postoperative respiratory complications 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 AIMS AND OBJECTIVES To examine the effects of an early postoperative walking exercise programme on postlobectomy lung cancer patients . BACKGROUND Few interventional studies on the postoperative health status of lung cancer patients have considered the efficacy of programmes design ed to improve critical health variables . DESIGN A two-group quasi-experimental , longitudinal approach repeated four times examined participant data collected 12 - 18 hours prior to surgery and again at one , three and six months after surgery . METHODS We assigned the first 33 enrolled participants to the intervention group and the second 33 to the control group . The intervention was a daily supervised walking exercise programme consisting of 12 weeks of brisk walking exercise that began on the day following transfer to the regular ward along with weekly telephone calls until 12 weeks after discharge . Health status was measured using a structured question naire ( World Health Organization Quality of Life , brief version ) and clinical tests ( pulmonary function test and 6-minute walk test ) . We analysed data using general estimating equations , with p < 0·05 considered significant . RESULTS Intervention group pulmonary and physical functions were increasingly better over time than those of the control group , with no significant difference in quality of life between the two groups . Compared to the control group , the intervention group earned significantly better values for FVC% at postoperative month 3 and for FEV1 % at postoperative months 3 and 6 . Intervention group 6MWT scores were significantly better than those of the control group at postoperative months 1 , 3 and 6 . CONCLUSION This study demonstrated the benefits of an early postoperative walking exercise intervention for pulmonary and physical function in postlobectomy lung cancer patients . RELEVANCE TO CLINICAL PRACTICE The results may guide the design of appropriate interventions in the future . Clinical trials in other population s are needed to confirm the results of this study 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: No significant difference in pulmonary function was observed between the two groups .
  However , 6MWD and VO2 peak were significantly improved after exercise training .
  Conclusion Preoperative exercise training may reduce PPCs for lung cancer patients .
  Rehabilitation exercise strengthens muscle capacity , but does not improve impaired pulmonary function , which emphasizes the possible mechanism of the protocol design
background: Objectives This meta- analysis aim ed to demonstrate the impact of preoperative exercise therapy on surgical outcomes in patients with lung cancer and COPD .
  Pulmonary function and muscle capacity were investigated to explore their potential links with outcome improvements after exercise .