Background: Patients with lung cancer often present poor cardio-respiratory fitness. Although rehabilitation programs have demonstrated beneficial effects in patients with cancer, heart failure and COPD, the impact of preoperative exercise intervention has not been thoroughly examined in lung cancer surgery.

Objectives: The primary aim was to test the effectiveness of a short-term high-intensity training (HIT) program on the occurrence of major postoperative complications. Secondary aims entailed the impact of HIT on aerobic exercise capacity.

Design: Randomized controlled trial, two centers

Methods: Patients scheduled to undergo lung cancer resection were randomized into usual care or rehabilitation arm (UC and Rehab groups). Preoperative rehabilitation was conducted by physiotherapists and consisted in 2 to 3 high-intensity training (HIT) sessions per week. Functional assessment included the peak oxygen uptake (VO 2peak ) and the anaerobic threshold (AT) during cardiopulmonary exercise testing (CPET) as well as the 6 minute walking test (6MWT). Postoperative clinical outcome data included 30-day mortality, admission in ICU as well as any postoperative organ dysfunction. Patients in both groups received a bundle of perioperative interventions to minimize the occurrence of postoperative pulmonary complications (PPCs).

Statistics: to analyze group differences, the unpaired Student t test or Mann–Whitney U-test was used for continuous variables, and the Pearson test χ2 test for dichotomous variables. To analyze within-group changes over time, the paired Student t test or Wilcoxon signed-rank test or paired was used.

Results: Over a 3 year period, a total of 189 patients were screened, and 151 were analyzed (N=77 in UC group and N=74 in Rehab group). The two groups were comparable regarding baseline patient characteristics and surgical data. The median time delay from the date of enrollment to surgery was 26 days (interquartile25-75%, 21-33 days). As shown in Figure 1, after completing the HIT program, rehabilitated patients presented significant increases in VO 2peak , in AT, in maximal power as well as in walking distance. In parallel, patients in the UC group presented significant decreases in VO 2peak , in AT and in walking distance at the 6MWT. At least one major postoperative complications occurred in 35% and 51% patients in the Rehab and UC groups (Odds Ratio [OR], 0.56; 95% confidence interval [CI], 0.29-0.1.07; P=0.080). The incidence of PPCs was lower in the Rehab group, compared with the UC group (23.0% vs 43.9%, P=0.018), with a significant reduction in the occurrence of atelectasis (12.2% vs 36.4%, P<0.001).

Conclusions: This study demonstrated that preparing patients scheduled to undergo lung cancer resection with a HIT program enhanced aerobic fitness parameters and resulted in fewer PPCs, compared with patients receiving usual care.

Preoperative exercise therapy in lung cancer surgery reduces the risk of postoperative pulmonary complications