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

Abstract

BackgroundSystemic 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.MethodsWe conducted a randomized clinical trial with 24 patients who were randomly 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.ResultsA 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).ConclusionPR reduced serum fibrinogen levels, improved functional parameters, and quality of life of patients with LC and inflammatory lung disease awaiting lung resection.Trial registrationCurrent Controlled Trials RBR-3nm5bv.

Impact of breathing exercises in subjects with lung cancer undergoing surgical resection: A systematic review and meta‐analysis

“…The titles and abstracts of the remaining 291 articles were assessed, and 28 articles were retained for the full‐text analysis. Finally, sixteen of them were found relevant and included in the meta‐analysis (Benzo et al., ; Brocki, Andreasen, Langer, Souza, & Westerdahl, ; Chen, Li, & Zhang, ; He, ; Huang et al., ; Jia, ; Jiang & Liang, ; Li, Huang, & Zhong, ; Lin, Yang, & Wu, ; Morano et al., ; Pehlivan et al., ; Sebio Garcia et al., ; Stefanelli et al., ; Sun, Tan, & Yang, ; Wang, Huang, Huang, & Guo, ; Zhang & Zhao, ).…”

“…In sixteen eligible RCTs, eight trials were preoperative intervention (Benzo et al., ; Huang et al., ; Morano et al., ; Pehlivan et al., ; Sebio Garcia et al., ; Stefanelli et al., ; Wang et al., ; Zhang & Zhao, ), four trials were postoperative intervention (Brocki et al., ; Chen et al., ; Jiang & Liang, ; Sun et al., ), and four trials covered perioperative breathing exercises that continued after the surgery (He, ; Jia, ; Li et al., ; Lin et al., ). The duration of breathing exercise interventions ranged from 1 week–6 months, and each exercise had a different intervention frequency.…”

“…Breathing exercises are a broad range of respiratory strategies that include pursed‐lip breathing, abdominal breathing, thoracic breathing exercises and others (Huang et al., ; Morano et al., ; Nici et al., ; Pehlivan, Turna, Gurses, & Gurses, ). They allow patients with lung cancer to take a deep breath and increase oxygen intake by prolonging and slowing down inhalation and exhalation (Ozalevli, Ilgin, Kul, Bulac, & Akkoclu, ).…”

Effects of preoperative physiotherapy education on hospital stay and postoperative pulmonary complications in patients undergoing thoracic surgery

“…This finding suggests that the In recent studies on preoperative rehabilitation, supervised training exercises were performed for 4 to 6 weeks, and these patients showed improved exercise capacity, fewer postoperative complications, shorter hospital stays, and improved quality of life. [14][15][16][17][18][19][20] Additionally, operations may be possible after pulmonary rehabilitation in patients who were inoperable due to the limited exercise capacity. [21] Despite the growing awareness of the importance of exercise training in the preoperative period, it is not realistic to include all patients in an exercise training in the clinical setting.…”

The key questions in rehabilitation in thoracic surgery

“…amegroups.com/public/system/jtd/jtd.2018.03.147-1. pdf) (24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42). summarises the key findings, in brief, studies reported a statistically significant improvement in peak oxygen consumption (VO2max) or in functional capacity measured with the 6-minute walk test from baseline to postintervention.…”