Effects of exercise training in people with non-small cell lung cancer before lung resection: a systematic review and meta-analysis

Abstract

IntroductionExercise training before lung resection for non-small cell lung cancer is believed to decrease postoperative complications (POC) by improving cardiorespiratory fitness. However, this intervention lacks a strong evidence base.AimTo assess the effectiveness of preoperative exercise training compared with usual care on POC and other secondary outcomes in patients with scheduled lung resection.MethodsA systematic search of randomised trials was conducted by two authors. Meta-analysis was performed, and the effect of exercise training was estimated by risk ratios (RR) and mean differences, with their CIs. Clinical usefulness was estimated according to minimal important difference values (MID).ResultsFourteen studies involving 791 participants were included. Compared with usual care, exercise training reduced overall POC (10 studies, 617 participants, RR 0.58, 95% CI 0.45 to 0.75) and clinically relevant POC (4 studies, 302 participants, Clavien-Dindo score ≥2 RR 0.42, 95% CI 0.25 to 0.69). The estimate of the effect of exercise training on mortality was very imprecise (6 studies, 456 participants, RR 0.66, 95% CI 0.20 to 2.22). The main risks of bias were a lack of participant blinding and selective reporting. Exercise training appeared to improve exercise capacity, pulmonary function and also quality of life and depression, although the clinical usefulness of the changes was unclear. The quality of the evidence was graded for each outcome.ConclusionPreoperative exercise training leads to a worthwhile reduction in postoperative complications. These estimates were both accurate and large enough to make recommendations for clinical practice.

The efficacy of pulmonary rehabilitation exercise training on complications and mortality after lung cancer resection: a systematic review and meta-analysis

“…Many systematic reviews and meta-analyses have been conducted to examine the effects of lung rehabilitation exercise training on postoperative lung cancer patients, including its effects on hospital stay, functional status, health-related quality of life, postoperative complications, and mortality. Notably, Gravier et al ( 19 ) reviewed the effects of pre-pneumonectomy exercise training on patients with non-small cell lung cancer, and found that exercise training improved patients’ exercise ability, lung function, quality of life, and depression levels. Mao et al ( 1 ) reviewed prospective and retrospective studies on the effects of lung rehabilitation exercise training on complications and mortality after lung cancer resection before 2020.…”

Association of Pretreatment Physical and Geriatric Parameters with Treatment Tolerance and Survival in Elderly Patients with Stage I–II Non-Small Cell Lung Cancer: An Evaluation of Usual Care Data

“…This means that especially patients with a poor physical status could benefit from pretreatment preventive lifestyle interventions. Physical exercise training on top of medical treatment could optimize physical status, leading to better tolerance of intensive treatment [ 42 ] and preservation of physical functioning. This can be achieved by exercise prehabilitation (physical exercise training before treatment initiation).…”

“…This can be achieved by exercise prehabilitation (physical exercise training before treatment initiation). The physiological reserve capacity can be increased by a combination of aerobic and resistance training [ 42 ]. Even better outcomes might be achieved when the diet is adapted to the needs of training as well, including healthy and protein-rich products [ 43 ].…”

Feasibility and outcomes of a real-world regional lung cancer prehabilitation programme in the UK

“…In the pilot programme, patients with lung cancer were eligible for P4C if surgical resection was planned, as it is this cohort of patients who have the clearest evidence of benefit. 8 The inclusion criteria were lung cancer MDT-agreed diagnosis of primary lung cancer with a treatment recommendation of surgical resection, aged 18 yr or over, registered with a GM primary care service, able to access the programme either independently or with support from a carer/family member, indicated informed consent to be referred, and walked more than 250 m on the incremental shuttle walk test (ISWT). As a community programme without clinical facility support, embedded risk assessment at all stages of the pathway was crucial to mitigate the risk of adverse events during prehabilitation.…”

“… 6 , 7 A recent meta-analysis of RCTs of exercise training before lung cancer surgery demonstrated a significant reduction in the rate of postoperative complications (risk ratio 0.42; 95% confidence interval [CI]: 0.25–0.69), postoperative length of stay in hospital (mean difference –2.29 days; 95% CI: –0.98 to –3.59), and improved exercise capacity (6 min walk distance mean difference +37.6 m; 95% CI: +20.5 to +54.7). 8 Given this strong evidence supporting the efficacy of prehabilitation before lung cancer surgery alongside the increasing volume of lung cancer surgery, service delivery is the primary challenge.…”