Exercise Training for Patients Pre- and Postsurgically Treated for Non–Small Cell Lung Cancer: A Systematic Review and Meta-analysis

Abstract

Background. This meta-analysis examined the effects of exercise training on length of hospital stay, postoperative complications, exercise capacity, 6-minute walking distance (6MWD), and health-related quality of life (HRQoL) in patients following resection of non–small cell lung cancer (NSCLC). Methods. This review searched PubMed, EMBASE, and the Cochrane Collaboration data base up to August 16, 2015. It includes 15 studies comparing exercise endurance and quality of life before versus after exercise training in patients undergoing lung resection for NSCLC. Results. This review identified 15 studies, 8 of which are randomized controlled trials including 350 patients. Preoperative exercise training shortened length of hospital stay; mean difference (MD): −4.98 days (95% CI = −6.22 to −3.74, P < .00001) and also decreased postoperative complications for which the odds ratio was 0.33 (95% CI = 0.15 to 0.74, P = .007). Four weeks of preoperative exercise training improved exercise capacity; 6MWD was increased to 39.95 m (95% CI = 5.31 to 74.6, P = .02) .While postoperative exercise training can also effectively improve exercise capacity, it required a longer training period; 6MWD was increased to 62.83 m (95% CI = 57.94 to 67.72) after 12 weeks of training (P < .00001). For HRQoL, on the EORTC-QLQ-30, there were no differences in patients’ global health after exercise, but dyspnea score was decreased −14.31 points (95% CI = −20.03 to −8.58, P < .00001). On the SF-36 score, physical health was better after exercise training (MD = 3 points, 95% CI = 0.81 to 5.2, P = .007) while there was no difference with regard to mental health. The I2 statistics of all statistically pooled data were lower than 30%. There was a low amount of heterogeneity among these studies. Conclusions. Evidence from this review suggests that preoperative exercise training may shorten length of hospital stay, decrease postoperative complications and increase 6MWD. Postoperative exercise training can also effectively improve both the 6MWD and quality of life in surgical patients with NSCLC, but requiring a longer training period.

Effect of postsurgical rehabilitation programmes in patients operated for lung cancer: A systematic review and meta-analysis

“…During completion of the current review, a new review by Ni et al (13) (evaluating the effects of pre-and post-operative exercise interventions) was published supporting our findings, in contrast their review included all study designs, as well as pre-and post-operative measurements.…”

“…In a population diagnosed with myocardial infarction, early-initiated exercise in the acute phase has shown greater benefits on exercise capacity than is the case in exercise interventions initiated in a later treatment phase (11). Systematic reviews investigating the effects of preand post-surgical exercise interventions in patients with NSCLC show that exercise may increase exercise capacity of people following lung resection for NSCLC (6,12,13). However, to date, no systematic reviews have been done investigating the effects of post-surgical exercise interventions for patients with NSCLC focusing on high-quality evidence and only post-operative outcomes to eliminate the impact of the surgery (no pre-operative baseline measurements).…”

A Model-Based Cost-Effectiveness Analysis of an Exercise Program for Lung Cancer Survivors Following Curative-Intent Treatment

“…Exercise interventions in lung cancer survivors commonly take place as part of comprehensive, multidisciplinary pulmonary rehabilitation programs, either in the preoperative or postoperative context. 37 Recent systematic reviews suggest that preoperative exercise improves cardiopulmonary fitness 38,39 and may reduce the risk of surgical complications, [40][41][42][43] while postoperative exercise may improve functional and/or exercise capacity and QoL. [42][43][44][45] While these findings provide supporting evidence for exercise in lung cancer survivorship, the authors of the systematic reviews raise concerns for volunteer and selection bias and inadequate sample size for the included studies, and note a lack of large randomized controlled trials (RCTs) of exercise interventions for lung cancer survivors.…”

“…37 Recent systematic reviews suggest that preoperative exercise improves cardiopulmonary fitness 38,39 and may reduce the risk of surgical complications, [40][41][42][43] while postoperative exercise may improve functional and/or exercise capacity and QoL. [42][43][44][45] While these findings provide supporting evidence for exercise in lung cancer survivorship, the authors of the systematic reviews raise concerns for volunteer and selection bias and inadequate sample size for the included studies, and note a lack of large randomized controlled trials (RCTs) of exercise interventions for lung cancer survivors. 40,[43][44][45] A more recent RCT 46 examining the impact of physical activity/exercise on fatigue in advanced lung cancer survivors showed no difference compared to usual care; however, in exploratory analyses of 38 (34%) of participants who increased physical activity/exercise during the intervention period, there was a significant reduction in fatigue symptoms.…”

Characterization of Dyspnea in Lung Cancer Survivors Following Curative-Intent Therapy

“…The evidence for effectiveness is not as consistent in lung cancer survivors [4]. Recent systematic reviews of exercise interventions in lung cancer survivors suggest that while exercise training can improve functional EC and QoL following curative-intent therapy [24][25][26][27], there are concerns for bias, inadequate sample size, and lack of large randomized controlled trials [24,25,28]. Moreover, a recent systematic review identified numerous patient-related barriers to regular physical activity in lung cancer survivors [29].…”