Preoperative high-intensity interval training is effective and safe in deconditioned patients with lung cancer: A randomized clinical trial

Abstract

High-intensity interval training is used increasingly in patient care. Various training patterns are used. For patients diagnosed with lung cancer, the first choice intervention is surgery. There is a wait of approximately a mean of 3 weeks between the clinical decision to operate and the intervention. A high-intensity interval training protocol was designed, to be performed during this time-window, to improve the physical condition of these patients before surgery. Patients cycled 3 times per week under supervision, performing 2 × 10-min series of 15-s sprints at peak power, interspersed with 15-s pauses. Compared to usual care, just before surgery, after 8 sessions of high-intensity interval training, the patients' physical fitness was significantly improved while after surgery the outcome was improved. Background: The outcome of surgery in deconditioned patients can be improved through prehabilitation. This study examined the effect of prehabilitation in patients diagnosed with lung cancer. Methods: Candidates for lung cancer resection were assigned to high-intensity interval training (n = 74) or usual care (n = 77). Cardiopulmonary exercise testing and 6-min walk test were performed before and after training. High-intensity interval training consisted of 2-3-weekly, 2 × 10-min series of cycling at peak power, measured with cardiopulmonary exercise testing prior to training, with a 15-s on-off duty cycle, preceded by a 5-min warm-up and followed by a 5-min cool-down. Work-rate, heart-rate, saturation, dyspnoea and leg effort were monitored. Results: Waiting time (median 25 days) allowed a median of 8 high-intensity interval training sessions to be performed. Adherence to mean high-intensity interval training was 87% (18% standard deviation; SD). High-intensity interval training power increased (23 watt, 95% confidence interval (95% CI): 20-26 watt), as did heart rate (14 bpm, 95% CI 11-16 bpm). Resting heart rate (-6 bpm, 95% CI-4 to-7 bpm) and heart rate 1 min post-cool-down decreased (-5 bpm, 95% CI-4 to-7 bpm). Aerobic capacity increased after high-intensity interval training (14%, 95% CI 3-26%), as did peak power output (median 7%, 95% CI 2-13%), but not after usual care. Six-min walk test score increased after high-intensity interval training (median 20%, 95% CI 14-26%), but not after usual care. Conclusion: Short-term high-intensity interval training is feasible in deconditioned patients and increases cardio-respiratory fitness and walking capacity.

High-intensity interval training in the prehabilitation of cancer patients—a systematic review and meta-analysis

“…For studies that were lacking this information, mean differences were calculated with simple subtraction ("mean_diff" of HIIT -"mean_diff" of UC). The 95% CI of the average difference for Bhatia et al [23] was calculated under the assumption that the data were normally distributed (which is appropriate given the sample size). Other missing standard errors were estimated using the average correlation of two studies: Dunne et al [34] and West et al [35], because these studies used simple between-group comparisons, whereas other studies conducted more complex statistical analyses [17,36], which do not allow for the calculation of the correlation based on the reported summary statistics.…”

“…Overall, seven RCTs [15-17, 23, 24, 34, 36] and one non-randomized controlled trial [35] with a total of 896 patients with a mean age of 61 (± 8) years were identified. Seven of the eight studies used a two-arm design (HIIT vs. UC) [16,17,23,24,[34][35][36], whereas one study had a mixed three-arm design comparing HIIT/RT vs. HIIT/MICT vs. UC [15]. No studies were identified that compared HIIT vs. MICT in a prehabilitative setting.…”

“…No studies were identified that compared HIIT vs. MICT in a prehabilitative setting. Three studies reported on non-small cell lung carcinoma [17,23,24], two on colorectal cancer [34,35], one on breast cancer [15], one on bladder cancer [36], and one on different cancer entities [16]. Five studies were conducted on patients awaiting cancer surgery [23,24,[34][35][36], two on patients during concomitant chemotherapy [15,16], and one on patients scheduled for radiotherapy [17].…”

“…Concerning eligibility criteria, five studies included patients with a diseases stage of III or less (= without peripheral metastases) [15,16,23,24,35], two studies explicitly included more advanced stages of disease [17,34], whereas one study did not report any staging [36]. To determine pre-treatment performance status of cancer patients, three studies limited the inclusion criteria for patients to a WHO performance status < 1 [16,17] and < 2 [35], while the other studies did not mention any criteria.…”

“…This time-efficient and effective method might be particularly relevant when the period from diagnosis to surgery, and therefore, the timeframe for a potential training intervention is limited. Nevertheless, patients might benefit from cardiovascular improvements, e.g., lung cancer patients awaiting lung resection surgery [23,24]. In this regard, VO 2peak has emerged as the strongest independent predictor for surgical complications and survival rates in non-small cell lung cancer [25,26].…”