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.

Keywords: exercise endurance; exercise training; health-related quality of life; non–small lung cell cancer; rehabilitation; surgical resection.

Figure 1.

Flowchart showing the progress through the stages of meta-analysis.

Figure 2.

Overall risk of bias assessment using the Cochrane tool.

Figure 3.

Risk of bias assessment by individual trials.

Figure 4.

Meta-analysis of length of hospital stay and postoperative complication. (A) Changes of length of hospital stay after exercise training. (B) Changes of postoperative complication. CI, confidence interval(s); IV, inverse variance; SD, standard deviation; M-H, Mueller-Hinton.

Figure 5.

Meta-analysis of 6-minute walk distance (6WMD). It shows the changes of 6MWD stratified by follow-up time after exercise training. A demonstrates shows the changes of 6WMD in preoperative exercise training patients. B shows the changes of 6WMD in postoperative exercise training patients. CI, confidence interval; IV, inverse variance; SD, standard deviation.

Figure 6.

Meta-analysis of Quality of Life Questionnaire. (A) Changes of EORTC-QLQ-30 in global health. (B) Changes of EORTC-QLQ-30 in dyspnea score. CI, confidence interval; IV, inverse variance; SD, standard deviation.

Figure 7.

Meta-analysis of Quality of Life Questionnaire. (A) Changes of SF-36 score in physical health. (B) Changes of SF-36 score in mental health. CI, confidence interval; IV, inverse variance; SD, standard deviation.