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. 2022 Sep 28;9(9):CD012020.
doi: 10.1002/14651858.CD012020.pub3.

Preoperative exercise training for people with non-small cell lung cancer

Catherine Granger  1   2 , Vinicius Cavalheri  3   4
Affiliations

Preoperative exercise training for people with non-small cell lung cancer

Catherine Granger et al. Cochrane Database Syst Rev. .

Abstract

Background: Surgical resection for early-stage non-small cell lung cancer (NSCLC) offers the best chance of cure, but it is associated with a risk of postoperative pulmonary complications. It is unclear if preoperative exercise training, and the potential resultant improvement in exercise capacity, may improve postoperative outcomes. This review updates our initial 2017 systematic review.

Objectives: 1. To evaluate the benefits and harm of preoperative exercise training on postoperative outcomes, such as the risk of developing a postoperative pulmonary complication and the postoperative duration of intercostal catheter, in adults scheduled to undergo lung resection for NSCLC. 2. To determine the effect on length of hospital stay (and costs associated with postoperative hospital stay), fatigue, dyspnoea, exercise capacity, lung function and postoperative mortality.

Search methods: We used standard, extensive Cochrane search methods. The latest search date was from 28 November 2016 to 23 November 2021.

Selection criteria: We included randomised controlled trials (RCTs) in which study participants who were scheduled to undergo lung resection for NSCLC were allocated to receive either preoperative exercise training or no exercise training.

Data collection and analysis: We used standard Cochrane methods. Our primary outcomes were 1. risk of developing a postoperative pulmonary complication; 2. postoperative duration of intercostal catheter and 3.

Safety: Our secondary outcomes were 1. postoperative length of hospital stay; 2. postintervention fatigue; 3. postintervention dyspnoea; 4. postintervention and postoperative exercise capacity; 5. postintervention lung function and 6. postoperative mortality. We used GRADE to assess the certainty of evidence for each outcome.

Main results: Along with the five RCTs included in the original version, we identified an additional five RCTs, resulting in 10 RCTs involving 636 participants. Preoperative exercise training results in a large reduction in the risk of developing a postoperative pulmonary complication compared to no preoperative exercise training (risk ratio (RR) 0.45, 95% CI 0.33 to 0.61; I2 = 0%; 9 studies, 573 participants; high-certainty evidence). The evidence is very uncertain about its effect on postoperative intercostal catheter duration (MD -2.07 days, 95% CI -4.64 to 0.49; I2 = 77%, 3 studies, 111 participants; very low-certainty evidence). Preoperative exercise training is likely safe as studies reported no adverse events. Preoperative exercise training likely results in a reduction in postoperative length of hospital stay (MD -2.24 days, 95% CI -3.64 to -0.85; I2 = 85%; 9 studies, 573 participants; moderate-certainty evidence). Preoperative exercise training likely increases postintervention exercise capacity measured by peak oxygen consumption (MD 3.36 mL/kg/minute, 95% CI 2.70 to 4.02; I2 = 0%; 2 studies, 191 participants; moderate-certainty evidence); but the evidence is very uncertain about its effect on postintervention exercise capacity measured by the 6-minute walk distance (MD 29.55 m, 95% CI 12.05 to 47.04; I2 = 90%; 6 studies, 474 participants; very low-certainty evidence). Preoperative exercise training may result in little to no effect on postintervention lung function (forced expiratory volume in one second: MD 5.87% predicted, 95% CI 4.46 to 7.28; I2 = 0%; 4 studies, 197 participants; low-certainty evidence). AUTHORS' CONCLUSIONS: Preoperative exercise training results in a large reduction in the risk of developing a postoperative pulmonary complication compared to no preoperative exercise training for people with NSCLC. It may also reduce postoperative length of hospital stay, and improve exercise capacity and lung function in people undergoing lung resection for NSCLC. The findings of this review should be interpreted with caution due to risk of bias. Research investigating the cost-effectiveness and long-term outcomes associated with preoperative exercise training in NSCLC is warranted.

PubMed Disclaimer

Conflict of interest statement

CG: none.

VC: none.

Figures

1
1
Flow diagram of references identified, excluded and included in review.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
4
4
Forest plot of comparison: 1 Intervention group versus control group, outcome: 1.1 Risk of developing a postoperative pulmonary complication.
5
5
Forest plot of comparison: 1 Intervention group versus control group, outcome: 1.2 Number of days patients needed an intercostal catheter.
6
6
Forest plot of comparison: 1 Intervention group versus control group, outcome: 1.3 Postoperative length of hospital stay.
1.1
1.1. Analysis
Comparison 1: Exercise versus no exercise, Outcome 1: Risk of developing a postoperative pulmonary complication
1.2
1.2. Analysis
Comparison 1: Exercise versus no exercise, Outcome 2: Number of days participants needed an intercostal catheter following surgery
1.3
1.3. Analysis
Comparison 1: Exercise versus no exercise, Outcome 3: Postoperative length of hospital stay (days)
1.4
1.4. Analysis
Comparison 1: Exercise versus no exercise, Outcome 4: Postintervention (preoperative) dyspnoea (BORG scale)
1.5
1.5. Analysis
Comparison 1: Exercise versus no exercise, Outcome 5: Postintervention (preoperative) exercise capacity (6‐minute walk distance in m)
1.6
1.6. Analysis
Comparison 1: Exercise versus no exercise, Outcome 6: Postintervention (preoperative) exercise capacity (VO2peak in mL/kg/minute)
1.7
1.7. Analysis
Comparison 1: Exercise versus no exercise, Outcome 7: Postoperative exercise capacity (6‐minute walk distance in m)
1.8
1.8. Analysis
Comparison 1: Exercise versus no exercise, Outcome 8: Postintervention (preoperative) forced expiratory volume in 1 second (% predicted)
1.9
1.9. Analysis
Comparison 1: Exercise versus no exercise, Outcome 9: Postintervention (preoperative) forced vital capacity (% predicted)
1.10
1.10. Analysis
Comparison 1: Exercise versus no exercise, Outcome 10: Postintervention (preoperative) peak expiratory flow (L/minute)
See this image and copyright information in PMC

Update of

References

References to studies included in this review

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Chen 2016 {published data only}
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