Effect of Exercise and Pulmonary Rehabilitation in Pre- and Post-Surgical Patients with Lung Cancer: Systematic Review and Meta-Analysis

Abstract

Background and objectives: Lung cancer is a common cancer, and its impact on public health is not only reflected in the 1 million deaths it causes annually but also in the significant implications it has on daily activities and quality of life, resulting in a considerable burden on healthcare systems. This review aims to determine the effects of pulmonary rehabilitation and pre- or post-surgical exercise in patients with lung cancer. Materials and methods: A systematic review with a meta-analysis of randomized controlled trials published between 2010 and 2024 was conducted; the search was carried out in PubMed, Cochrane Clinical Trial, SCOPUS, Science Direct, Web of Science, Scielo, and LILAC. Results: Pulmonary rehabilitation or exercise before surgery was associated with a greater 6 min walking distance (MD: 37.42, 95% CI: 9.68-65.1; p = 0.008); however, it had no implications on hospital stay (MD: -0.91, 95% CI: -1.88-0.055; p = 0.06). When the intervention was performed post-surgery, higher FEV1 (SMD: 0.62, 95% CI: 0.32-0.92; p = 0.0001) and improved 6 min walking distances (60.8, 95% CI: 20.96-100.6; p = 0.0033) were found compared to standard management. Conclusions: This review suggests that, depending on the timing of implementation, pulmonary rehabilitation or exercise could produce positive effects on certain clinical variables in lung cancer patients.

Keywords: exercise intervention; length of stay; lung cancer; mortality; non-small-cell lung cancer; postoperative; quality of life; rehabilitation.

Figure 1

PRISMA flow diagram with the search and study selection strategy.

Figure 2

Risk of bias assessment for studies included in this systematic review. (a) Risk of bias for each study included in the review, according to the authors’ assessment. The symbol «+» represents a low risk of bias, «?» indicates an unclear risk of bias, and «-» suggests a high risk of bias. The colors used with each symbol are green for low risk, yellow for unclear risk, and red for high risk. (b) Summary of the risk of bias as evaluated for each study, with each bias item presented as a percentage [46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69].

Figure 3

Forest plots estimating the effect of exercise-based rehabilitation on lung function. (a) Effect of pre-surgical exercise-based rehabilitation vs. control on FEV1 values. (b) Effect of post-surgical exercise-based rehabilitation vs. control on FEV1 values. (c) Effect of pre-surgical exercise-based rehabilitation vs. control on FVC values. (d) Effect of post-surgical exercise-based rehabilitation vs. control on FVC values [46,50,51,52,56,57,59,60,64].

Figure 4

Forest plots estimating the effect of exercise-based rehabilitation on the 6-min walking distance. (a) Effect of pre-surgical exercise-based rehabilitation vs. control on 6 min walking distance. (b) Effect of post-surgical exercise-based rehabilitation vs. control on 6 min walking distance [46,49,50,52,55,56,57,60,62,64,69].

Figure 5

Forest plots estimating the effect of pre-surgical exercise-based rehabilitation on hospital stay [46,50,51,52,55].