Preoperative exercise training for non-small cell lung cancer

Dr Catherine Granger1,2,3, Dr Vinicius  Cavalheri4,5,6

1Royal Melbourne Hospital, Parkville, Australia, 2The University of Melbourne, Parkville, Australia, 3Institute for Breathing and Sleep, Heidelberg, Australia, 4Curtin University, , Australia, 5Cancer Council Western Australia, , Australia, 6Institute for Respiratory Health, , Australia

Aims: To determine the effect of preoperative exercise training on postoperative outcomes including risk of developing a postoperative pulmonary complication (PPC), postoperative duration of intercostal catheter and length of hospital stay in adults scheduled to undergo lung resection for non-small cell lung cancer (NSCLC).

Methods: We searched the Cochrane Central Register of Controlled Trials, PubMed, EMBASE, PEDro and SciELO (The Scientific Electronic Library Online) to March 2016. Randomised controlled trials (RCTs) were included in which study participants who were scheduled to undergo lung resection for NSCLC were allocated to receive preoperative exercise training or no exercise training. Two authors independently screened and assessed studies for inclusion. Risk of bias was assessed using the Cochrane seven evidence-based domain table. Meta-analyses were conducted.

Results: Five RCTs involving 167 participants were identified. Overall, the risk of bias in studies was high. Pooled data from three studies demonstrated that preoperative exercise training reduced the risk of developing a PPC by 70% (RR 0.30; 95%CI 0.14-0.66). Compared to the control group, the number of days patients in the intervention group needed intercostal catheters was lower (MD -3.33 days; 95%CI -5.35 to -1.30 days) (pooled data from two studies), and postoperative length of hospital stay was also lower in the intervention group (MD -4.34 days; 95%CI -5.65 to -3.03 days) (pooled data from three studies).

Significance of the findings to allied health: Preoperative exercise training appears to reduce the risk of developing a PPC, the duration of intercostal catheter and postoperative length of hospital stay in people undergoing lung resection for NSCLC.