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Short-term preoperative exercise therapy does not improve long-term outcome after lung cancer surgery: a randomized controlled study†

OBJECTIVES
Poor aerobic fitness is a potential modifiable risk factor for long-term survival and quality of life in patients with lung cancer. This randomized trial evaluates the impact of adding rehabilitation (Rehab) with high-intensity interval training (HIIT) before lung cancer surgery to enhance cardiorespiratory fitness and improve long-term postoperative outcome.


METHODS
Patients with operable lung cancer were randomly assigned to usual care (UC, n  = 77) or to intervention group (Rehab, n  = 74) that entailed HIIT that was implemented only preoperatively. Cardiopulmonary exercise testing (CPET) and pulmonary functional tests (PFTs) including forced vital capacity (FVC), forced expiratory volume (FEV 1 ) and carbon monoxide transfer factor (KCO) were performed before and 1 year after surgery.


RESULTS
During the preoperative waiting time (median 25 days), Rehab patients participated to a median of 8 HIIT sessions (interquartile [IQ] 25-75%, 7-10). At 1 year follow-up, 91% UC patients and 93% Rehab patients were still alive ( P  = 0.506). Pulmonary functional changes were non-significant and comparable in both groups (FEV 1 mean -7.5%, 95% CI, -3.6 to -12.9 and in KCO mean 5.8% 95% CI 0.8-11.8) Compared with preoperative CPET results, both groups demonstrated similar reduction in peak oxygen uptake (mean -12.2% 95% CI -4.8 to -18.2) and in peak work rate (mean -11.1% 95% CI -4.2 to -17.4).


CONCLUSIONS
Short-term preoperative rehabilitation with HIIT does not improve pulmonary function and aerobic capacity measured at 1 year after lung cancer resection.


TRIAL REGISTRY
ClinicalTrials.gov; No. NCT01258478; www.clinicaltrials.gov .