Prehabilitation sessions can be provided more frequently in a shortened regimen with similar or better efficacy in people with non-small cell lung cancer: a randomised trial

Question: In people with non-small cell lung cancer, what is the effect of condensing 15 prehabilitation sessions into a 3-week regimen compared with a 5-week regimen? Design: Randomised controlled trial with concealed allocation, intention-to-treat analysis and blinded assessment of the primary outcome. Participants: People with diagnosed or suspected non-small cell lung cancer and moderate-to-high risk of postoperative complications. Intervention: Fifteen supervised prehabilitation sessions delivered with either a dense regimen of five sessions/week for 3 weeks (experimental group) or a non-dense regimen of three sessions/week for 5 weeks (control group). Outcome measures: The primary outcome was the change in cardiorespiratory fitness measured by the (V) over dotO(2pea)I< in ml/kg/min. The secondary outcomes were the change in other variables of interest measured during cardiopulmonary exercise testing, non-invasive nutritional markers, quadriceps maximal voluntary isometric contractions, maximal inspiratory pressure, quality of life, adherence and postoperative complications. Results: Changes with the experimental regimen were similar to or better than changes with the control regimen for: (V) over dotO(2peak)< (MD 1.2 ml/kg/min, 95% CI -0.1 to 2.6); (V)over dotE/(V)over dotCO(2) slope (MD -3.6 points, 95% CI -8.7 to 1.5); and work rate at ventilatory threshold (MD 3.7 W, 95% CI -5.6 to 13.0). The two regimens had similar effects on: peak work rate (MD 1.3 W, 95% CI -6.4 to 9.0), (V)over dotO(2) at ventilatory threshold (MD 0.0 ml/kg/min, 95% CI -1.4 to 1.4); body mass index (MD -0.2 kg/m(2), 95% CI -0.5 to 0.1); and maximal inspiratory pressure (MD -0.7 cmH 2 0, 95% CI -9.8 to 8.4). The relative effect was uncertain for quadriceps maximal voluntary isometric contractions, quality of life and complications. Conclusion: Condensing prehabilitation sessions led to similar or better improvement in cardiorespiratory fitness and did not decrease adherence or increase adverse events. This could increase the number of patients who can be referred for prehabilitation, despite short presurgical periods. (C) 2021 Australian Physiotherapy Association. Published by Elsevier B.V.

Automated summary

Condensing prehabilitation sessions into a 3-week regimen compared with a 5-week regimen can lead to similar or better improvement in cardiorespiratory fitness in individuals with non-small cell lung cancer, without decreasing adherence or increasing adverse events.