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 (FEV1) 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 (FEV1 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; ext-link-type=uri xlink:href=http://www.clinicaltrials.gov>www.clinicaltrials.gov.