Preoperative exercise training prevents functional decline after lung resection surgery: a randomized, single-blind controlled trial

Objectives: To investigate the effects of a preoperative pulmonary rehabilitation programme in patients with lung cancer undergoing video-assisted thoracic surgery. Design: Randomized, single-blind controlled trial. Setting: Teaching hospital. Subjects: Patients with suspected or confirmed lung cancer undergoing video-assisted thoracic surgery. Intervention: Participants were randomized to either a prehabilitation group or a control group. Participants in the prehabilitation group underwent a combination of moderate endurance and resistance training plus breathing exercises three to five times per week. Main measures: The primary outcome of the study was exercise capacity. Secondary outcomes were muscle strength (Senior Fitness Test), health-related quality of life (Short-Form 36) and the postoperative outcomes. Patients were evaluated at baseline (before randomization), presurgery (only the prehabilitation group), after surgery and three months post-operatively. Results: A total of 40 patients were randomized and 22 finished the study (10 in the prehabilitation group and 12 in the control group). Three patients were lost to follow-up at three months. After the training, there was a statistically significant improvement in exercise tolerance (+397 seconds, p = 0.0001), the physical summary component of the SF-36 (+4.4 points, p = 0.008) and muscle strength (p < 0.01). There were no significant differences between groups after surgery. However, three months postoperatively, significant differences were found in the mean change of exercise capacity (p = 0.005), physical summary component (p = 0.001) and upper and lower body strength (p = 0.045 and p = 0.002). Conclusions: A pulmonary rehabilitation programme before video-assisted improve patients' preoperative condition and may prevent functional decline after surgery.