Effects of presurgical exercise training on cardiorespiratory fitness among patients undergoing thoracic surgery for malignant lung lesions

BACKGROUND: To determine the effects of preoperative exercise training on cardiorespiratory fitness in patients undergoing thoracic surgery for malignant lung lesions. METHODS: Using a single-group design, 25 patients with suspected operable lung cancer were provided with structured exercise training until surgical resection. Exercise training consisted of 5 endurance cycle ergometry sessions per week at intensities varying from 60% to 100% of baseline peak oxygen consumption (VO(2 peak)). Participants underwent cardiopulmonary exercise testing, 6-minute walk (6 MW), and pulmonary function testing at baseline, immediately before, and 30 days after surgical resection. RESULTS: Five patients were deemed ineligible before surgical resection and were removed from the analysis. Of the remaining 20 patients follow-up assessments were obtained for 18 (90%) before resection and 13 (65%) patients postresection. The overall adherence rate was 72%. Intention-to-treat analysis indicated that mean VO(2peak) increased by 2.4 mL . kg(-1) . min(-1)(95% confidence interval CI, 1.0-3.8; P = .002) and 6MW distance increased 40 m (95% CI, 16-64; P = .003) baseline to presurgery. Per protocol analyses indicated that patients who attended >or=80% of prescribed sessions increased VO(2peak) and 6 MWD by 3.3 mL.kg(-1).min(-1) (95% CI, 1.1-5.4; P = .006) and 49 meters (95% CI, 12-85; P = .013), respectively. Exploratory analyses indicated that presurgical exercise capacity decreased postsurgery, but did not decrease beyond baseline values. CONCLUSIONS: Preoperative exercise training is a beneficial intervention to improve cardiorespiratory fitness in patients undergoing pulmonary resection. This benefit may have important implications for surgical outcome and postsurgical recovery in this population. Larger randomized controlled trials are warranted.