Effectiveness of Exercise after Lung Cancer Surgery: A Systematic Review in PubMed Database

Objectives This study is to review the effectiveness of exercise after lung cancer surgery. Methods Relevant randomized controlled trials (RCTs) were searched in PubMed database. The systematic review was conducted through flow diagram. The risk of biases were assessed through the Cochrane guideline. Characteristics and outcomes were extracted from each study. Meta-analyses of forced expiratory volume in one second (FEV 1 ), 6-minute walk test (6MWT), quality of life (QoL), pulmonary complications were conducted. Results 14 RCTs were selected. In meta-analysis, exercise improved FEV 1 (mean difference [MD] 0.14; 95% confidence interval [CI] 0.04 to 0.25; p=0.009; I 2 =55%) and mean change of FEV 1 (MD 0.11; 95% CI 0.02 to 0.20; p=0.02; I 2 =0%). Exercise increased the distance of 6MWT, but there was considerable heterogeneity (MD 45; 95% CI 21.16 to 68.83; p=0.0002, I 2 =89%). There was no differences in QoL scores by 2 questionnaires (European Organisation for Research and Treatment of Cancer quality of life questionnaire, short form-36). Exercise reduced the duration of hospital stay (MD -3.32; 95% CI -5.27 to -1.36; I 2 =0%; 2 studies) but not duration of chest tube intubation (MD -1.37; 95% CI -2.81 to 0.06; I 2 =0%) and incidence of pulmonary complications (pooled risk ratio 0.54; 95% CI 0.23 to 1.30; I 2 =0%). Conclusions Exercise might reduce the duration of hospital stay after lung surgery. There was not enough evidence to prove improvement of lung function, aerobic capacity, muscle strength, QoL, and decline of pulmonary complications. Low-quality risk of bias, different units or estimation of outcome, different exercise type and duration, heterogeneity among studies make the evidence of effectiveness weak. Future researches are required to redeem these defects.