A six-week inspiratory muscle training and aerobic exercise improves respiratory muscle strength and exercise capacity in lung cancer patients after video-assisted thoracoscopic surgery: A randomized controlled trial

Abstract

Objective: To compare the postoperative outcomes of inspiratory muscle training and aerobic exercise, along with standard care, on lung cancer patients undergoing video-assisted thoracoscopic surgery (VATS). Design: A parallel-group, single-blind randomized clinical trial Setting: Thoracic surgery ward and outpatient clinic in a teaching hospital Subjects: Overall 63 patients underwent VATS were randomly assigned to a triaging (TG, n = 32) or control group (CG, n = 31). A total of 54 patients (TG, n = 26; CG, n = 28) completed the study. Intervention: TG: six-week threshold inspiratory muscle training and aerobic exercise. CG: standard care. Main measures: Maximum inspiratory pressure (PImax), maximum expiratory pressure (PEmax) lung expansion volume, and 6-min walking test (6MWT) were performed on the day of chest tube removal (baseline), and 2, 6, and 12 weeks postoperatively. Results: The TG showed significant improvement in PImax at week 6 (71.6 ± 34.9 vs. 94.3 ± 32.8 cmH2O, P = 0.018), PEmax at week 2 (70.9 ± 24.3 vs. 90.9 ± 28.2 cmH2O, P = 0.015) and week 12 (76.1 ± 20.2 vs. 98.6 ± 35.3 cmH2O, P = 0.012), the lung expansion volume at week 2 (1080 ± 433 vs 1457 ± 624 mL, P = 0.02) and week 12 (1200 ± 387 vs 1885 ± 678 mL, P < 0.001), in addition to the 6MWT at week 2 (332 ± 78 vs 412 ± 74 m, P = 0.002), week 6 (360 ± 70 vs 419 ± 60 m, P = 0.007) and week 12 (360 ± 58 vs 402 ± 65 m, P = 0.036). Conclusion: A six weeks of inspiratory muscle training and aerobic exercise had improved respiratory muscle strength and aerobic exercise postoperatively in lung cancer patients after VATS as early as 2 weeks.

The effectiveness of pre- and post-operative rehabilitation for lung cancer: A systematic review and meta-analysis on postoperative pulmonary complications and length of hospital stay

“…15,18,19,30,34 Two studies had daily physiotherapy sessions, 16,21 three studies included physical training. 4,14,17…”

“…Four postoperative studies reported the days of needing chest tube (two to five days), and each study found no between-group differences. 15 –17,30 Five studies reported data on mortality: one study reported zero mortalities in both groups, 18 two studies reported one death (1.1%–2.9%) in the control group 15,34 one study reported one death in the treatment group (2.4%), 21 and one study reported one death in the intervention group (1.6%) and four in the control group (6.0%). 14 The included perioperative study reported the median and interquartile range of postoperative length of hospital stay and found no between-group differences.…”

“…Postoperative studies : Seven studies reported on postoperative pulmonary complications. 14,15,17,18,21,30,34 The Ottawa Thoracic Morbidity and Mortality System for Classifying Thoracic Surgical Complications was used in one study, 18 and this study reported the postoperative pulmonary complications data collected at 30 days after surgery. Two studies only reported the incidence of each complication (e.g.…”

“…pneumothorax and pneumonia), which were excluded from the meta-analysis, in these two studies there was no significant difference between groups. 15,17 The remaining five studies were included in the meta-analysis. 14,18,21,30,34 The meta-analysis showed that postoperative studies reduced the likelihood of postoperative pulmonary complication by 15%; however, the effect was not significant (OR = 0.85, CI = 0.56, 1.29, I 2 = 0.0%; Figure 4(a)).…”

“…Since the review’s publication, more randomised controlled trials have emerged within the literature. 14 –19 In order to establish the optimal timing and content of rehabilitation, an updated systematic review and meta-analysis evaluating the effective of both pre- and post-operative interventions is needed.…”