Preoperative Pulmonary Rehabilitation Versus Chest Physical Therapy in Patients Undergoing Lung Cancer Resection: A Pilot Randomized Controlled Trial

Universidade Federal do Ceará (UFC), Fortaleza, Brazil
Archives of physical medicine and rehabilitation (Impact Factor: 2.57). 08/2012; 94(1). DOI: 10.1016/j.apmr.2012.08.206
Source: PubMed


Objective: To evaluate the effect of 4 weeks of pulmonary rehabilitation (PR) versus chest physical therapy (CPT) on the preoperative functional capacity and postoperative respiratory morbidity of patients undergoing lung cancer resection. Design: Randomized single-blinded study. Setting: A teaching hospital. Participants: Patients undergoing lung cancer resection (N=24). Interventions: Patients were randomly assigned to receive PR (strength and endurance training) versus CPT (breathing exercises for lung expansion). Both groups received educational classes. Main Outcome Measures: Functional parameters assessed before and after 4 weeks of PR or CPT (phase 1), and pulmonary complications assessed after lung cancer resection (phase 2). Results: Twelve patients were randomly assigned to the PR arm and 12 to the CPT arm. Three patients in the CPT arm were not submitted to lung resection because of inoperable cancer. During phase 1 evaluation, most functional parameters in the PR group improved from baseline to 1 month: forced vital capacity (FVC) (1.47L [1.27-2.33L] vs 1.71L [1.65-2.80L], respectively; P=.02); percentage of predicted FVC (FVC%; 62.5% [49%-71%] vs 76% [65%-79.7%], respectively; P<.05); 6-minute walk test (425.5±85.3m vs 475±86.5m, respectively; P<.05); maximal inspiratory pressure (90±45.9cmH 2O vs 117.5±36.5cmH2O, respectively; P<.05); and maximal expiratory pressure (79.7±17.1cmH2O vs 92.9±21.4cmH2O, respectively; P<.05). During phase 2 evaluation, the PR group had a lower incidence of postoperative respiratory morbidity (P=.01), a shorter length of postoperative stay (12.2±3.6d vs 7.8±4.8d, respectively; P=.04), and required a chest tube for fewer days (7.4±2.6d vs 4.5±2.9d, respectively; P=.03) compared with the CPT arm. Conclusions: These findings suggest that 4 weeks of PR before lung cancer resection improves preoperative functional capacity and decreases the postoperative respiratory morbidity.

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Available from: Guilherme Silva, Sep 03, 2014
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    • "Few studies assessed the impact of pulmonary rehabilitation on postoperative complications of patients who undergo lung resection for lung cancer [9-11], One of the postoperative outcomes observed by Morano et al. [11] was that in the PR group, fewer patients developed bronchopleural fistulas and required a chest tube for a fewer number of days. However, none of these studies used a randomized design to assess the influence of pulmonary rehabilitation on the serum levels of fibrinogen and albumin. "
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    ABSTRACT: Systemic inflammation plays an important role in the initiation, promotion, and progression of lung carcinogenesis. In patients with non-small cell lung cancer (NSCLC), fibrinogen levels correlate with neoplasia. Here we compared the effects of pulmonary rehabilitation (PR) with chest physical therapy (CPT) on fibrinogen and albumin levels in patients with LC and previous inflammatory lung disease awaiting lung resection. We conducted a randomized clinical trial with 24 patients who were randomly assigned to Pulmonary Rehabilitation (PR) and Chest Physical Therapy (CPT) groups. Each group underwent training 5 days weekly for 4 weeks. All patients were assessed before and after four weeks of training through clinical assessment, measurement of fibrinogen and albumin levels, spirometry, 6-minute Walk Test (6MWT), quality of life survey, and anxiety and depression scale. PR involved strength and endurance training, and CPT involved lung expansion techniques. Both groups attended educational classes. A mixed between-within subjects analysis of variance (ANOVA) revealed a significant interaction between time (before and after intervention) and group (PR vs. CPT) on fibrinogen levels (F(1, 22) = 0.57, p < 0.0001) and a significant main effect of time (F(1, 22) = 0.68, p = 0.004). Changes in albumin levels were not statistically significant relative to the interaction effect between time and group (F(1, 22) = 0.96, p = 0.37) nor the main effects of time (F(1, 22) = 1.00, p = 1.00) and group (F(1, 22 ) = 0.59, p = 0.45). A mixed between-within subjects ANOVA revealed significant interaction effects between time and group for the peak work rate of the unsupported upper limb exercise (F(1, 22) = 0.77, p = 0.02), endurance time (F(1, 22) = 0.60, p = 0.001), levels of anxiety (F(1, 22) = 0.60, p = 0.002) and depression (F(1, 22) = 0.74, p = 0.02), and the SF-36 physical component summary (F(1, 22) = 0.83, p = 0.07). PR reduced serum fibrinogen levels, improved functional parameters, and quality of life of patients with LC and inflammatory lung disease awaiting lung resection. Trial registration Current Controlled Trials RBR-3nm5bv.
    BMC Pulmonary Medicine 07/2014; 14(1):121. DOI:10.1186/1471-2466-14-121 · 2.40 Impact Factor
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    • "Moreover, preoperative aerobic exercise training is associated with improved physical fitness of patients before [40▪] and improved functional recovery after abdominal and thoracic surgery [41]. Evidence for the prevention of postoperative complications is still weak [40▪,42–44], as most studies lack statistical power to demonstrate an effect on postoperative complications. Therefore, in order to determine the effectiveness of this intervention, it is recommended to include patients at high risk for postoperative complications. "
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    ABSTRACT: Advances in medical care have led to an increasing elderly population. Elderly individuals should be able to participate in society as long as possible. However, with an increasing age their adaptive capacity gradually decreases, specially before and after major life events (like hospitalization and surgery) making them vulnerable to reduced functioning and societal participation. Therapeutic exercise before and after surgery might augment the postoperative outcomes by improving functional status and reducing the complication and mortality rate. There is high quality evidence that preoperative exercise in patients scheduled for cardiovascular surgery is well tolerated and effective. Moreover, there is circumstantial evidence suggesting preoperative exercise for thoracic, abdominal and major joint replacement surgery is effective, provided that this is offered to the high-risk patients. Postoperative exercise should be initiated as soon as possible after surgery according to fast-track or enhanced recovery after surgery principles. The perioperative exercise training protocol known under the name 'Better in, Better out' could be implemented in clinical care for the vulnerable group of patients scheduled for major elective surgery who are at risk for prolonged hospitalization, complications and/or death. Future research should aim to include this at-risk group, evaluate perioperative high-intensity exercise interventions and conduct adequately powered trials.
    Current opinion in anaesthesiology 02/2014; 27(2). DOI:10.1097/ACO.0000000000000062 · 1.98 Impact Factor
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    ABSTRACT: The exercise capacity has a specific importance in patients with non small cell lung cancer (NSCLC) at all stages of the disease. In the preoperative period for the early stages of the disease, low exercise capacity can be improved and thus allow curative surgery for unfit patients with NSCLC. The body of current literature suggests a beneficial effect of cardiopulmonary rehabilitation on exercise capacity, quality of life and length of hospital stay or rate of post-operative complications. For patients with advanced disease, exercise capacity, which is a predictor of survival, could be maintained at higher level with adapted cardiopulmonary rehabilitation. Ongoing studies will precise the best programs for patients with NSCLC and help to establish guidelines for clinicians.
    Revue médicale suisse 04/2013; 9(381):758, 760-3.
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