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Effects of exercise training in people with non-small cell lung cancer before lung resection: a systematic review and meta-analysis
  1. Francis-Edouard Gravier1,2,
  2. Pauline Smondack1,
  3. Guillaume Prieur2,3,
  4. Clement Medrinal3,4,5,
  5. Yann Combret3,
  6. Jean-François Muir1,2,
  7. Jean-Marc Baste6,7,
  8. Antoine Cuvelier2,8,
  9. Fairuz Boujibar6,7,
  10. Tristan Bonnevie1,2
  1. 1ADIR Association, University Hospital Centre Rouen, Rouen, France
  2. 2UPRES EA 3830, Haute Normandie Research and Biomedical Innovation, Rouen University, Rouen, France
  3. 3Intensive Care Unit Department, Groupe Hospitalier du Havre, Le Havre, France
  4. 4IFMK Saint-Michel, Paris, France
  5. 5Equipe de Recherche Paramédicale sur le HAndicap Neuromoteur (ERPHAN), Université Paris-Saclay, Versailles, France
  6. 6Thoracic Surgery Department, University Hospital Centre Rouen, Rouen, France
  7. 7INSERM U1096, Haute Normandie Research and Biomedical Innovation, Rouen University, Rouen, France
  8. 8Pulmonary, Thoracic Oncology and Respiratory Intensive Care Department, University Hospital Centre Rouen, Rouen, France
  1. Correspondence to Francis-Edouard Gravier, ADIR Association, University Hospital Centre Rouen, Rouen, Normandie, France; f.gravier{at}adir-hautenormandie.com

Abstract

Introduction Exercise training before lung resection for non-small cell lung cancer is believed to decrease postoperative complications (POC) by improving cardiorespiratory fitness. However, this intervention lacks a strong evidence base.

Aim To assess the effectiveness of preoperative exercise training compared with usual care on POC and other secondary outcomes in patients with scheduled lung resection.

Methods A systematic search of randomised trials was conducted by two authors. Meta-analysis was performed, and the effect of exercise training was estimated by risk ratios (RR) and mean differences, with their CIs. Clinical usefulness was estimated according to minimal important difference values (MID).

Results Fourteen studies involving 791 participants were included. Compared with usual care, exercise training reduced overall POC (10 studies, 617 participants, RR 0.58, 95% CI 0.45 to 0.75) and clinically relevant POC (4 studies, 302 participants, Clavien-Dindo score ≥2 RR 0.42, 95% CI 0.25 to 0.69). The estimate of the effect of exercise training on mortality was very imprecise (6 studies, 456 participants, RR 0.66, 95% CI 0.20 to 2.22). The main risks of bias were a lack of participant blinding and selective reporting. Exercise training appeared to improve exercise capacity, pulmonary function and also quality of life and depression, although the clinical usefulness of the changes was unclear. The quality of the evidence was graded for each outcome.

Conclusion Preoperative exercise training leads to a worthwhile reduction in postoperative complications. These estimates were both accurate and large enough to make recommendations for clinical practice.

  • exercise
  • pulmonary rehabilitation
  • non-small cell lung cancer
  • thoracic surgery

Data availability statement

Data are available on reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. Other supplementary data are available on reasonable request.

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Data availability statement

Data are available on reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. Other supplementary data are available on reasonable request.

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Footnotes

  • Contributors Has made substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data: F-EG, PS, FB, TB. Has drafted the submitted article or revised it critically for important intellectual content: F-EG, PS, GP, CM, YC, J-FM, J-MB, AC, FB, TB. Has provided final approval of the version to be published: F-EG, PS, GP, CM, YC, J-FM, J-MB, AC, FB, TB. Has agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: F-EG, PS, GP, CM, YC, J-FM, J-MB, AC, FB, TB.

  • Funding This work was supported by ADIR Association.

  • Competing interests TB declares receiving grants from Fisher and Paykel and from KerNel Biomedical, both unrelated to this study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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