PT  - JOURNAL ARTICLE
AU  - Gravier, Francis-Edouard
AU  - Smondack, Pauline
AU  - Prieur, Guillaume
AU  - Medrinal, Clement
AU  - Combret, Yann
AU  - Muir, Jean-François
AU  - Baste, Jean-Marc
AU  - Cuvelier, Antoine
AU  - Boujibar, Fairuz
AU  - Bonnevie, Tristan
TI  - Effects of exercise training in people with non-small cell lung cancer before lung resection: a systematic review and meta-analysis
AID  - 10.1136/thoraxjnl-2021-217242
DP  - 2022 May 01
TA  - Thorax
PG  - 486--496
VI  - 77
IP  - 5
4099  - http://thorax.bmj.com/content/77/5/486.short
4100  - http://thorax.bmj.com/content/77/5/486.full
SO  - Thorax2022 May 01; 77
AB  - 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.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.