Preoperative exercise training for patients with non‐small cell lung cancer

Vinicius Cavalheri; Catherine Granger

doi:10.1002/14651858.CD012020.pub2

Cochrane Database of Systematic Reviews

Entrenamiento preoperatorio con ejercicios para pacientes con cáncer de pulmón de células no pequeñas

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DOI:

https://doi.org/10.1002/14651858.CD012020.pub2 Copiar DOI

Base de datos:

Cochrane Database of Systematic Reviews

Versión publicada:

07 junio 2017see what's new

Tipo:

Intervention

Etapa:

Review

Grupo Editorial Cochrane:

Grupo Cochrane de Cáncer de pulmón

Copyright:

Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Autores

Vinicius Cavalheri

Correspondencia a: School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia

[email protected]

[email protected]

Institute for Respiratory Health, Perth, Australia
Catherine Granger

Department of Physiotherapy, The University of Melbourne, Parkville, Australia

Physiotherapy, Royal Melbourne Hospital, Parkville, Australia

Contributions of authors

Vinicius Cavalheri: initiation, writing of protocol, organisation of protocol into RevMan, selection of studies, extraction of data from studies, conduct of the analysis, and writing of the final review paper.

Catherine Granger: initiation, writing of protocol and protocol development, selection of studies, extraction of data from studies, and writing of the final review paper.

Sources of support

Internal sources

School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Australia.
Department of Physiotherapy, The University of Melbourne, Australia.
Department of Physiotherapy, Royal Melbourne Hospital, Australia.
Institute for Respiratory Health, Sir Charles Gairdner Hospital, Perth, Australia.

External sources

Cancer Council Western Australia, Australia.

Vinicius Cavalheri is supported by a Cancer Council Western Australia Postdoctoral Fellowship
Victorian Cancer Agency, Australia.

Catherine Granger is supported by a Victorian Cancer Agency Clinical Research Fellowship

Declarations of interest

Vinicius Cavalheri: none known

Catherine Granger: none known

Acknowledgements

The authors would like to thank Corynne Marchal, Managing Editor of the Cochrane Lung Cancer Group, for her feedback and support; Fergus MacBeth, Frederic Fiteni, and Ramon Rami Porta, Editors of the Cochrane Lung Cancer Group, as well as Paul Van Schil, Bruno Degano and Pierre‐Emmanuel Falcoz, peer referees, and André Stoop, consumer, for their feedback and assistance; François Calais and Giorgio Maria Agazzi for their work on the search strategies; and Virginie Westeel, Sign‐off Editor.

This research was supported by a Cancer Council WA Postdoctoral Fellowship (VC) and a Victorian Cancer Agency Clinical Research Fellowship (CG).

Version history

Published

Title

Stage

Authors

Version

2022 Sep 28

Preoperative exercise training for people with non‐small cell lung cancer

Review

Catherine Granger, Vinicius Cavalheri

https://doi.org/10.1002/14651858.CD012020.pub3

2017 Jun 07

Preoperative exercise training for patients with non‐small cell lung cancer

Review

Vinicius Cavalheri, Catherine Granger

https://doi.org/10.1002/14651858.CD012020.pub2

2015 Dec 22

Preoperative exercise training for patients with non‐small cell lung cancer

Protocol

Vinicius Cavalheri, Catherine Granger

https://doi.org/10.1002/14651858.CD012020

Differences between protocol and review

We did not perform subgroup or sensitivity analyses due to the small number of studies included in the meta‐analyses, as well as their small sample sizes.

Keywords

MeSH

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

Aged; Humans; Middle Aged;

PICO

Population

Intervention

Comparison

Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Figure 1

Flow diagram of references identified, excluded, and included in review

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Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Figure 4

Forest plot of comparison: 1 Intervention group versus control group, outcome: 1.1 Risk of developing a postoperative pulmonary complication.

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Figure 5

Forest plot of comparison: 1 Intervention group versus control group, outcome: 1.2 Number of days patients needed an intercostal catheter.

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Figure 6

Forest plot of comparison: 1 Intervention group versus control group, outcome: 1.3 Postoperative length of hospital stay.

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Analysis 1.1

Comparison 1 Intervention group versus control group, Outcome 1 Risk of developing a postoperative pulmonary complication.

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Analysis 1.2

Comparison 1 Intervention group versus control group, Outcome 2 Number of days patients needed an intercostal catheter.

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Analysis 1.3

Comparison 1 Intervention group versus control group, Outcome 3 Postoperative length of hospital stay.

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Analysis 1.4

Comparison 1 Intervention group versus control group, Outcome 4 Preoperative exercise capacity (6‐minute walk distance).

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Analysis 1.5

Comparison 1 Intervention group versus control group, Outcome 5 Forced vital capacity (% pred).

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Summary of findings for the main comparison. Preoperative exercise training compared to no exercise training for patients scheduled to undergo lung resection for non‐small cell lung cancer

Preoperative exercise training compared to no exercise training for patients scheduled to undergo lung resection for non‐small cell lung cancer
Patient or population: patients scheduled to undergo lung resection for non‐small cell lung cancer Setting: the studies were based in the USA, China, Brazil, Turkey, and Italy. Intervention: preoperative exercise training Comparison: no exercise training
Outcomes	*Anticipated absolute effects^ (95% CI)**		Relative effect (95% CI)	№ of participants (studies)	Quality of the evidence (GRADE)	Comments
	Risk with no exercise training	Risk with preoperative exercise training
Number of patients who developed postoperative pulmonary complications	Study population		RR 0.33 (0.17 to 0.61)	158 (4 RCTs)	⊕⊕⊝⊝ LOW ^{1, 2}
	22 per 100	7 per 100 (4 to 13)
Number of days patients needed an intercostal catheter	The mean number of days patients needed an intercostal catheter in the control groups ranged from 7.4 to 8.8 days	The number of days patients needed an intercostal catheter in the intervention groups was, on average, 3.33 fewer days (95% CI 5.35 to 1.3 fewer days)	‐	38 (2 RCTs)	⊕⊕⊝⊝ LOW ^{1, 2}
Postoperative length of hospital stay	The mean postoperative length of hospital stay in the control groups ranged from 9.7 to 12.2 days	The postoperative length of hospital stay in the intervention groups was, on average, 4.34 fewer days (95% CI 5.65 to 3.03 fewer days)	‐	158 (4 RCTs)	⊕⊕⊝⊝ LOW ^{1, 2}
Post‐intervention exercise capacity assessed with: 6‐minute walk distance (6MWD)	The mean post‐intervention exercise capacity in the control groups ranged from 340 to 434 metres in 6 minutes.	The post‐intervention exercise capacity in the intervention groups was, on average, 18.23 metres more (95% CI 8.5 to 27.96 metres more)	‐	81 (2 RCTs)	⊕⊕⊝⊝ LOW ^{1, 2}
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio; OR: Odds ratio;
GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
¹ Significant risk of bias across the studies ² Small sample sizes across the studies, some with wide confidence intervals

Summary of findings for the main comparison. Preoperative exercise training compared to no exercise training for patients scheduled to undergo lung resection for non‐small cell lung cancer

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Table 1. Table 1. Results of included studies

Study	Results
Benzo 2011	Number of patients who developed a postoperative pulmonary complication: Intervention group (IG): 3 of 9 (33%) Control Group (CG): 5 of 8 (63%) P = 0.23 (between‐group) Number of days patients needed a chest tube: IG: 4.3 ± 2.1 days CG: 8.8 ± 5.3 days P = 0.03 (between‐group) Postoperative length of hospital stay: IG: 6.3 ± 3.0 days CG: 11.0 ± 6.3 days P = 0.058 (between‐group)
Lai 2017	Number of patients who developed a postoperative pulmonary complication: IG: 4 of 30 (13%) CG: 11 of 30 (37%) P = 0.037 (between‐group) Postoperative length of hospital stay: IG: 6.9 ± 4.4 days CG: 10.7 ± 6.4 days P = 0.01 (between‐group) Exercise capacity: Six‐Minute Walk Distance (6MWD), in metres: IG: 30 participants completed; CG: 30 participants completed; Preoperative measurements: baseline and post‐intervention: Mean ± standard deviation (SD): IG: 431.7 ± 102.8 m to 460.3 ± 93.6 m; CG: 434.5 ± 86.2 m to 443.9 ± 88.4 m P = 0.029 (between‐group)
Morano 2013	Number of patients who developed a postoperative pulmonary complication: IG: 2 of 12 (17%) CG: 7 of 9 (78%) P = 0.01 (between‐group) Number of days patients needed a chest tube: IG: 4.5 ± 2.9 days CG: 7.4 ± 2.6 days P = 0.03 (between‐group) Postoperative length of hospital stay: IG: 7.8 ± 4.8 days CG: 12.2 ± 3.6 days P = 0.04 (between‐group) Exercise capacity: Six‐Minute Walk Distance (6MWD), in metres: IG: 12 participants completed; CG: 12 participants completed; Preoperative measurements: baseline and post‐intervention: Mean ± standard deviation (SD): IG: 425.5 ± 85.3 m to 475 ± 86.5 m (P < 0.01); CG: 339.6 ± 107 m to 335 ± 107 m (P > 0.05) P < 0.001 (between‐group) Lung function: (i) Forced expired volume in one second (FEV₁; % predicted): IG: 12 participants completed; CG: 12 participants completed; Preoperative measurements: baseline and post‐intervention: IG: 48.1 ± 13.9% to 54.8 ± 22.4% (P = 0.08); CG: 51.7 ± 9.8% to 58.8 ± 13.0% (P = 0.23) Between‐group difference was not calculated (ii) Forced vital capacity (FVC; % predicted): IG: 12 participants completed; CG: 12 participants completed; Preoperative measurements: baseline and post‐intervention: Median (interquartile range): IG: 62.5% (49 to 71) to 76% (65 to 79.7); P = 0.02; CG: 62.5% (56 to 92) to 71% (63.2 to 89); P = 0.37 Between‐group difference was not calculated
Pehlivan 2011	Number of patients who developed a postoperative pulmonary complication: IG: 1 of 30 (3%) CG: 5 of 30 (17%) P = 0.04 (between‐group) Postoperative length of hospital stay: IG: 5.4 ± 2.7 days CG: 9.7 ± 3.1 days P < 0.001 (between‐group) Lung function: (i) FEV₁; % predicted: IG: 30 participants completed; CG: 30 participants completed; Preoperative measurements: change from baseline to post‐intervention: IG: 15.84 ± 2.10%; CG: 9.92 ± 3.5% P = 0.3 (between‐group) (ii) FVC; % predicted: IG: 30 participants completed; CG: 30 participants completed; Preoperative measurements: baseline and post‐intervention: IG: 19.26 ± 2.33%; CG: 16.3 ± 2.4% P = 0.6 (between‐group)
Stefanelli 2013	Exercise capacity: Peak rate of oxygen uptake (VO_2peak), in ml/kg/min: IG: 20 participants completed; CG: 20 participants completed; Preoperative measurements: baseline and post‐intervention: IG: 14.9 ± 2.3 ml/kg/min to 17.8 ± 2.1 ml/kg/min; CG: 14.8 ± 1.4 ml/kg/min to 14.5 ± 1.2 ml/kg/min P < 0.001 (between‐group) Lung function: FEV₁; % predicted: IG: 20 participants completed; CG: 20 participants completed; Preoperative measurements: baseline and post‐intervention: IG: 57.4 ± 19.1% to 59.8 ± 19.2%; CG: 57.6 ± 16.9% to 57.5 ± 17.0% P > 0.05 (between‐group)
Intervention group (IG), Control Group (CG)

Table 1. Table 1. Results of included studies

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Comparison 1. Intervention group versus control group

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Risk of developing a postoperative pulmonary complication Show forest plot	4	158	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.17, 0.61]

2 Number of days patients needed an intercostal catheter Show forest plot	2	38	Mean Difference (IV, Fixed, 95% CI)	‐3.33 [‐5.35, ‐1.30]

3 Postoperative length of hospital stay Show forest plot	4	158	Mean Difference (IV, Fixed, 95% CI)	‐4.24 [‐5.43, ‐3.06]

4 Preoperative exercise capacity (6‐minute walk distance) Show forest plot	2	81	Mean Difference (IV, Fixed, 95% CI)	18.23 [8.50, 27.96]

5 Forced vital capacity (% pred) Show forest plot	2	84	Mean Difference (IV, Fixed, 95% CI)	2.97 [1.78, 4.16]

Comparison 1. Intervention group versus control group

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Entrenamiento preoperatorio con ejercicios para pacientes con cáncer de pulmón de células no pequeñas

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