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Exercise BEFORE Surgery (article)

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Exercise Before Halves Problems After Lung Cancer Surgery


Roxanne Nelson, RN, BSN

February 07, 2018

Regular exercise before lung cancer surgery cuts the risk for postoperative complications in half, according to a new analysis.

Researcher report that not only were complications reduced, but the hospital stay was also shortened by nearly 3 days.

However, the evidence for preoperative exercise was less compelling for other cancer types, largely because of the limited number of trials and the poor quality of the evidence.

The findings come from a review published in the British Journal of Sports Medicine.

"In terms of our findings, we have moderate quality of evidence suggesting that exercise reduces complication rates and length of hospital stay on patients with lung cancer," said lead author, Daniel Steffens, PhD, from the Surgical Outcomes Research Centre, University of Sydney, New South Wales, Australia.

"But for other cancers, more evidence is needed in the form of well-designed randomized controlled trials," Dr Steffens told Medscape Medical News.

This review looked specifically at whether preoperative exercise was beneficial for patients with cancer who underwent surgery, specifically whether it affected postoperative complications, length of hospital stay, and quality of life.

The meta-analysis included 17 articles (reporting on 13 different trials) and a total cohort of 806 individual participants and six tumor categories (colon cancer; liver resection for colorectal metastatic disease; and esophageal, lung, oral, and prostate cancer).

The studies ranged in size from 15 to 151 participants, and patients had an average age of 63.3 years. The duration of the preoperative exercise ranged from 1 to 4 weeks, but most patients participated in a 2-week program.

The team found the strongest evidence was for lung cancer, with eight reports presenting data from five randomized clinical trials (RCTs) and one quasi-randomized trial that looked at postoperative complications (ie, pulmonary and cardiopulmonary complications).

When they pooled the data for lung cancer,  moderate-quality evidence suggested that preoperative exercise significantly reduced postoperative complication rates (relative risk [RR], 0.52) among patients undergoing lung resection, as well as shortening the length of hospital stay (mean difference [MD], –2.86) compared with that in controls.

For colon cancer, only one study compared the effects of a preoperative short-term intensive exercise program with those of exercise advice (n = 41). No effect was observed on postoperative complications (RR, 1.07), length of hospital stay (−5.40 days), or quality of life (MD, −4.00). The quality of evidence was also rated as very low.

Two reports presented data from one clinical trial that investigated a supervised exercise program for patients undergoing liver resection for colorectal metastatic disease (n = 34). The quality of evidence was very low, and compared with standard care, exercise did not appear to improve postoperative complication rates (RR, 0.90) or length of hospital stay (−0.66 days).

For esophageal cancer, three reports presented data from two trials that evaluated the effect of a preoperative respiratory muscle training program on postoperative complications (n = 83) and length of hospital stay (n = 99). The results from one quasi-randomized trial found no evidence that preoperative respiratory muscle training was better than usual care for postoperative complications (RR, 1.18), and pooling data from both trials found no difference in length of hospital stay.

Even though there was only one study, preoperative mouth-opening exercise training with follow-up telephone calls (n = 60) enhanced postoperative quality of life in patients with oral cancer (no estimates reported).

Finally, in prostate cancer, two RCTs reported on the effectiveness of preoperative pelvic floor muscle exercise vs control on self-reported quality of life after radical prostatectomy. One trial (n = 118) that assessed quality of life found a benefit for exercise compared with control. Through use of the International Continence Society Male Short Form, there was a significant mean difference at 1 month (MD, −3.70; P = .002) and 3 months (MD, −4.10; P = 0.002) between groups in the postoperative period.

The second trial (n = 16) assessed quality of life by using the mental and physical component of the Prostate Cancer Index. It did not find any significant difference between the intervention group and controls for the mental or the physical component scores.

"The results of our systematic review and meta-analysis clearly warrant the development of new high-quality RCTs aimed at investigating the effect of a preoperative exercise programme for most major oncological procedures," write the authors.

"Since preoperative pulmonary rehabilitation was effective in reducing postoperative complication and length of hospital stay in patients with lung cancer, it is possible that similar exercise and educational programmes could benefit patients undergoing other oncological surgeries, although the literature is currently lacking," they add.

No external funding source is listed. The authors have disclosed no relevant financial relationships.

Br J Sports Med. Published online February 1, 2018. Abstract


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