Seven-day exercise-based prehabilitation for people with non-small cell lung cancer: a systematic review and meta-analysis

Introduction: Exercise based prehabilitation (EBPP) for people with non-small cell lung cancer (NSCLC) can reduce postoperative complications, however the four-week intervention period may negatively affect tumour growth, condition deterioration and programme adherence. It is unclear whether shorter 7-day EBPP can improve fitness to reduce postoperative complications. Therefore, the aim was to determine whether 7-day EBPP can increase six-minute walk distance (6MWD), improve peak expiratory flow (PEF) and improve postoperative outcomes.

Method: Electronic databases (PubMed, Scopus, Medline, Web of Science and Cochrane Library), were systematically searched. Reference lists of relevant papers were also searched. Study selection was performed independently in a non-blinded manner. Only randomised controlled trials (RCTs) were included, with people with NSCLC undergoing 7-day EBPP, including at least one of pre- to post-EBPP change in 6MWD or PEF and at least one of: pulmonary complications (PC), length of stay (LoS) or length of antibiotic use. Review Manager was used to analyse risk of bias (RoB), risk ratio (RR) and standardised mean difference (SMD).

Results: 6 studies, with 346 participants, were included and presented a high RoB. Reporting of exercise performed, progression and adherence were limited. All studies used applied seated aerobic training for 15-30 minutes, at a perceived exertion of “somewhat hard”, 1-2 times daily. One study implemented resistance training. All studies included respiratory muscle training (20 min or 12-30 breaths). Pooled data suggested that compared to standard care, 7-day EBPP significantly increased 6MWD (20.6 m; 95% CI: 13.6 to 27.6; p<0.00001) and PEF (20.8 L‧min-1; 95% CI: 15.5 to 26.0; p<0.00001) in three studies and significantly reduced LoS (-2.7 days; 95% CI: -3.6 to -1.1; p<0.00001) in four studies, significantly reduced the risk of developing a PC (RR 0.39; 95% CI: 0.25 to 0.62; P<0.0001) in all studies and significantly reduced antibiotic use (1.2 days; 95% CI: -2.1 to 0.3; p<0.01) in two studies.

Conclusion: Low quality evidence suggests that 7-day EBPP may significantly increase 6MWD & PEF and significantly reduce PPC, LoS & antibiotic use. Future RCTs should apply greater methodological quality and record and report details of their intervention.