Preoperative pulmonary rehabilitation versus chest physical therapy in patients undergoing lung cancer resection : a pilot randomized controlled trial

Abstract

Objective: To evaluate the effect of 4 weeks of pulmonary rehabilitation (PR) versus chest physical therapy (CPT) on the preoperative functional capacity and postoperative respiratory morbidity of patients undergoing lung cancer resection. Design: Randomized single-blinded study. Setting: A teaching hospital. Participants: Patients undergoing lung cancer resection (NZ24). Interventions: Patients were randomly assigned to receive PR (strength and endurance training) versus CPT (breathing exercises for lung expansion). Both groups received educational classes. Main Outcome Measures: Functional parameters assessed before and after 4 weeks of PR or CPT (phase 1), and pulmonary complications assessed after lung cancer resection (phase 2). Results: Twelve patients were randomly assigned to the PR arm and 12 to the CPT arm. Three patients in the CPT arm were not submitted to lung resection because of inoperable cancer. During phase 1 evaluation, most functional parameters in the PR group improved from baseline to 1 month: forced vital capacity (FVC) (1.47L [1.27e2.33L] vs 1.71L [1.65e2.80L], respectively; PZ.02); percentage of predicted FVC (FVC%; 62.5% [49%e71%] vs 76% [65%e79.7%], respectively; P<.05); 6-minute walk test (425.5 85.3m vs 475 86.5m, respectively; P<.05); maximal inspiratory pressure (90 45.9cmH2O vs 117.5 36.5cmH2O, respectively; P<.05); and maximal expiratory pressure (79.7 17.1cmH2O vs 92.9 21.4cmH2O, respectively; P<.05). During phase 2 evaluation, the PR group had a lower incidence of postoperative respiratory morbidity (PZ.01), a shorter length of postoperative stay (12.2 3.6d vs 7.8 4.8d, respectively; PZ.04), and required a chest tube for fewer days (7.4 2.6d vs 4.5 2.9d, respectively; PZ.03) compared with the CPT arm. Conclusions: These findings suggest that 4 weeks of PR before lung cancer resection improves preoperative functional capacity and decreases the postoperative respiratory morbidity.