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Systematic Review and Meta-Analysis of Randomized, Controlled Trials on Preoperative Physical Exercise Interventions in Patients with Non-Small-Cell Lung Cancer

Department of Health Sciences, Public University of Navarra, Navarrabiomed-Biomedical Research Centre, IDISNA-Navarra’s Health Research Institute, C/irunlarrea 3, Complejo Hospitalario de Navarra, 31008 Pamplona, Navarra, Spain
Research Institute of the Hospital 12 de Octubre (i + 12), 28670 Madrid, Spain
Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain
Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, 28029 Madrid, Spain
i+HeALTH, Department of Health Sciences, European University Miguel de Cervantes, 47012 Valladolid, Spain
Department of Systems Biology, University of Alcalá, 28805 Madrid, Spain
Author to whom correspondence should be addressed.
Cancers 2019, 11(7), 944;
Received: 20 June 2019 / Accepted: 2 July 2019 / Published: 5 July 2019
PDF [1244 KB, uploaded 5 July 2019]


Preoperative physical exercise protocols prior to cancer surgery increased in popularity over recent years; however, the beneficial effect of such protocols is not well established, with conflicting results reported. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess the effects of different modalities or combinations of preoperative exercise interventions and/or prehabilitation multicomponent training in patients with non-small-cell lung cancer (NSCLC) after surgery on the outcomes related to functional capacity, mental wellness and medical care. We searched in OVID Embase, Pubmed, Cochrane Library, CINAHL, Scopus, and Web of Science. Characteristics of studies and program results and outcome data were extracted. Changes between the intervention and control groups, from baseline to follow-up (standardized mean difference (SMD) or relative risk (RR) with 95% confidence interval (CI) for each intervention was pooled using weighted random-effects models). A total of 676 participants from 10 RCTs were included in the final analysis (aerobic training + inspiratory muscle training, n = 5; aerobic training + strength training + inspiratory muscle training, n = 2; aerobic training + strength training, n = 1; multicomponent training, n = 1; aerobic training alone, n = 1). The results showed intervention-induced improvement in walking endurance (SMD = 0.27; 95% CI, 0.11 to 0.44; I2 = 0.0%), peak exercise capacity (SMD = 0.78; 95% CI, 0.35 to 1.21; I2 = 76.7%), dyspnoea (SMD = −0.30; 95% CI, −0.51 to −0.10; I2 = 0.0%), risk of hospitalization (SMD = −0.58; 95% CI, −0.97 to −0.20; I2 = 70.7%), and postoperative pulmonary complications (relative risk (RR) = 0.50; 95% CI, 0.39 to 0.66; I2 = 0.0%). For the functional capacity and medical care parameters, preoperative combined aerobic, resistance, and inspiratory muscle training was shown to be effective if comprising one to four weeks, performing 1–3 sessions per week, with moderate intensity (50% for endurance capacity). Further studies with larger samples and higher methodological quality are needed to clarify the potential benefits of preoperative exercise training for patients with NSCLC. View Full-Text
Keywords: resistance training; cardiovascular; functional capacity; lung cancer resistance training; cardiovascular; functional capacity; lung cancer

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Rosero, I.D.; Ramírez-Vélez, R.; Lucia, A.; Martínez-Velilla, N.; Santos-Lozano, A.; Valenzuela, P.L.; Morilla, I.; Izquierdo, M. Systematic Review and Meta-Analysis of Randomized, Controlled Trials on Preoperative Physical Exercise Interventions in Patients with Non-Small-Cell Lung Cancer. Cancers 2019, 11, 944.

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