Preoperative pulmonary rehabilitation in patients undergoing lung resection for non-small cell lung cancer. Combined aerobic exercise and high-intensity respiratory muscle training in patients surgically treated for non-small cell lung cancer: a pilot randomized clinical trial. Supervised physical exercise to improve the quality of life of cancer patients: the EFICANCER randomised controlled trial Outcomes of Pulmonary Rehabilitation After Treatment for Non-Small Cell Lung Cancer Stages I to IIIa: AN OBSERVATIONAL STUDY Exercise in patients with non-small cell lung cancer. Effects of exercise training on exercise capacity in patients with non-small cell lung cancer receiving targeted therapy Safety and Feasibility of an Exercise Intervention for Patients Following Lung Resection Effects of intentional weight loss in patients with obesity and heart failure: a systematic review. Perioperative rehabilitation in operation for lung cancer (PROLUCA) – rationale and design Perioperative Rehabilitation in Operable Lung Cancer Patients (PROLUCA) Preoperative Exercise Vo2 Measurement for Lung Resection Candidates: Results of Cancer and Leukemia Group B Protocol 9238 Short and long-term effects of supervised versus unsupervised exercise training on health-related quality of life and functional outcomes following lung cancer surgery - a randomized controlled trial. Predictors of exercise oxygen desaturation following major lung resection. Preoperative exercise training prevents functional decline after lung resection surgery: a randomized, single-blind controlled trial Which field walking test should be used to assess functional exercise capacity in lung cancer? an observational study A rehabilitation program for lung cancer patients during postthoracotomy chemotherapy [Effects of an inpatient pulmonary rehabilitation program on dyspnea, exercise capacity, and health related quality of life for patients with chronic lung disease]. The effects of pulmonary rehabilitation in patients with non-cystic fibrosis bronchiectasis: protocol for a randomised controlled trial Physical exercise training for cystic fibrosis. Safety and feasibility of a combined exercise intervention for inoperable lung cancer patients undergoing chemotherapy: a pilot study. Inspiratory muscle training improves respiratory muscle strength, functional capacity and quality of life in patients with chronic kidney disease: a systematic review. The short and long term effects of exercise training in non-cystic fibrosis bronchiectasis – a randomised controlled trial The Impact of a Multidimensional Exercise Intervention on Physical and Functional Capacity, Anxiety, and Depression in Patients With Advanced-Stage Lung Cancer Undergoing Chemotherapy
BACKGROUND The impact of short-term preoperative pulmonary rehabilitation on exercise capacity of patients with chronic obstructive pulmonary disease undergoing lobectomy for non-small cell lung cancer is evaluated . METHODS A prospect i ve observational study was design ed . Inclusion criteria consisted of an indication to lung resection because of a clinical stage I or II non-small cell lung cancer and a chronic obstructive disease on preoperative pulmonary function test . In such conditions , maximal oxygen consumption by a cardio-pulmonary exercise test was evaluated ; when this result ed as being < or = 15 ml/kg/min a pulmonary rehabilitation programme lasting 4 weeks was considered . Twelve patients fulfilled inclusion criteria , completed the preoperative rehabilitation programme and underwent a new functional evaluation prior to surgery . The postoperative record of these patients was collected . RESULTS On completion of pulmonary rehabilitation , the resting pulmonary function test and diffuse lung capacity of patients was unchanged , whereas the exercise performance was found to have significantly improved ; the mean increase in maximal oxygen consumption proved to be at 2.8 ml/kg/min ( p<0.01 ) . Eleven patients underwent lobectomy ; no postoperative mortality was noted and mean hospital stay was 17 days . Postoperative pulmonary complication was recorded in 8 patients . CONCLUSIONS Short-term preoperative pulmonary rehabilitation could improve the exercise capacity of patients with chronic obstructive pulmonary disease who are c and i date s for lung resection for non-small cell lung cancer BACKGROUND Lung resection surgery further decreases exercise capacity and negatively affects respiratory muscle function in patients with non-small cell lung cancer ( NSCLC ) . The best design for exercise interventions in these patients has not been determined yet . AIM To assess the impact of aerobic exercise and high-intensity respiratory muscle training on patient outcomes following lung cancer resection surgery . DESIGN Prospect i ve , single-blind , pilot r and omized controlled trial . SETTING Outpatient cardiopulmonary rehabilitation unit of two university hospitals . POPULATION Thirty-seven patients with NSCLC after tumor resection . METHODS Patients were r and omly assigned to exercise training or usual post-operative care . The training program consisted of aerobic exercises and high-intensity respiratory muscle training ( 24 supervised sessions , 3 per week , 8 weeks ) . Primary outcome was exercise capacity assessed with peak oxygen uptake ( VO2peak ) during cardiopulmonary exercise test . Secondary outcomes included changes in respiratory muscle strength , levels of serum insulin growth factor I ( IGF-I ) and IGF binding protein 3 ( IGFBP-3 ) , and quality of life assessed with the European Organization for Research and Treatment of Cancer ( EORTC QLQ-C30 ) question naire . RESULTS The 8-week training program was associated with significant improvement in VO2peak ( 2.13 mL/Kg/min [ 95%CI 0.06 to 4.20 ] ) , maximal inspiratory and expiratory pressures ( 18.96 cmH2O [ 95 % CI 2.7 to 24.1 ] and 18.58 cmH2O [ 95 % CI 4.0 to 33.1 ] , respectively ) and IGFBP-3 ( 0.61 µg/mL [ % 95 CI 0.1 to 1.12 ] ) . No significant differences were observed in the EORTC QLQ-C30 . CONCLUSIONS An 8-week exercise program consisting of aerobic exercise and high-intensity respiratory muscle training improved exercise capacity , respiratory muscle strength , and serum IGFBP-3 levels in NSCLC patients after lung resection . There was no impact on the other outcomes assessed . CLINICAL REHABILITATION IMPACT A combination of aerobic exercise and respiratory muscle training could be included in the rehabilitation program of deconditioned patients with NSCLC after lung resection surgery Background The optimal form of exercise for individuals with cancer has yet to be identified , but there is evidence that exercise improves their quality of life . The aim of this study is to assess the efficacy and efficiency of an innovative physical exercise programme , for individuals undergoing chemotherapy for breast , gastrointestinal or non-small cell lung tumours , for improving quality of life , reducing level of fatigue , and enhancing functional capacity over time . Design / Methods We will conduct a clinical trial in 66 patients with stage IV breast , gastrointestinal or non-small cell lung cancer , recruited by the Department of Oncology of the referral hospital from 4 primary care health centres of the Basque Health Service ( Osakidetza ) . These patients will be r and omised to one of two groups . The treatment common to both groups will be the usual care for cancer : optimized usual drug therapies and strengthening of self-care ; in addition , patients in the intervention group will participate in a 2-month exercise programme , including both aerobic and strength exercises , supervised by nurses in their health centre . The principal outcome variable is health-related quality of life , measured blindly with the 30-item European Organization for the Research and Treatment of Cancer Core Quality of Life Question naire and Short Form-36 four times : at baseline , and 2 , 6 and 12 months later . The secondary outcome variables are fatigue ( Functional Assessment of Chronic Illness Therapy-Fatigue question naire ) , functional capacity ( 6-Minute Walk Test and cardiorespiratory test ) , muscle strength ( h and -held dynamometry and sit-to-st and test ) , radiological response to treatment ( Response Evaluation Criteria In Solid Tumors ) and progression-free and overall survival . Age , sex , diagnosis , chemotherapy regimen , Eastern Cooperative Oncology Group performance status and smoking status will be considered as predictive variables . Data will be analysed on an intention-to-treat basis , comparing changes at each time point between groups , adjusting for baseline values by analysis of covariance . Discussion As well as achieving the objectives set , this study will provide us with information on patient perception of the care received and an opportunity to develop a project based on collaborative action between the primary care and oncology professionals . Trial registration Clinical Trials.gov Identifier : NCT01786122 Registration date : 02/05/2013 PURPOSE : Although rehabilitation after treatment for non-small cell lung cancer ( NSCLC ) was found to have a beneficial effect on exercise capacity in a number of studies , insight into its effect on quality of life ( QoL ) and fatigue is limited . The aim of this study was to examine the outcome of pulmonary rehabilitation ( PR ) regarding fatigue , QoL , and exercise capacity in adult patients curatively treated for NSCLC stages I to IIIa . METHODS : Study data were prospect ively and routinely gathered in daily practice in patients taking part in an outpatient PR program after treatment for NSCLC stages I to IIIa . PR consisted of 12 weeks of supervised exercises 3 times a week , supplemented with scheduled visits with members of a multidisciplinary team . Data were gathered at initial assessment and discharge . Outcomes included fatigue ( the Functional Assessment of Cancer Therapy-Fatigue and the fatigue domain of the Chronic Respiratory Disease Question naire ) ; QoL ( total CRQ score ) , Functional Assessment of Cancer Therapy-Lung , and the Short Form 36 ; and exercise capacity ( cardiopulmonary exercise testing ) . RESULTS : Fifty patients started the program out of the 70 patients referred to PR and 43 ( 86 % ) completed the program . Significant ( P ⩽ .01 ) and clinical ly relevant improvements were observed for all outcome measures . CONCLUSIONS : Rehabilitation after treatment for NSCLC stages I to IIIa showed promising improvements regarding patient fatigue , QoL , and exercise capacity . PR should be considered for patients after treatment for NSCLC stages I to IIIa PURPOSE This study aim ed to evaluate the safety , feasibility , and effects of an 8-wk combined resistance and endurance exercise program in patients with advanced non-small cell lung cancer ( NSCLC ) during in- and outpatient care . METHODS In this intervention study , 40 patients with predominantly advanced NSCLC receiving simultaneous or sequential radiochemotherapy or chemotherapy alone were enrolled . For a period of 8 wk , patients were instructed to exercise at least five times per week during the inpatient setting and at least three times per week in the outpatient setting . Physical performance status ( endurance capacity : 6-min walk test ; strength capacity : h and held dynamometry ) , quality -of-life ( Functional Assessment of Cancer Therapy-Lung ) , fatigue ( Multidimensional Fatigue Inventory ) , and depression ( Patient Health Question naire ) were assessed at baseline ( T0 ) , after the exercise intervention ( T1 ) , and at a follow-up time point 8 wk later ( T2 ) . The primary end point was adequate adherence ( feasibility ) defined as completing at least two training sessions per week during a minimum of 6 wk . RESULTS Of 40 patients , 31 ( 77.5 % ) completed the postexercise assessment ( T1 ) and 22 ( 55 % ) completed follow-up ( T2 ) . The stages were IIA ( 5 % ) , IIIA ( 8 % ) , IIIB ( 20 % ) , and IV ( 67 % ) , and the median age was 63 yr ( range = 22 - 75 yr ) . Overall , adherence was 82 % for those patients who completed T1 , and 55 % of the 40 participating patients fulfilled the adequate adherence criterion . Those who completed the intervention showed a significant improvement in the 6-min walk distance and in knee , elbow , and hip muscle strength after the intervention ( T1 ) . Quality of life , fatigue , and depression scores remained stable or declined slightly . Significant improvements in knee-muscle strength were also observed at T2 . CONCLUSIONS Exercise training is feasible in advanced and metastatic NSCLC patients during anticancer treatment . In this pilot study , endurance and strength capacity improved over time , indicating the rehabilitative importance of the applied intervention . To investigate the potential impact of exercise training in this patient group , a larger r and omized trial is warranted Purpose Peak oxygen consumption ( VO2peak ) is an important predictive factor for long-term prognosis in patients with non-small cell lung cancer ( NSCLC ) . The purpose of this study was to investigate whether 8 weeks of exercise training improves exercise capacity , as assessed by VO2peak , and other related factors in patients with NSCLC receiving targeted therapy . Methods A total of 24 participants with adenocarcinoma were r and omly assigned to either the control group ( n = 11 ) or the exercise group ( n = 13 ) . Subjects in the exercise group participated in individualized , high-intensity aerobic interval training of exercise . The outcome measures assessed at baseline and after 8 weeks were as follows : VO2peak and the percentage of predicted VO2peak ( % predVO2peak ) , muscle strength and endurance of the right quadriceps , muscle oxygenation during exercise , insulin resistance as calculated by the homeostasis model , high-sensitivity C-reactive protein , and quality of life ( QoL ) question naire inventory . Results No exercise-related adverse events were reported . After exercise training , VO2peak and % predVO2peak increased by 1.6 mL kg−1 min−1 and 5.3 % ( p < 0.005 ) , respectively ; these changes were associated with improvements in circulatory , respiratory , and muscular functions at peak exercise ( all p = 0.001 ) . The exercise group also had less dyspnea ( p = 0.01 ) and favorably lower fatigue ( p = 0.05 ) than baseline . Conclusions Patients with NSCLC receiving targeted therapy have quite a low exercise capacity , even with a relatively high QoL. Exercise training appears to improve exercise capacity and alleviate some cancer-related symptoms Purpose . Following surgical lung resection , patients frequently suffer functional decline and reduced activity levels . Despite this exercise interventions are not routinely provided . This study aim ed to establish the safety and feasibility of exercise administered following lung resection in an Australian setting . Method . Pilot r and omized controlled trial . Fifteen individuals ( 53 % male ) , mean ± st and ard deviation age 65.5 ± 16.1 years , undergoing surgery for suspected lung cancer . R and omization occurred postoperatively . Control arm received protocol ized inpatient respiratory physiotherapy . Intervention arm additionally received twice daily exercise until discharge home and twice weekly as outpatient for 8 weeks . Outcome measures ( safety , feasibility , functional capacity , functional mobility , and health-related quality of life [ HRQoL ] ) were assessed preoperatively and 2 and 12 weeks postoperatively . Results . Fifteen participants ( lung cancer n = 10 ) were assigned to control ( n = 8) and intervention ( n = 7 ) groups . Inpatient exercise was delivered on 71 % of occasions ( 35 out of 49 planned sessions ) . Four participants attended outpatient exercise sessions and these participants attended sessions on 81 % of occasions ( 52 out of 64 planned sessions ) . No adverse events occurred . There was a significant between group difference in 6-Minute Walk Test ( 6MWT ; P = .024 ) . In both groups the 6MWT declined from baseline to 2 weeks postoperative and then improved up to 12 weeks ; improvements were greater in the intervention group . Intervention was associated with positive trends of improvement in some HRQoL domains . Conclusions . Exercise intervention performed in the inpatient and outpatient setting s for individuals following lung resection  was safe and feasible . The uptake rate for outpatient exercise was 57 % , similar to previous trials ; however , adherence was excellent within the subgroup of participants who attended . Further research is required to investigate the best setting of exercise delivery and explore ways to improve the uptake rate OBJECTIVE Obesity is an independent risk factor for the development of heart failure , and the two commonly co-exist . The European Society of Cardiology does not provide guidance regarding weight loss strategies in heart failure . The aim of this study was to systematic ally review the evidence for outcomes following intentional weight loss in patients with heart failure and obesity . METHOD A systematic review of English articles was undertaken using data bases PubMed , Embase and CENTRAL . R and omized controlled trials and observational studies reporting outcomes following intentional weight loss by lifestyle , surgical or pharmacotherapy intervention in patients with obesity and heart failure were included . RESULTS Four r and omized controlled trials and seven observational studies were identified . Two r and omized controlled trials used  diet and exercise  as an intervention , one used diet alone and one used a pharmacological intervention ( orlistat ) . All but one reported significant weight loss . Two reported improvement in exercise capacity and quality of life . One reported improvement in New York Heart Association functional class in heart failure with preserved ejection fraction . The observational studies , five of which reported on outcomes following bariatric surgery , despite being small , heterogeneous and high risk of bias , suggested a trend in improvement of left ventricular function , quality of life and exercise capacity following weight loss . CONCLUSION Weight loss is achievable with lifestyle intervention in those with heart failure and obesity and may result in improvements in New York Heart Association classification , quality of life and exercise capacity Background The purpose of the PROLUCA study is to investigate the efficacy of preoperative and early postoperative rehabilitation in a non-hospital setting in patients with operable lung cancer with special focus on exercise . Methods Using a 2x2 factorial design with continuous effect endpoint ( Maximal Oxygen Uptake ( VO2peak ) ) , 380 patients with non-small cell lung cancer ( NSCLC ) stage I-IIIa referred for surgical resection will be r and omly assigned to one of four groups : ( 1 ) preoperative and early postoperative rehabilitation ( starting two weeks after surgery ) ; ( 2 ) preoperative and late postoperative rehabilitation ( starting six weeks after surgery ) ; ( 3 ) early postoperative rehabilitation alone ; ( 4 ) today ’s st and ard care which is postoperative rehabilitation initiated six weeks after surgery . The preoperative rehabilitation program consists of an individually design ed , 30-minute home-based exercise program performed daily . The postoperative rehabilitation program consists of a supervised group exercise program comprising cardiovascular and resistance training two-hour weekly for 12 weeks combined with individual counseling . The primary study endpoint is VO2peak and secondary endpoints include : Six-minute walk distance ( 6MWD ) , one-repetition-maximum ( 1RM ) , pulmonary function , patient-reported outcomes ( PROs ) on health-related quality of life ( HRQoL ) , symptoms and side effects of the cancer disease and the treatment of the disease , anxiety , depression , wellbeing , lifestyle , hospitalization time , sick leave , work status , postoperative complications ( up to 30 days after surgery ) and survival . Endpoints will be assessed at baseline , the day before surgery , pre-intervention , post-intervention , six months after surgery and one year after surgery . Discussion The results of the PROLUCA study may potentially contribute to the identification of the optimal perioperative rehabilitation for operable lung cancer patients focusing on exercise initiated immediately after diagnosis and rehabilitation shortly after surgery . Trial Registration Introduction . Surgical resection in patients with non – small cell lung cancer ( NSCLC ) may be associated with significant morbidity , functional limitations , and decreased quality of life . Objectives . The safety and feasibility of a preoperative and early postoperative rehabilitation program in patients operated for NSCLC was determined in a nonhospital setting , with focus on high-intensity interval exercise . Methods . Forty patients with biopsy-proven NSCLC stages I to IIIa referred for surgical resection at the Department of Cardiothoracic Surgery RT , Rigshospitalet , University of Copenhagen , were r and omly assigned to 1 of 4 groups ( 3 intervention groups and 1 control group ) . The preoperative intervention consisted of a home-based exercise program , while the postoperative exercise program comprised a supervised group exercise program involving resistance and high-intensity interval cardiorespiratory exercise 2 hours weekly for 12 weeks combined with individual counseling . The study endpoints were inclusion rate , adherence , and number of adverse events . Results . Forty patients ( of 124 screened ; 32 % ) were included and r and omized into the 4 groups . The postoperative exercise was completed by 73 % of the patients r and omized to this intervention . No adverse events were observed , indicating that the early postoperative exercise program is safe . The preoperative home-based exercise program was not feasible due to interfering diagnostic procedures and fast-track surgery that left only 1 to 2 weeks between diagnosis and surgery . Conclusion . The early postoperative exercise program for patients with NSCLC was safe and feasible , but in a fast-track set up , a preoperative home-based exercise program was not feasible for this population Introduction : A stepwise approach to the functional assessment of lung resection c and i date s is widely accepted , and this approach incorporates the measurement of exercise peak Vo2 when spirometry and radionuclear studies suggest medical inoperability . A new functional operability ( FO ) algorithm incorporates peak exercise Vo2 earlier in the preoperative assessment to determine which patients require preoperative radionuclear studies . This algorithm has not been studied in a multicenter study . Methods : The CALGB ( Cancer and Leukemia Group B ) performed a prospect i ve multi-institutional study to investigate the use of primary exercise Vo2 measurement for the prediction of surgical risk . Patients with known or suspected resectable non-small cell lung cancer ( NSCLC ) were eligible .  Exercise testing including measurement of peak oxygen uptake ( Vo2 ) , spirometry , and single breath diffusion capacity ( DLCO ) was performed on each patient . Nuclear perfusion scans were obtained on selected high-risk patients . After surgery , morbidity and mortality data were collected and correlated with preoperative data . Mortality and morbidity were retrospectively compared by algorithm-based risk groups . Results : Three hundred forty-six patients with suspected lung cancer from nine institutions underwent thoracotomy with or without resection ; 57 study patients did not undergo thoracotomy .  Patients who underwent surgery had a median survival time of 30.9 months , whereas patients who did not undergo surgery had a median survival time of 15.6 months . Among the 346 patients who underwent thoracotomy , 15 patients died postoperatively ( 4 % ) , and 138 patients ( 39 % ) exhibited at least one cardiorespiratory complication postoperatively . We found that patients who had a peak exercise Vo2 of < 65 % of predicted ( or a peak Vo2/kg < 16 ml/min/kg ) were more likely to suffer complications ( p = 0.0001 ) and were also more likely to have a poor outcome ( respiratory failure or death ) if the peak Vo2 was < 15 ml/min/kg ( p = 0.0356 ) . We also found a subset of 58 patients who did not meet FO algorithm criteria for operability , but who still tolerated lung resection with a 2 % mortality rate . Conclusions : Our data provide multicenter validation for the use of exercise Vo2 for preoperative assessment of lung cancer patients , and we encourage an aggressive approach when evaluating these patients for surgery OBJECTIVE Surgical resection enhances long-term survival after lung cancer , but survivors face functional deficits and report on poor quality of life long time after surgery . This study evaluated short and long-term effects of supervised group exercise training on health-related quality of life and physical performance in patients , who were radically operated for lung cancer . METHODS A r and omized , assessor-blinded , controlled trial was performed on 78 patients undergoing lung cancer surgery . The intervention group ( IG , n=41 ) participated in supervised out-patient exercise training sessions , one hour once a week for ten weeks . The sessions were based on aerobic exercises with target intensity of 60 - 80 % of work capacity , resistance training and dyspnoea management . The control group ( CG , n=37 ) received one individual instruction in exercise training . Measurements consisted of : health-related quality of life ( SF36 ) , six minute walk test ( 6MWT ) and lung function ( spirometry ) , assessed three weeks after surgery and after four and twelve months . RESULTS Both groups were comparable at baseline on demographic characteristic and outcome values . We found a statistically significant effect after four months in the bodily pain domain of SF36 , with an estimated mean difference ( EMD ) of 15.3 ( 95 % CI:4 to 26.6 , p=0.01 ) and a trend in favour of the intervention for role physical functioning ( EMD 12.04 , 95 % CI : -1 to 25.1 , p=0.07 ) and physical component summary ( EMD 3.76 , 95 % CI:-0.1 to 7.6 , p=0.06 ) . At 12 months , the tendency was reversed , with the CG presenting overall slightly better measures . We found no effect of the intervention on 6MWT or lung volumes at any time-point . CONCLUSION Supervised compared to unsupervised exercise training result ed in no improvement in health-related quality of life , except for the bodily pain domain , four months after lung cancer surgery . No effects of the intervention were found for any outcome after one year OBJECTIVE To identify predictors of postoperative exercise oxygen desaturation ( EOD ) in patients su bmi tted to lobectomy or pneumonectomy for lung carcinoma . PATIENTS AND METHODS A consecutive series of 227 patients with non-small cell lung cancer su bmi tted to lobectomy or pneumonectomy from January 2000 through October 2002 were prospect ively analyzed . Maximal stair-climbing tests were performed preoperatively ( the day before the operation ) and postoperatively ( on average , 9.2 days after operation ) in room air for all patients . A fall in oxygen saturation during the exercise below 90 % was termed ' desaturation ' . Univariate and multivariate analyses were performed to identify predictors of postoperative EOD . RESULTS Thirty-five patients ( 15.4 % ) developed postoperative EOD . After multivariate analysis , the only independent predictor of postoperative EOD result ed a reduction in oxygen saturation during the preoperative exercise ( P=0.0004 ) . CONCLUSIONS Patients with a reduction in oxygen saturation during the preoperative exercise test are at increased risk to develop a postoperative EOD below 90 % . A postoperative exercise test should be performed in all these patients . Should EOD be confirmed , an intermittent home oxygen therapy is recommended in order to facilitate recovery from operation and improve the quality of life Objectives : To investigate the effects of a preoperative pulmonary rehabilitation programme in patients with lung cancer undergoing video-assisted thoracic surgery .  Design : R and omized , single-blind controlled trial . Setting : Teaching hospital . Subjects : Patients with suspected or confirmed lung cancer undergoing video-assisted thoracic surgery .  Intervention : Participants were r and omized  to either a prehabilitation group or a control group .  Participants in the prehabilitation group underwent a combination of moderate endurance and resistance training plus breathing exercises three to five times per week . Main measures : The primary outcome of the study was exercise capacity . Secondary outcomes were muscle strength ( Senior Fitness Test ) , health-related quality of life ( Short-Form 36 ) and the postoperative outcomes . Patients were evaluated at baseline ( before r and omization ) , presurgery ( only the prehabilitation group ) , after surgery and three months post-operatively . Results : A total of 40 patients were r and omized and 22 finished the study ( 10 in the prehabilitation group and 12 in the control group ) . Three patients were lost to follow-up at three months . After the training , there was a statistically significant improvement in exercise tolerance ( + 397 seconds , p = 0.0001 ) , the physical summary component of the SF-36 ( + 4.4 points , p = 0.008 ) and muscle strength ( p < 0.01 ) . There were no significant differences between groups after surgery . However , three months postoperatively , significant differences were found in the mean change of exercise capacity ( p = 0.005 ) , physical summary component ( p = 0.001 ) and upper and lower body strength ( p = 0.045 and p = 0.002 ) . Conclusions : A pulmonary rehabilitation programme before video-assisted thoracic surgery seems to improve patients ’ preoperative condition and may prevent functional decline after surgery . Clinical Registration Number : NCT01963923 ( Registration date 10/10/2013 Background There is emerging evidence regarding the efficacy of exercise training to improve exercise capacity for individuals with non-small cell lung cancer ( NSCLC ) .  Cardiopulmonary exercise testing ( CPET ) is the gold st and ard measure of exercise capacity ; however this laboratory test has limitations for use in research and clinical practice . Alternative field walking tests are the six-minute walk test ( 6MWT ) , incremental-shuttle walk test ( ISWT ) and endurance-shuttle walk test ( ESWT ) ; however there is limited information about their clinimetric properties in NSCLC . Aims : In NSCLC to determine the 1 ) criterion validity of the 6MWT , ISWT and ESWT against CPET ; 2 ) construct validity of the 6MWT , ISWT and ESWT against measures of function , strength , respiratory function and health-related quality of life ( HRQoL ) ; and 3 ) clinical applicability of the tests . Methods Twenty participants ( 40 % male , mean ± SD age 66.1 ± 6.5 years ) with stage I-IIIb NSCLC completed the 6MWT , ISWT , ESWT and CPET within six months of treatment . Testing order was r and omised . Additional measures included Eastern Cooperative Oncology Group Performance-Status ( ECOG-PS , function ) , respiratory function , h and -grip dynamometry and HRQoL. Correlations and regression analyses were used to assess relationships . Results The ISWT demonstrated criterion validity with a moderate relationship between ISWT distance and CPET peak oxygen consumption ( r = 0.61 , p = 0.007 ) . Relationships between CPET and six minute walk distance ( 6MWD ) ( r = 0.24 , p = 0.329 ) or ESWT time ( r = 0.02 , p = 0.942 ) were poor . Moderate construct validity existed for the 6MWD and respiratory function ( forced vital capacity % predicted r = 0.53 , p = 0.019 ; forced expiratory volume in the first second % predicted r = 0.55 , p = 0.015 ) . There were no relationships between the walking tests and measures of function , strength or HRQoL. The ESWT had a ceiling effect with 18 % reaching maximum time . No floor effects were seen in the tests . The mean ± SD time required to perform the individual 6MWT , ISWT and ESWT was 12.8 ± 2.5 , 14.7 ± 3.7 and 16.3 ± 5.0 min respectively ; in comparison to CPET which was 51.2 ± 12.7 min . Only one assessor was required to perform all field walking tests and no adverse events occurred . Conclusions The ISWT is a promising measure of functional exercise capacity in lung cancer . Findings need to be confirmed in a larger sample prior to translation into practice Objective The objective of this pilot study was to describe the effects of a 16-week home-based rehabilitative exercise program on cancer-related fatigue ( CRF ) , other symptoms , functional status , and quality of life ( QOL ) for patients with non-small cell lung cancer ( NSCLC ) after thoracotomy starting within days after hospital discharge and continuing through the initiation and completion of chemotherapy .  Material s and methods Five patients with NSCLC completed the Brief Fatigue Inventory ( measuring CRF severity ) and the MD And erson Symptom Inventory ( measuring symptom severity ) before and after thoractomy , and at the end of each week of the 16-week exercise program . Additionally , the Medical Outcomes Study Short Form-36 ( measuring physical and mental functional status ) and the Quality of Life Index ( measuring QOL ) were completed before and after thoracotomy , after weeks 3 , 6 , 12 , and 16 ( the end of the exercise program ) . Further , the 6-minute walk test  ( measuring functional capacity ) was administered before thoracotomy , prior to the initiation of chemotherapy and /or radiation therapy , and at the end of the 16-week exercise program , after completion of chemotherapy . Results Participants had a mean age of 63 years and a mean of five comorbid conditions ; the exercise program was initiated within 4 days after hospital discharge . Participants ’ CRF severity scores were reduced to mild levels , while the mean number of symptoms decreased from 9 postthoracotomy to 6 after the exercise program , with mean levels of severity and interference decreasing to below prethoracotomy levels . Likewise , participants ’ functional status and QOL after completing the exercise program improved to near or above prethoracotomy levels . Conclusion The home-based , light-intensity exercise program for NSCLC patients receiving and completing adjuvant chemotherapy postthoracotomy showed promising trends in improving CRF severity , other symptom severity , functional status , and QOL . Further testing via a two-arm r and omized controlled trial is being conducted PURPOSE The purpose of this study was to examine the effects of an  inpatient pulmonary rehabilitation program  on dyspnea , exercise capacity , and health related quality of life in in patients with chronic lung disease . METHOD This quasi experimental study was design ed with a nonequivalent control group pre-post test time series . Twenty three patients were assigned to the experimental group and nineteen to the control group . The inpatient pulmonary rehabilitation program was composed of upper and lower extremity exercise , breathing retraining , inspiratory muscle training , education , relaxation and telephone contacts . This program consisted of 4 sessions with in patients and 4 weeks at home after discharge . The control group was given a home based pulmonary rehabilitation program at the time of discharge . The outcomes were measured by the Borg score , 6MWD and the Chronic Respiratory Disease Question naire(CRQ ) . RESULTS There was a statistically significant difference in dyspnea between the experimental group and control group , but not among time sequence , or interaction between groups and time sequence . Also significant improvements in exercise capacity and health related quality of life were found only in the experimental group . CONCLUSIONS An Inpatient pulmonary rehabilitation program may be a useful intervention to reduce dyspnea , and increase exercise capacity and health related quality of life for chronic lung disease patients Background Non-cystic fibrosis bronchiectasis is characterised by sputum production , exercise limitation and recurrent infections . Although pulmonary rehabilitation is advocated for this patient group , its effects are unclear . The aims of this study are to determine the short and long term effects of pulmonary rehabilitation on exercise capacity , cough , quality of life and the incidence of acute pulmonary exacerbations . Methods / Design This r and omised controlled trial aims to recruit 64 patients with bronchiectasis from three tertiary institutions . Participants will be r and omly allocated to the intervention group ( supervised , twice weekly exercise training with regular review of airway clearance therapy ) or a control group ( twice weekly telephone support ) . Measurements will be taken at baseline , immediately following the intervention and at six and 12 months following the intervention period by a blinded assessor . Exercise capacity will be measured using the incremental shuttle walk test and the six-minute walk test . Quality of life and health status will be measured using the Chronic Respiratory Question naire , Leicester Cough Question naire , Assessment of Quality of Life Question naire and the Hospital Anxiety and Depression Scale . The rate of hospitalisation will be captured as well as the incidence of acute pulmonary exacerbations using a daily symptom diary . Discussion Results from this study will help to determine the efficacy of supervised twice-weekly pulmonary rehabilitation upon exercise capacity and quality of life in patients with bronchiectasis and will contribute to clinical practice guidelines for physiotherapists in the management of this population .Trial registration This study protocol is registered with Clinical Trials.gov ( NCT00885521 ) Cystic fibrosis ( CF ) is the most common life-shortening autosomal recessively inherited disease in Caucasian population s [ 2 ] . Progressive respiratory disease in CF results in an abnormal ventilatory response to exercise which contributes to dyspnea and is a major limiting factor to exercise tolerance [ 3 ] . In addition , a sedentary lifestyle contributes to the progression of physical and functional impairment in CF [ 4 ] , likely with the consequence of a reduced life expectancy as exercise capacity is linked to survival [ 5 ] . Exercise has received growing recognition among research ers and clinicians as treatment for chronic disease including CF lung disease [ 6,7 ] . In CF , exercise has the potential to improve airway clearance through a combination of hyperventilation , mechanical vibration , and improved sputum viscoelasticity thereby leading to facilitated and increased sputum expectoration [ 8,9 ] . Regular physical exercise  improves exercise tolerance and slows progressive pulmonary function decline [ 4,10 ] . Until today , much of the knowledge on the effects of physical conditioning in CF originates predominantly from observational or small non-r and omized and non-controlled studies . Therefore , a systematic review of evidence from r and omised controlled trials ( RCTs ) on the effects of regular physical exercise training was required to critically evaluate potential beneficial effects on patient-relevant outcomes in CF AIM To investigate the safety and feasibility of a six-week supervised structured exercise and relaxation training programme on estimated peak oxygen consumption , muscle strength and health related quality of life ( HRHRQOL ) in patients with inoperable lung cancer , undergoing chemotherapy . METHODS A prospect i ve , single-arm intervention study of supervised , hospital based muscle and cardiovascular group training and individual home-based training . Peak oxygen consumption ( VO(2peak ) ) was assessed using an incremental exercise test . Muscle strength was measured with one repetition maximum test ( 1RM ) . HRQOL was assessed using the Functional Assessment of Cancer Therapy-Lung ( FACT-L ) scale . RESULTS Twenty-five patients with non-small cell cancer ( NSCLC ) stage III-IV and four patients with extensive disease small cell lung cancer ( SCLC-ED ) were recruited . Six patients ( 20.7 % ) dropped out leaving 23 patients for analysis .  Exercise adherence in the group training was 73.0 % and 8.7 % in the home-based training . There were improvements in estimated VO(2peak ) and six-minute walk distance ( 6 MWD ) as well as increased muscle strength measurements ( p<0.05 ) . There was significant improvement in the " emotional well-being " parameter ( FACT-L ) while there were no significant changes in HRQOL . CONCLUSION Exercise training produces significant improvements in physiological indices and emotional HRQOL and is safe and feasible in patients with advanced stage lung cancer , undergoing chemotherapy .  No analysis on home-based training was done because of low adherence QUESTION Does inspiratory muscle training improve respiratory muscle strength , functional capacity , lung function and quality of life of patients with chronic kidney disease ? Does inspiratory muscle training improve these outcomes more than breathing exercises ? DESIGN Systematic review and meta- analysis of r and omised trials . PARTICIPANTS People with chronic kidney disease undergoing dialysis treatment . OUTCOME MEASURES The primary outcomes were : maximal inspiratory pressure , maximal expiratory pressure , and distance covered on the 6-minute walk test . The secondary outcomes were : forced vital capacity , forced expiratory volume in the first second ( FEV1 ) , and quality of life . RESULTS The search identified four eligible studies . The sample consisted of 110 participants . The inspiratory muscle training used a Threshold ® or PowerBreathe ® device , with a load ranging from 30 to 60 % of the maximal inspiratory pressure and lasting from 6 weeks to 6 months . The studies showed moderate to high risk of bias , and the quality of the evidence was rated low or very low , due to the studies ' method ological limitations . The meta- analysis showed that inspiratory muscle training significantly improved maximal inspiratory pressure ( MD 23 cmH2O , 95 % CI 16 to 29 ) and the 6-minute walk test distance ( MD 80 m , 95 % CI 41 to 119 ) when compared with controls . Significant benefits in lung function and quality of life were also identified . When compared to breathing exercises , significant benefits were identified in maximal expiratory pressure ( MD 6 cmH2O , 95 % CI 2 to 10 ) and FEV1 ( MD 0.24litres 95 % CI 0.14 to 0.34 ) , but not maximal inspiratory pressure or forced vital capacity . CONCLUSION In patients with chronic renal failure on dialysis  , inspiratory muscle training with a fixed load significantly improves respiratory muscle strength , functional capacity , lung function and quality of life . The evidence for these benefits may be influenced by some sources of bias . REGISTRATION PROSPERO ( CRD 42015029986 ) . [ de Medeiros AIC , Fuzari HKB , Rattesa C , Br and ão DC , de Melo Marinho PÉ ( 2017 ) Inspiratory muscle training  improves respiratory muscle strength , functional capacity and quality of life in patients with chronic kidney disease : a systematic review . Journal of Physiotherapy 63 : 76 - 83 ] Background Exercise training is recommended for non-cystic fibrosis ( CF ) bronchiectasis , but the long-term effects are unclear . This r and omised controlled trial aim ed to determine the effects of exercise training and review of airway clearance therapy ( ACT ) on exercise capacity , health related quality of life ( HRQOL ) and the incidence of acute exacerbations in people with non-CF bronchiectasis . Methods Participants were r and omly allocated to 8 weeks of supervised exercise training and review of ACT , or control . Primary outcomes of exercise capacity and HRQOL ( Chronic respiratory disease question naire ) and secondary outcomes of cough-related QOL ( Leicester cough question naire ) and psychological symptoms ( Hospital anxiety and depression scale ) were measured at baseline , following completion of the intervention period and at 6 and 12 months follow up . Secondary outcomes of the exacerbation rate and time to first exacerbation were analysed over 12 months . Results Eighty-five participants ( mean FEV1 74 % predicted ; median Modified Medical Research Council Dyspnoea grade of 1 ( IQR [ 1–3 ] ) were included . Exercise training increased the incremental shuttle walk distance ( mean difference to control 62 m , 95 % CI 24 to 101 m ) and the 6-minute walking distance ( mean difference to control 41 m , 95 % CI 19 to 63 m ) , but these improvements were not sustained at 6 or 12 months . Exercise training  reduced dyspnoea ( p = 0.009 ) and fatigue ( p = 0.01 ) but did not impact on cough-related QOL or mood .  Exercise training reduced the frequency of acute exacerbations ( median 1[IQR 1–3 ] ) compared to the control group ( 2[1–3 ] ) over 12 months follow up ( p = 0.012 ) , with a longer time to first exacerbation with exercise training of 8 months ( 95 % CI 7 to 9 months ) compared to the control group ( 6 months [ 95 % CI 5 to 7 months ] , p = 0.047 ) . Conclusions Exercise training in bronchiectasis is associated with short term improvement in exercise capacity , dyspnoea and fatigue and fewer exacerbations over 12 months . Trial registry Clinical Trials.gov ( NCT00885521 ) Introduction . Patients with advanced-stage lung cancer face poor survival and experience co-occurring chronic physical and psychosocial symptoms . Despite several years of research in exercise oncology , few exercise studies have targeted advanced lung cancer patients undergoing chemotherapy . The aim of the present study was to investigate the benefits of a 6-week supervised group exercise intervention and to outline the effect on aerobic capacity , strength , health-related quality of life ( HRQoL ) , anxiety , and depression . Methods . VO2peak was assessed using an incremental exercise test .  Muscle strength  was measured with one repetition maximum test ( 1RM ) . HRQoL , anxiety , and depression were assessed using Functional Assessment of Cancer Therapy – Lung ( FACT-L ) scale and the Hospital Anxiety and Depression Scale ( HADS ) . Results . One hundred and forthteen patients with advanced stage lung cancer were recruited . Forty-three patients dropped out . No serious adverse events were reported . Exercise adherence in the group training was 68 % . Improvements in VO2peak ( P < .001 ) and 6-minute walk distance ( P < .001 ) and muscle strength measurements ( P < .05 ) were seen . There was a reduction in anxiety level ( P = .0007 ) and improvement in the emotional well-being parameter ( FACT-L ) but no statistically significant changes in HRQoL were observed . Conclusion . The results of the present study show that during a 6-week hospital-based supervised , structured , and group-based exercise program , patients with advanced-stage lung cancer ( NSCLC IIIb-IV , ED-SCLC ) improve their physical capacity ( VO2peak , 1RM ) , functional capacity , anxiety level , and emotional well-being , but not their overall HRQoL. A r and omized controlled trial testing the intervention including 216 patients is currently being carried out
There was no difference between the effect of late- and early-initiated exercise intervention .
Exercise has a small-to-moderate effect at short-term follow-up on exercise capacity and the physical component of health-related quality of life in patients operated for lung cancer .
The long-term effects of exercise capacity are unknown .
Early-initiated exercise programmes ( 2 weeks post-operation ) did not show an effect on exercise capacity .
OBJECTIVE To review the evidence concerning the effects of  postoperative exercise interventions  on exercise capacity and health-related quality of life  following resection for non-small cell lung cancer , and to review whether different initiation times of exercise produce different effects on exercise capacity .