High-intensity interval training ( HIT ) with duration of 2 to 6 weeks seems to be the best exercise programme in a prehabilitation intervention but it exists heterogeneity in terms of intensity and duration .
Prehabilitation increase exercise capacity and significantly enhances pulmonary function .
But the reduction of postoperative complication and mortality has not been clearly demonstrated .
It seems that not all patients can benefit from prehabilitation and it could be indicated only in patients with impaired lung function .
Meanwhile , safety of prehabilitation and good results of some studies support this intervention in high-risk patients
Surgical resection remains the best treatment option for patients with early stage of non-small cell lung cancer ( NSCLC ) .
However , it may be responsible of postoperative complication and mortality , especially in patients with impaired pulmonary function .
Enhanced recovery after surgery ( ERAS ) programs have been focused mainly in minimal invasive surgery approach during lung resection and respiratory rehabilitation after surgery .
Preoperative exercise-based intervention ( prehabilitation ) has demonstrated reduction of morbi-mortality in other surgeries but in thoracic surgery continues to be under discussion .
Cardio-pulmonary exercise test ( CPET ) is the gold st and ard technique to predict postoperative morbi-mortality .
The implementation of a preoperative respiratory rehabilitation could optimize patient 's physical capacity before surgery and improve outcomes and enhance recovery .
The aim of this systematic review of the literature is to identify the effectiveness and safety of prehabilitation programs in thoracic surgery , the type of exercise and its duration , and the group of patients with best benefit .
Prehabilitation is a safe intervention without side effects in patients .
Reduction of postoperative pulmonary complications after lung surgery using a fast track clinical pathway.
BACKGROUND Fast track programs , multimodal therapy strategies , have been introduced in many surgical fields to minimize postoperative morbidity and mortality . In terms of lung resections no r and omized controlled trials exist to evaluate such patient care programs . METHODS In a prospect i ve , r and omized controlled pilot study a conservative and fast track treatment regimen in patients undergoing lung resections was compared . Main differences between the two groups consisted in preoperative fasting ( 6h vs 2h ) and analgesia ( patient controlled analgesia vs patient controlled epidural analgesia ) . Study endpoints were pulmonary complications ( pneumonia , atelectasis , prolonged air leak ) , overall morbidity and mortality . Analysis was performed in an intention to treat . RESULTS Both study groups were similar in terms of age , sex , preoperative forced expiratory volume in one second ( FEV(1 ) ) , American Society of Anesthesiologists score and operations performed . The rate of postoperative pulmonary complications was 35 % in the conservative and 6.6 % in the fast track group ( p=0.009 ) . A subgroup of patients with reduced preoperative FEV(1 ) ( < 75 % of predicted value ) experienced less pulmonary complications in the fast track group ( 55 % vs 7 % , p=0.023 ) . Overall morbidity was not significantly different ( 46 % vs 26 % , p=0.172 ) , mortality was comparable in both groups ( 4 % vs 3 % ) . CONCLUSION We evaluated an optimized patient care program for patients undergoing lung resections in a prospect i ve r and omized pilot study . Using this fast track clinical pathway the rate of pulmonary complications could be significantly decreased as compared to a conservative treatment regimen ; our results support the implementation of an optimized perioperative treatment in lung surgery in order to reduce pulmonary complications after major lung surgery
High-intensity interval training ( HIT ) with duration of 2 to 6 weeks seems to be the best exercise programme in a prehabilitation intervention but it exists heterogeneity in terms of intensity and duration .
Prehabilitation increase exercise capacity and significantly enhances pulmonary function .
But the reduction of postoperative complication and mortality has not been clearly demonstrated .
It seems that not all patients can benefit from prehabilitation and it could be indicated only in patients with impaired lung function .
Meanwhile , safety of prehabilitation and good results of some studies support this intervention in high-risk patients
Surgical resection remains the best treatment option for patients with early stage of non-small cell lung cancer ( NSCLC ) .
However , it may be responsible of postoperative complication and mortality , especially in patients with impaired pulmonary function .
Enhanced recovery after surgery ( ERAS ) programs have been focused mainly in minimal invasive surgery approach during lung resection and respiratory rehabilitation after surgery .
Preoperative exercise-based intervention ( prehabilitation ) has demonstrated reduction of morbi-mortality in other surgeries but in thoracic surgery continues to be under discussion .
Cardio-pulmonary exercise test ( CPET ) is the gold st and ard technique to predict postoperative morbi-mortality .
The implementation of a preoperative respiratory rehabilitation could optimize patient 's physical capacity before surgery and improve outcomes and enhance recovery .
The aim of this systematic review of the literature is to identify the effectiveness and safety of prehabilitation programs in thoracic surgery , the type of exercise and its duration , and the group of patients with best benefit .
Prehabilitation is a safe intervention without side effects in patients .