J Thorac Oncol. 2016 Oct 5;:
BACKGROUND: Impairment in aerobic fitness is a potential modifiable risk factor for postoperative complications. In this randomized controlled trial, we hypothesized that a high-intensity interval training (HIIT) program enhances cardiorespiratory fitness before lung cancer surgery and therefore reduces the risk of postoperative complications.
METHODS: Patients with operable lung cancer were randomly assigned to usual care (UC, N=77) or preoperative rehabilitation based on HIIT (Rehab, N=74). Maximal cardiopulmonary exercise testing and the six-minute walk test were performed twice before surgery. The primary outcome measure was a composite of death and in-hospital postoperative complications.
RESULTS: Groups were well balanced in terms of patient characteristics. During the preoperative waiting period (median 25 days), the peak oxygen consumption (peakVO2) and the six-minute walking distance increased (respectively, median +15 % [IQ 25-75%, +9 to +22%] P=0.003 and +15% [IQ25-75, +8 to +28%], P<0.001) in the Rehab group whereas VO2peak declined in the UC group (median -8% [IQ25-75, -16 to 0%], P=0.005). The primary endpoint did not differ significantly between the two groups: 27 of the 74 patients (35.5%) in the Rehab group and 39 of 77 patients (50.6%) in the UC group developed at least one postoperative complication (P=0.080). Noteworthy, the incidence of pulmonary complications was lower in the Rehab compared with the UC group (23% vs 44%, P=0.018), owing to a significant reduction in atelectasis (12.2% vs 36.4%, P<0.001) and this was accompanied by a shorter length of stay in the postanesthesia care unit (median -7 hours, IQ25-75% -4 to -10).
CONCLUSIONS: In this RCT, preoperative HIIT resulted in significant improvement in aerobic performances but failed to reduce early complications after lung cancer resection.