Complications and hospital stay cut by exercise before lung surgery

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Exercising regularly before surgery for lung cancer halves the complication rate afterwards, finds a synthesis of the available published evidence. And it reduces length of hospital stay for these patients by almost three days, the findings show.

Several studies have suggested that an exercise programme undertaken before surgery might help produce better outcomes. But as this is a rapidly growing area of research, the study authors at the Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney and the School of Public Health, The University of Sydney, wanted to explore this in more depth and find out whether exercise before surgery might reduce the complication rate, length of hospital stay, and boost quality of life in patients who had had surgery for cancer.

They trawled research databases for relevant studies and found 17 suitable articles which reported on 13 clinical trials, involving 806 participants and six different types of cancer: bowel; liver; gullet (oesophageal); lung; mouth; and prostate.

The exercise programmes, which were compared with standard care or advice, lasted from one to four weeks, with the average length a fortnight. Most of the trials assessed aerobic exercise–walking, for example–breathing, and resistance (weight training) exercises. The frequency of the sessions varied from three times a week to three times a day.

Pooled analysis of the data showed that compared with standard care/advice, an exercise programme before surgery cut the complication rate afterwards by 48% and reduced length of hospital stay by nearly three days for patients with lung cancer. Trials that reported more numerous sessions of exercise had better results, suggesting that there may be a dose response effect, say the study authors.

The impact on the other types of cancer was much less clear, largely because of the few trials which included other cancers and the poor quality of the evidence. But exercise may improve quality of life after surgery for patients with mouth and prostate cancers, say the study authors, although this was only assessed in individual studies rather than in several, they point out.

“Post-operative complication is a major concern for patients undergoing (cancer) surgery,” note the authors, who go on to say that based on their findings, exercise before lung cancer surgery might be worth considering.

“(The) findings may also impact on healthcare costs and on patients’ quality of life, and consequently have important implications for patients, healthcare professionals and policy makers,” they add, although future research would be needed to test this out, they say.

Abstract
Objective: To investigate the effectiveness of preoperative exercises interventions in patients undergoing oncological surgery, on postoperative complications, length of hospital stay and quality of life.
Design: Intervention systematic review with meta-analysis.
Data sources: MEDLINE, Embase and PEDro.
Eligibility criteria for selecting studies: Trials investigating the effectiveness of preoperative exercise for any oncological patient undergoing surgery were included. The outcomes of interest were postoperative complications, length of hospital stay and quality of life. Relative risks (RRs), mean differences (MDs) and 95% CI were calculated using random-effects models.
Results: Seventeen articles (reporting on 13 different trials) involving 806 individual participants and 6 tumour types were included. There was moderate-quality evidence that preoperative exercise significantly reduced postoperative complication rates (RR 0.52, 95% CI 0.36 to 0.74) and length of hospital stay (MD −2.86 days, 95% CI −5.40 to −0.33) in patients undergoing lung resection, compared with control. For patients with oesophageal cancer, preoperative exercise was not effective in reducing length of hospital stay (MD 2.00 days, 95% CI −2.35 to 6.35). Although only assessed in individual studies, preoperative exercise improved postoperative quality of life in patients with oral or prostate cancer. No effect was found in patients with colon and colorectal liver metastases.
Conclusions: Preoperative exercise was effective in reducing postoperative complications and length of hospital stay in patients with lung cancer. Whether preoperative exercise reduces complications, length of hospital stay and improves quality of life in other groups of patients undergoing oncological surgery is uncertain as the quality of evidence is low.

Authors
Daniel Steffens, Paula R Beckenkamp, Mark Hancock, Michael Solomon, Jane Young

BMJ material
British Journal of Sports Medicine abstract


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