File
T.-C. Lin1, S.-W. Su1,2
1Taipei Medical University Hospital, Department of Physical Medicine and Rehabilitation, Taipei, Taiwan, 2National Yang-Ming University, Department of Physical Therapy and Assistive Technology, Taipei, Taiwan
Background: Among the increased options of lung cancer treatments in recent medical advancement, surgical removal remains the major treatment option. Statistics have indicated that patients experience declining pulmonary functions because of cancer cell invasion before the surgery. After the surgery, the patients’ lobes are removed and the wound pain causes reduced cardiorespiratory fitness, which easily results in complications and affects well-beings. Cardiorespiratory physical therapy has been considered a strategy to improve the patients’ cardiorespiratory fitness and well-beings. Although studies have explored the effect of such intervention on patients, relevant studies have yielded little homogeneity in results and exhibited inconsistent qualities.
Purpose: Synthesize the effect of cardiorespiratory physical therapy on cardiorespiratory fitness and well-beings in postoperative patients with lung cancer.
Methods: This study comprised a systematic review and meta-analysis. The Cochrane library, EMBASE, PEDro, and PubMed were used as the main electronic databases. A search strategy was developed by selecting keywords according to populations, intervention methods, and results. Articles from January 2015 to December 2019 presenting quantitative data available for analysis were selected. Three researchers evaluated and screened the articles one by one. Review Manager 5.3 was employed to conduct meta-analysis.
Results: Thirteen articles (10 randomized clinical trials and 3 non-randomized clinical trials) were included in this study, of which 5 and 8 respectively explored the effects of preoperative and postoperative cardiorespiratory physical therapies on the patients (n = 728; average age = 60.0–72.5 years). Cardiorespiratory physical therapy includes respiratory muscle strengthening, resistance exercise, and endurance training. The meta-analysis results revealed that patients receiving preoperative cardiorespiratory physical therapy performed significantly greater than the control group in terms of the postoperative 6-minute walk test (95% confidence interval [CI] = 8.05–32.98, I2 = 71%, p = 0.001), forced expiratory volume in one second (95% CI = 0.19–0.42, I2 = 88%, p < 0.001), and well-beings (95% CI = 1.98–3.59, I2 = 99%, p < 0.001). The patients who received cardiorespiratory physical therapy within 3 months after the surgery had significantly increased maximum oxygen consumption (95% CI = 0.12–0.32, I2 = 0%, p < 0.001) and reduced breathing reservation (95% CI = −1.96–−1.76, I2 = 15%, p = 0.01). Compared with postoperative cardiorespiratory physical therapy intervention, the preoperative intervention significantly improved dyspnea (95% CI = 0.62–0.96, I2 = 97%, p < 0.01). Compared with the preoperative intervention group, the group receiving postoperative cardiorespiratory physical therapy exhibited more significant improvement in the performance of 6-minute walk test.
Conclusion(s): According to the systematic review and meta-analysis, patients who received preoperative cardiorespiratory physical therapy exhibited greater postoperative cardiorespiratory fitness and well-beings compared with patients who did not receive any cardiorespiratory physical therapy. Patients performing cardiorespiratory physical therapy within 3 months after the surgery also improved cardiorespiratory fitness.
Implications: Patients with lung cancer who experienced limited pulmonary functions, cardiorespiratory fitness and well-beings after the surgery. Preoperative and postoperative cardiorespiratory physical therapy interventions effectively improved the patients’ cardiorespiratory fitness and well-beings. This systematic review can provide references for therapists in handling cardiorespiratory rehabilitation of patients with lung cancer.
Funding, acknowledgements: A part of this study was funded by Taipei Medical University Hospital, Taipei, Taiwan (108TMUH-P-02).
Keywords: lung cancer, exercise, meta-analysis
Topic: Cardiorespiratory
Did this work require ethics approval? No
Institution: Taipei Medical University
Committee: TMU-Joint Institutional Review Board
Reason: We analysed publicly available data. The study was confirm Exemption by TMU-Joint Institutional Review Board in meeting #108-11-4 (date: 2019/11/28).
All authors, affiliations and abstracts have been published as submitted.
