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Brocki B.C.1, Andreasen J.J.1, Westerdahl E.2,3
1Aalborg University Hospital, Aalborg, Denmark, 2Örebro University Hospital, Örebro, Sweden, 3Örebro University, Örebro, Sweden
Background: Deterioration in ambulatory capacity and physical activity levels is common for individuals surgically treated for lung cancer. Higher levels of physical activity are associated with better health-related quality of life in this population, but methods for enhancing postoperative physical recovery have been scarcely evaluated.
Purpose: This study aim was to evaluate the effect of postoperative inspiratory training for two weeks on self-reported physical activity in high-risk patients who underwent lung cancer surgery. Furthermore, we aimed at identifying potential predictors for enhanced recovery of activity level.
Methods: The study was a single-centre, parallel-group, randomised trial with assessor blinding and intention-to treat-analysis. The intervention group (IG, n=34) underwent two weeks of postoperative inspiratory muscle training, twice daily with 2 x 30 breaths on a target intensity of 30% of maximal inspiratory pressure in addition to standard postoperative physiotherapy. Standard physiotherapy in the control group (CG, n=34) consisted of breathing exercises, coughing techniques and early mobilisation. We assessed pulmonary function, respiratory muscle strength (maximal inspiratory/expiratory pressure, MIP/MEP), functional performance (6-minute walk test) and self-reported physical activity (PAS 2 questionnaire) the day before surgery and two weeks postoperatively.
Results: The mean age (±SD) in the study sample was 70 ± 8 years and 58 % were males. Thoracotomy was performed in 48 % (n= 33) of the cases. Two weeks postoperatively, a significant number of participants from the IG reported on a higher activity levels, compared with the CG (inactive 6 % vs. 2%, low activity 6% vs. 6%, moderate activity 38% vs. 12%), p = 0.0063, for the IG and the CG, respectively (Mantel Haenzel Chi Square test). There were no significant differences between groups regarding postoperative respiratory muscle strength, functional performance and pulmonary function. In a multivariable logistic regression analysis we found that higher preoperative carbon monoxide diffusion capacity (DlCO) and MIP values at two weeks were associated with higher activity levels (OR 1.56, 95% CI [1.00;2.45], p = 0.0508 and OR 1.31, 95% CI [1.03; 1.67], p = 0.0304) respectively for DlCO and MIP.
Conclusion(s): Patients who performed postoperative inspiratory muscle training had an increased recovery of activity levels following lung cancer surgery than patients performing no exercises. More research is needed to confirm these findings.
Implications: Inspiratory muscle training may be a treatment option to enhance recovery of activity levels following lung cancer surgery.
Funding acknowledgements: The Danish Cancer Society (R72-A4690), the Swedish Cancer Foundation (CAN 205/721) and Aalborg University Hospital.
Topic: Cardiorespiratory
Ethics approval: The Research Ethics Committee in Denmark - Region North (N- 20120027). Informed consent was obtained prior to inclusion.
All authors, affiliations and abstracts have been published as submitted.
