ORIGINAL ARTICLE   Free access

European Journal of Physical and Rehabilitation Medicine 2019 February;55(1):113-22

DOI: 10.23736/S1973-9087.18.05156-0

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Combined aerobic exercise and high-intensity respiratory muscle training in patients surgically treated for non-small cell lung cancer: a pilot randomized clinical trial

Monique MESSAGGI-SARTOR ^{1, 2}, Ester MARCO ^{1, 2, 3} ✉, Elisabeth MARTÍNEZ-TÉLLEZ ⁴, Alberto RODRIGUEZ-FUSTER ⁵, Carolina PALOMARES ⁶, Sandra CHIARELLA ², Josep M. MUNIESA ^{1, 2}, Mauricio OROZCO-LEVI ^{7, 8}, Esther BARREIRO ^{8, 9, 10}, Maria R. GÜELL ⁶

¹ Rehabilitation Research Group, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain; ² Department of Physical Medicine and Rehabilitation, Parc de Salut Mar, Hospital del Mar, Hospital de l’Esperança, Barcelona, Spain; ³ School of Medicine, Autonomous University of Barcelona, Barcelona, Spain; ⁴ Department of Thoracic Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; ⁵ Department of Thoracic Surgery, Hospital del Mar, Barcelona, Spain; ⁶ Unit of Pulmonary Rehabilitation, Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; ⁷ Department of Respiratory Medicine, Hospital del Mar, Barcelona, Spain; ⁸ Department of Health and Experimental Sciences (CEXS), Universitat Pompeu i Fabra (UPF), Parc de Recerca Biomèdica de Barcelona (PRBB), Barcelona, Spain; ⁹ Department of Pulmonology, Lung Cancer and Muscle Research Group, IMIM, Hospital del Mar, Barcelona, Spain; ¹⁰ Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain

BACKGROUND: Lung resection surgery further decreases exercise capacity and negatively affects respiratory muscle function in patients with non-small cell lung cancer (NSCLC). The best design for exercise interventions in these patients has not been determined yet.
AIM: To assess the impact of aerobic exercise and high-intensity respiratory muscle training on patient outcomes following lung cancer resection surgery.
DESIGN: Prospective, single-blind, pilot randomized controlled trial.
SETTING: Outpatient cardiopulmonary rehabilitation unit of two university hospitals.
POPULATION: Thirty-seven patients with NSCLC after tumor resection.
METHODS: Patients were randomly assigned to exercise training or usual post-operative care. The training program consisted of aerobic exercises and high-intensity respiratory muscle training (24 supervised sessions, 3 per week, 8 weeks). Primary outcome was exercise capacity assessed with peak oxygen uptake (VO2peak) during cardiopulmonary exercise test. Secondary outcomes included changes in respiratory muscle strength, levels of serum insulin growth factor I (IGF-I) and IGF binding protein 3 (IGFBP-3), and quality of life assessed with the European Organization for Research and Treatment of Cancer (EORTC QLQ-C30) questionnaire.
RESULTS: The 8-week training program was associated with significant improvement in VO2peak (2.13 mL/Kg/min [95%CI 0.06 to 4.20]), maximal inspiratory and expiratory pressures (18.96 cmH2O [95% CI 2.7 to 24.1] and 18.58 cmH2O [95% CI 4.0 to 33.1], respectively) and IGFBP-3 (0.61 µg/mL [%95 CI 0.1 to 1.12]). No significant differences were observed in the EORTC QLQ-C30.
CONCLUSIONS: An 8-week exercise program consisting of aerobic exercise and high-intensity respiratory muscle training improved exercise capacity, respiratory muscle strength, and serum IGFBP-3 levels in NSCLC patients after lung resection. There was no impact on the other outcomes assessed.
CLINICAL REHABILITATION IMPACT: A combination of aerobic exercise and respiratory muscle training could be included in the rehabilitation program of deconditioned patients with NSCLC after lung resection surgery.

KEY WORDS: Lung neoplasms - Cardiorespiratory fitness - Breathing exercises - Rehabilitation