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A randomized trial comparing preoperative chemotherapy plus surgery with surgery alone in patients with non-small-cell lung cancer.
Objectives : To investigate the effects of a preoperative pulmonary rehabilitation programme in patients with lung cancer undergoing video-assisted thoracic surgery .  Design : R and omized , single-blind controlled trial . Setting : Teaching hospital . Subjects : Patients with suspected or confirmed lung cancer undergoing video-assisted thoracic surgery .  Intervention : Participants were r and omized  to either a prehabilitation group or a control group .  Participants in the prehabilitation group underwent a combination of moderate endurance and resistance training plus breathing exercises three to five times per week . Main measures : The primary outcome of the study was exercise capacity . Secondary outcomes were muscle strength ( Senior Fitness Test ) , health-related quality of life ( Short-Form 36 ) and the postoperative outcomes . Patients were evaluated at baseline ( before r and omization ) , presurgery ( only the prehabilitation group ) , after surgery and three months post-operatively . Results : A total of 40 patients were r and omized and 22 finished the study ( 10 in the prehabilitation group and 12 in the control group ) . Three patients were lost to follow-up at three months . After the training , there was a statistically significant improvement in exercise tolerance ( + 397 seconds , p = 0.0001 ) , the physical summary component of the SF-36 ( + 4.4 points , p = 0.008 ) and muscle strength ( p < 0.01 ) . There were no significant differences between groups after surgery . However , three months postoperatively , significant differences were found in the mean change of exercise capacity ( p = 0.005 ) , physical summary component ( p = 0.001 ) and upper and lower body strength ( p = 0.045 and p = 0.002 ) . Conclusions : A pulmonary rehabilitation programme before video-assisted thoracic surgery seems to improve patients ’ preoperative condition and may prevent functional decline after surgery . Clinical Registration Number : NCT01963923 ( Registration date 10/10/2013 Importance Preserving functional capacity is a key element in the care continuum for patients with esophagogastric cancer .  Prehabilitation , a preoperative conditioning intervention aim ing to optimize physical status , has not been tested in upper gastrointestinal surgery to date . Objective To investigate whether prehabilitation is effective in improving functional status in patients undergoing esophagogastric cancer resection . Design , Setting , and Participants A r and omized clinical trial ( available-case analysis based on completed assessment s ) was conducted at McGill University Health Centre ( Montreal , Quebec , Canada ) comparing prehabilitation with a control group . Intervention consisted of preoperative exercise and nutrition optimization .  Participants were adults awaiting elective esophagogastric resection for cancer . The study date s were February 13 , 2013 , to February 10 , 2017 . Main Outcomes and Measures The primary outcome was change in functional capacity , measured with absolute change in 6-minute walk distance ( 6MWD ) . Preoperative ( end of the prehabilitation period ) and postoperative ( from 4 to 8 weeks after surgery ) data were compared between groups . Results Sixty-eight patients were r and omized , and 51 were included in the primary analysis . The control group were a mean ( SD ) age , 68.0 ( 11.6 ) years and 20 ( 80 % ) men . Patients in the prehabilitation group were a mean ( SD ) age , 67.3 ( 7.4 ) years and 18 ( 69 % ) men . Compared with the control group , the prehabilitation group had improved functional capacity both before surgery ( mean [ SD ] 6MWD change , 36.9 [ 51.4 ] vs −22.8 [ 52.5 ] m ; P < .001 ) and after surgery ( mean [ SD ] 6MWD change , 15.4 [ 65.6 ] vs −81.8 [ 87.0 ] m ; P < .001 ) . Conclusions and Relevance Prehabilitation improves perioperative functional capacity in esophagogastric surgery . Keeping patients from physical and nutritional status decline could have a significant effect on the cancer care continuum . Trial Registration Clinical Trials.gov Identifier : BACKGROUND Abdominal surgery represents a physiologic stress and is associated with a period of recovery during which functional capacity is often diminished . " Prehabilitation " is a program to increase functional capacity in anticipation of an upcoming stressor . We reported recently the results of a r and omized trial comparing 2 prehabilitation programs before colorectal surgery  ( stationary cycling plus weight training versus a recommendation to increase walking coupled with breathing exercises ) ; however , adherence to the programs was low . The objectives of this study were to estimate : ( 1 ) the extent to which physical function could be improved with either prehabilitation program and identify variables associated with response ; and ( 2 ) the impact of change in preoperative function on postoperative recovery . METHODS This study involved a re analysis of data arising from a r and omized trial . The primary outcome measure was functional walking capacity measured by the Six-Minute Walk Test ; secondary outcomes were anxiety , depression , health-related quality of life , and complications ( Clavien classification ) . Multiple linear regression was used to estimate the extent to which key variables predicted change in functional walking capacity over the prehabilitation and follow-up periods . RESULTS We included 95 people who completed the prehabilitation phase ( median , 38 days ; interquartile range , 22 - 60 ) , and 75 who were also evaluated postoperatively ( mean , 9 weeks ) . During prehabilitation , 33 % improved their physical function , 38 % stayed within 20 m of their baseline score , and 29 % deteriorated . Among those who improved , mental health , vitality , self-perceived health , and peak exercise capacity also increased significantly . Women were less likely to improve ; low baseline walking capacity , anxiety , and the belief that fitness aids recovery were associated with improvements during prehabilitation . In the postoperative phase , the patients who had improved during prehabilitation were also more likely to have recovered to their baseline walking capacity than those with no change or deterioration ( 77 % vs 59 % and 32 % ; P = .0007 ) . Patients who deteriorated were at greater risk of complications requiring reoperation and /or intensive care management . Significant predictors of poorer recovery included deterioration during prehabilitation , age > 75 years , high anxiety , complications requiring intervention , and timing of follow-up assessment . CONCLUSION In a group of patients undergoing scheduled colorectal surgery , meaningful changes in functional capacity can be achieved over several weeks of prehabilitation . Patients and those who care for them , especially those with poor physical capacity , should consider a prehabilitation regimen to enhance functional exercise capacity before colectomy Abstract Background : Multimodal prehabilitation is a preoperative conditioning intervention in form of exercise , nutritional assessment , whey protein supplementation , and anxiety-coping technique . Despite recent evidence suggesting that prehabilitation could improve functional capacity in patients undergoing colorectal surgery for cancer , all studies were characterized by a relatively small sample size . The aim of this study was to confirm what was previously found in three small population trials . Material and methods : Data of 185 participants enrolled in a pilot single group study and two r and omized control trials conducted at the McGill University Health Center from 2010 to 2015 were reanalyzed . Subjects performing trimodal prehabilitation ( exercise , nutrition , and coping strategies for anxiety ) were compared to the patients who underwent the trimodal program only after surgery ( rehabilitation/control group ) . Functional capacity was assessed with the six-minute walk test ( 6MWT ) , a measure of the distance walked over six minutes ( 6MWD ) . A significant functional improvement was defined as an increase in 6MWD from baseline by at least 19 m. Changes in 6MWD before surgery , at four and eight weeks were compared between groups . Results : Of the total study population , 113 subjects ( 61 % ) underwent prehabilitation . Changes in 6MWD in the prehabilitation group were higher compared to the rehabilitation/control group during the preoperative period { 30.0 [ st and ard deviation ( SD ) 46.7 ] m vs. −5.8 ( SD 40.1 ) m , p < 0.001 } , at four weeks [ −11.2 ( SD 72 ) m vs. −72.5 ( SD 129 ) m , p < 0.01 ] , and at eight weeks [ 17.0 ( SD 84.0 ) m vs. −8.8 ( SD 74.0 ) m , p = 0.047 ] . The proportion of subjects experiencing a significant preoperative improvement in physical fitness was higher in those patients who underwent prehabilitation [ 68 ( 60 % ) vs. 15 ( 21 % ) , p < 0.001 ] . Conclusion : In large secondary analysis , multimodal prehabilitation result ed in greater improvement in walking capacity throughout the whole perioperative period when compared to rehabilitation started after surgery 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 Prospect i ve , single-blind , pilot r and omized controlled trial . SETTING Outpatient cardiopulmonary rehabilitation unit of two university hospitals . POPULATION Thirty-seven patients with NSCLC after tumor resection . METHODS Patients were r and omly 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 ) question naire . 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 Background The purpose of the PROLUCA study is to investigate the efficacy of preoperative and early postoperative rehabilitation in a non-hospital setting in patients with operable lung cancer with special focus on exercise . Methods Using a 2x2 factorial design with continuous effect endpoint ( Maximal Oxygen Uptake ( VO2peak ) ) , 380 patients with non-small cell lung cancer ( NSCLC ) stage I-IIIa referred for surgical resection will be r and omly assigned to one of four groups : ( 1 ) preoperative and early postoperative rehabilitation ( starting two weeks after surgery ) ; ( 2 ) preoperative and late postoperative rehabilitation ( starting six weeks after surgery ) ; ( 3 ) early postoperative rehabilitation alone ; ( 4 ) today ’s st and ard care which is postoperative rehabilitation initiated six weeks after surgery . The preoperative rehabilitation program consists of an individually design ed , 30-minute home-based exercise program performed daily . The postoperative rehabilitation program consists of a supervised group exercise program comprising cardiovascular and resistance training two-hour weekly for 12 weeks combined with individual counseling . The primary study endpoint is VO2peak and secondary endpoints include : Six-minute walk distance ( 6MWD ) , one-repetition-maximum ( 1RM ) , pulmonary function , patient-reported outcomes ( PROs ) on health-related quality of life ( HRQoL ) , symptoms and side effects of the cancer disease and the treatment of the disease , anxiety , depression , wellbeing , lifestyle , hospitalization time , sick leave , work status , postoperative complications ( up to 30 days after surgery ) and survival . Endpoints will be assessed at baseline , the day before surgery , pre-intervention , post-intervention , six months after surgery and one year after surgery . Discussion The results of the PROLUCA study may potentially contribute to the identification of the optimal perioperative rehabilitation for operable lung cancer patients focusing on exercise initiated immediately after diagnosis and rehabilitation shortly after surgery . Trial Registration Introduction : A stepwise approach to the functional assessment of lung resection c and i date s is widely accepted , and this approach incorporates the measurement of exercise peak Vo2 when spirometry and radionuclear studies suggest medical inoperability . A new functional operability ( FO ) algorithm incorporates peak exercise Vo2 earlier in the preoperative assessment to determine which patients require preoperative radionuclear studies . This algorithm has not been studied in a multicenter study . Methods : The CALGB ( Cancer and Leukemia Group B ) performed a prospect i ve multi-institutional study to investigate the use of primary exercise Vo2 measurement for the prediction of surgical risk . Patients with known or suspected resectable non-small cell lung cancer ( NSCLC ) were eligible .  Exercise testing including measurement of peak oxygen uptake ( Vo2 ) , spirometry , and single breath diffusion capacity ( DLCO ) was performed on each patient . Nuclear perfusion scans were obtained on selected high-risk patients . After surgery , morbidity and mortality data were collected and correlated with preoperative data . Mortality and morbidity were retrospectively compared by algorithm-based risk groups . Results : Three hundred forty-six patients with suspected lung cancer from nine institutions underwent thoracotomy with or without resection ; 57 study patients did not undergo thoracotomy .  Patients who underwent surgery had a median survival time of 30.9 months , whereas patients who did not undergo surgery had a median survival time of 15.6 months . Among the 346 patients who underwent thoracotomy , 15 patients died postoperatively ( 4 % ) , and 138 patients ( 39 % ) exhibited at least one cardiorespiratory complication postoperatively . We found that patients who had a peak exercise Vo2 of < 65 % of predicted ( or a peak Vo2/kg < 16 ml/min/kg ) were more likely to suffer complications ( p = 0.0001 ) and were also more likely to have a poor outcome ( respiratory failure or death ) if the peak Vo2 was < 15 ml/min/kg ( p = 0.0356 ) . We also found a subset of 58 patients who did not meet FO algorithm criteria for operability , but who still tolerated lung resection with a 2 % mortality rate . Conclusions : Our data provide multicenter validation for the use of exercise Vo2 for preoperative assessment of lung cancer patients , and we encourage an aggressive approach when evaluating these patients for surgery Background Patients with advanced stage non-small cell lung cancer ( NSCLC ) or small cell lung cancer ( SCLC ) often experience multidimensional impairments , affecting quality of life during their course of disease . In lung cancer patients with operable disease , several studies have shown that exercise has a positive impact on quality of life and physical functioning . There is limited evidence regarding efficacy for advanced lung cancer patients undergoing palliative treatment . Therefore , the POSITIVE study aims to evaluate the benefit of a 24-week exercise intervention during palliative treatment in a r and omized controlled setting . Methods / design The POSITIVE study is a r and omized , controlled trial investigating the effects of a 24-week exercise intervention during palliative treatment on quality of life , physical performance and immune function in advanced , non-operable lung cancer patients . 250 patients will be recruited in the Clinic for Thoracic Diseases in Heidelberg , enrolment begun in November 2013 . Main inclusion criterion is histologically confirmed NSCLC ( stage IIIa , IIIb , IV ) or SCLC ( Limited Disease-SCLC , Extensive Disease-SCLC ) not amenable to surgery . Patients are r and omized into two groups . Both groups receive weekly care management phone calls ( CMPCs ) with the goal to assess symptoms and side effects . Additionally , one group receives a combined resistance and endurance training ( 3x/week ) . Primary endpoints are quality of life assessed by the Functional Assessment of Cancer Therapy for patients with lung cancer ( FACT-L , subcategory Physical Well-Being ) and General Fatigue measured by the Multidimensional Fatigue Inventory ( MFI-20 ) . Secondary endpoints are physical performance ( maximal voluntary isometric contraction , 6-min walk distance ) , psychosocial ( depression and anxiety ) and immunological parameters and overall survival . Discussion The aim of the POSITIVE trial is the evaluation of effects of a 24-week structured and guided exercise intervention during palliative treatment stages . Analysis of various outcomes ( such as quality of life , physical performance , self-efficacy , psychosocial and immunological parameters ) will contribute to a better underst and ing of the potential of exercise in advanced lung cancer patients . In contrast to other studies with advanced oncological patients the POSITIVE trial provides weekly phone calls to support patients both in the intervention and control group and to segregate the impact of physical activity on quality of life . Trial registration Clinical Trials.gov NCT02055508 ( Date : December 12 , 2013 BACKGROUND The impact of short-term preoperative pulmonary rehabilitation on exercise capacity of patients with chronic obstructive pulmonary disease undergoing lobectomy for non-small cell lung cancer is evaluated . METHODS A prospect i ve observational study was design ed . Inclusion criteria consisted of an indication to lung resection because of a clinical stage I or II non-small cell lung cancer and a chronic obstructive disease on preoperative pulmonary function test . In such conditions , maximal oxygen consumption by a cardio-pulmonary exercise test was evaluated ; when this result ed as being < or = 15 ml/kg/min a pulmonary rehabilitation programme lasting 4 weeks was considered . Twelve patients fulfilled inclusion criteria , completed the preoperative rehabilitation programme and underwent a new functional evaluation prior to surgery . The postoperative record of these patients was collected . RESULTS On completion of pulmonary rehabilitation , the resting pulmonary function test and diffuse lung capacity of patients was unchanged , whereas the exercise performance was found to have significantly improved ; the mean increase in maximal oxygen consumption proved to be at 2.8 ml/kg/min ( p<0.01 ) . Eleven patients underwent lobectomy ; no postoperative mortality was noted and mean hospital stay was 17 days . Postoperative pulmonary complication was recorded in 8 patients . CONCLUSIONS Short-term preoperative pulmonary rehabilitation could improve the exercise capacity of patients with chronic obstructive pulmonary disease who are c and i date s for lung resection for non-small cell lung cancer Introduction Perioperative chemotherapy is the gold st and ard treatment of the resectable gastro-oesophageal adenocarcinoma . However , 70 % of patients can not receive the complete sequence because of a postoperative complication or a decrease in functional and nutritional reserves . Recently , a new concept appeared in digestive surgery : prehabilitation . This interventional process consists of patient preparation , between surgical consultation and surgery , and is based on 3 components : ( 1 ) physical management , ( 2 ) nutritional care and ( 3 ) psychological care . Prehabilitation should decrease postoperative complications and improve nutritional and physical status during the preoperative and postoperative periods . Therefore , it is becoming essential to evaluate the effect of prehabilitation , compared to conventional care , on the percentage of patients reaching the complete oncological treatment . Methods and analysis The PREHAB trial aim ed to evaluate the efficacy of prehabilitation compared to conventional care , in patients with gastro-oesophageal cancer with perioperative chemotherapy .  This trial is a prospect i ve , r and omised , controlled , open-blind and interventional study in 4 centres . Patients ( n=60 per group ) will be r and omly assigned for management with either prehabilitation or conventional care . The primary outcome is the percentage of patients reaching the complete oncological treatment decided in a multidisciplinary tumour board . The secondary outcomes are the postoperative morbidity , disease-free survival , overall survival , feasibility of the protocol , length of stay , variation of the functional reserve after the preoperative chemotherapy ( defined by the VO2peak , ventilatory threshold and 6-min walk test ) , preoperative and postoperative nutritional status , preoperative anxiety , quality of life , 30-day and 90-day mortality and cumulative dose of cytotoxic treatment received . Ethics and dissemination The study was approved by an independent medical ethics committee ( IRB00008526 , CPP Sud-Est VI , Clermont-Ferr and , France ) and by the competent French authority ( ANSM , Saint Denis , France ) and registered on Clinical trial.gov . The results will be disseminated in a peer- review ed journal . Trial registration number NCT02780921 PURPOSE Exercise is commonly recommended to women after breast cancer surgery , yet it is difficult for patients and health professionals to adopt safe and beneficial types and modes of exercise . Thus studies on exercise interventions targeting women with breast cancer treatment were systematic ally review ed . METHODS The review process and quality assessment of the studies followed the guideline of the National Evidence -based Healthcare Collaborating Agency . Relevant studies were obtained from electronic data bases , and two trained review ers independently analyzed the studies . Of the 902 articles sorted , 11 were selected . Then , quality assessment for each study was carried out with the Scottish Intercollegiate Guideline Network ( SIGN ) checklist . RESULTS Seven different types of  exercise interventions were identified from 3 quasi-experimental and 8 r and omized controlled trial studies . The interventions varied in duration from several days to 13 weeks , and tended to show significant effects on psychological outcomes and upper body functions within a short-term period and were effective in alleviating lymphedema at a longer 1-year point . Supervised , professional intervention had significant effects on health indicators and a higher adherence rate . CONCLUSION Well- design ed exercises are effective and beneficial for improving women 's physical , physiological , and psychological health outcomes after breast cancer treatment as well as to facilitate changes in exercise behaviors . The feasibility of applying intervention protocol s , efficiency of interventions , and strengths of exercise protocol s should be further examined Purpose Patients with advanced cancer frequently experience anxiety , depression and poor quality of life ( QOL ) , as well as physical symptoms such as fatigue and weakness .  Physical exercise has potential to help control these symptoms but the optimal training prescription is still not clear . We performed a study comparing medical Qigong ( QG ) and st and ard endurance and strength training ( SET ) in patients with advanced stage non-small cell lung ( NSCLC ) and gastrointestinal ( GI ) cancers . Methods A r and omized , cross-over study was performed in patients with advanced NSCLC and GI cancers receiving or eligible for chemotherapy . Patients received supervised QG or SET twice-weekly for 6 weeks . Psychological functioning , QOL , symptoms and physical functioning were assessed before and after each intervention period . Results Nineteen patients completed both interventions . Comparing interventions revealed no difference between QG and SET on change in anxiety or depression scores or QOL . However , SET treatment was better at improving perceived strength ( P = 0.05 ) and walking distance ( P = 0.02 ) . The order in which interventions were performed had a significant impact on the improvement in certain symptoms ( sleep quality , breathlessness , P < 0.05 ) , QOL ( P = 0.01 ) and walking distance ( P = 0.008 ) . In all cases , the beneficial effects of the exercise interventions were markedly reduced during the second interval . Conclusions QG and SET are equivalent in their impact on many aspects of psychological function in cancer patients . However , SET leads to greater improvements in exercise capacity and helps reduce some symptoms . The reduction in beneficial effect of SET on exercise function when offered as the second intervention is a new finding that warrants further study Background : The preoperative period ( prehabilitation ) may represent a more appropriate time than the postoperative period to implement an intervention . The impact of prehabilitation on recovery of function al exercise capacity was thus studied in patients undergoing colorectal resection for cancer . Methods : A parallel-arm single-blind superiority r and omized controlled trial was conducted . Seventy-seven patients were r and omized to receive either prehabilitation ( n = 38 ) or rehabilitation ( n = 39 ) . Both groups received a home-based intervention of moderate aerobic and resistance exercises , nutritional counseling with protein supplementation , and relaxation exercises initiated either 4 weeks before surgery ( prehabilitation ) or immediately after surgery ( rehabilitation ) , and continued for 8 weeks after surgery . Patients were managed with an enhanced recovery pathway . Primary outcome was functional exercise capacity measured using the vali date d 6-min walk test . Results : Median duration of prehabilitation was 24.5 days . While awaiting surgery , functional walking capacity increased ( ≥20 m ) in a higher proportion of the prehabilitation group compared with the rehabilitation group ( 53 vs. 15 % , adjusted P = 0.006 ) . Complication rates and duration of hospital stay were similar . The difference between baseline and 8-week 6-min walking test was significantly higher in the prehabilitation compared with the rehabilitation group ( + 23.7 m [ SD , 54.8 ] vs. −21.8 m [ SD , 80.7 ] ; mean difference 45.4 m [ 95 % CI , 13.9 to 77.0 ] ) . A higher proportion of the prehabilitation group were also recovered to or above baseline exercise capacity at 8 weeks compared with the rehabilitation group ( 84 vs. 62 % , adjusted P = 0.049 ) . Conclusion : Meaningful changes in postoperative functional exercise capacity can be achieved with a prehabilitation program Introduction . Surgical resection in patients with non – small cell lung cancer ( NSCLC ) may be associated with significant morbidity , functional limitations , and decreased quality of life . Objectives . The safety and feasibility of a preoperative and early postoperative rehabilitation program in patients operated for NSCLC was determined in a nonhospital setting , with focus on high-intensity interval exercise . Methods . Forty patients with biopsy-proven NSCLC stages I to IIIa referred for surgical resection at the Department of Cardiothoracic Surgery RT , Rigshospitalet , University of Copenhagen , were r and omly assigned to 1 of 4 groups ( 3 intervention groups and 1 control group ) . The preoperative intervention consisted of a home-based exercise program , while the postoperative exercise program comprised a supervised group exercise program involving resistance and high-intensity interval cardiorespiratory exercise 2 hours weekly for 12 weeks combined with individual counseling . The study endpoints were inclusion rate , adherence , and number of adverse events . Results . Forty patients ( of 124 screened ; 32 % ) were included and r and omized into the 4 groups . The postoperative exercise was completed by 73 % of the patients r and omized to this intervention . No adverse events were observed , indicating that the early postoperative exercise program is safe . The preoperative home-based exercise program was not feasible due to interfering diagnostic procedures and fast-track surgery that left only 1 to 2 weeks between diagnosis and surgery . Conclusion . The early postoperative exercise program for patients with NSCLC was safe and feasible , but in a fast-track set up , a preoperative home-based exercise program was not feasible for this population Introduction The aim of this study was to assess the effects of preoperative pulmonary rehabilitation ( PPR ) on preoperative clinical status changes in patients with chronic obstructive pulmonary disease ( COPD ) and non-small cell lung cancer ( NSCLC ) , and net effects of PPR and cancer resection on residual pulmonary function and functional capacity . Material and methods This prospect i ve single group study included 83 COPD patients ( 62 ±8 years , 85 % males , FEV1 = 1844 ±618 ml , Tiffeneau index = 54 ±9 % ) with NSCLC , on 2–4-week PPR , before resection . Pulmonary function , and functional and symptom status were evaluated by  spirometry , 6-minute walking distance ( 6MWD ) and Borg scale , on admission , after PPR and after surgery . Results Following PPR significant improvement was registered in the majority of spirometry parameters ( FEV1 by 374 ml , p < 0.001 ; VLC by 407 ml , p < 0.001 ; FEF50 by 3 % , p = 0.003 ) , 6MWD ( for 56 m , p < 0.001 ) and dyspnoeal symptoms ( by 1.0 Borg unit , p < 0.001 ) . A positive correlation was identified between preoperative increments of FEV1 and 6MWD ( r s = 0.503 , p = 0.001 ) . Negative correlations were found between basal FEV1 and its percentage increment ( r s = –0.479 , p = 0.001 ) and between basal 6MWD and its percentage change ( r s = –0.603 , p < 0.001 ) during PPR . Compared to basal values , after resection a significant reduction of most spirometry parameters and 6MWD were recorded , while Tiffeneau index , FEF25 and dyspnoea severity remained stable ( p = NS ) . Conclusions Preoperative pulmonary rehabilitation significantly enhances clinical status of COPD patients before NSCLC resection . Preoperative increase of exercise tolerance was the result of pulmonary function improvement during PPR . The beneficial effects of PPR were most emphasized in patients with initially the worst pulmonary function and the weakest functional capacity Abstract Background : Prehabilitation has been previously shown to be more effective in enhancing postoperative functional capacity than rehabilitation alone . The purpose of this study was to determine whether a weekly supervised exercise session could provide further benefit to our current prehabilition program , when comparing to st and ard post-surgical rehabilitation . Methods : A parallel-arm single-blind r and omized control trial was conducted in patients scheduled for non-metastatic colorectal cancer resection . Patients were assigned to either a once weekly supervised prehabilitation ( PREHAB+ , n = 41 ) or st and ard rehabilitation ( REHAB , n = 39 ) program . Both multimodal programs were home-based program and consisted of moderate intensity aerobic and resistance exercise , nutrition counseling with daily whey protein supplementation and anxiety-reduction strategies . Perioperative care was st and ardized for both groups as per enhanced recovery after surgery ( ERAS ® ) guidelines . Functional exercise capacity , as determined by the 6-minute walk test distance ( 6MWD ) , was the primary outcome . Exercise quantity , intensity and energy expenditure was determined by the CHAMPS question naire . Results : Both groups were comparable for baseline walking capacity ( PREHAB+ : 448 m [ IQR 375–525 ] vs. REHAB : 461 m [ 419–556 ] , p=.775 ) and included a similar proportion of patients who improved walking capacity ( > 20 m ) during the preoperative period ( PREHAB+ : 54 % vs. REHAB : 38 % , p = .222 ) . After surgery , changes in 6MWD were also similar in both groups . In PREHAB+ , however , there was a significant association between physical activity energy expenditure and 6MWD ( p < .01 ) . Previously inactive patients were more likely to improve functional capacity due to PREHAB+ ( OR 7.07 [ 95 % CI 1.10–45.51 ] ) . Conclusions : The addition of a weekly supervised exercise session to our current prehabilitation program did not further enhance postoperative walking capacity when compared to st and ard REHAB care . Sedentary patients , however , seemed more likely to benefit from PREHAB+ . An association was found between energy spent in physical activity and 6MWD . This information is important to consider when design ing cost-effective prehabilitation programs OBJECTIVE The objective of this study was to investigate the effect of prehabilitation on survival after colorectal cancer surgery .  SUMMARY OF BACKGROUND DATA Preoperative multimodal exercise and nutritional programs ( prehabilitation ) improve functional capacity and recovery following colorectal surgery . Exercise may also affect cancer outcomes by mediating the systemic inflammatory response . The effect of prehabilitation on cancer outcomes is unknown . METHODS Pooled data from 3 prehabilitation trials ( 2 r and omized controlled trials , 1 cohort ) in patients undergoing elective , biopsy-proven , primary non-metastatic colorectal cancer surgery from 2009 to 2014 within an enhanced recovery program were analyzed . Patients were grouped into + prehab or-prehab . The primary outcomes were 5-year disease-free ( DFS ) and overall survival ( OS ) . DFS and OS were analyzed using Kaplan-Meier curves and multiple Cox regression . RESULTS A total of 202 patients were included ( + prehab 104 , -prehab 98 ) . Median prehabilitation duration was 29 days ( interquartile range 20 - 40 ) . Patient and tumor characteristics were well-balanced ( 33 % stage III ) . Postoperative complications and time to adjuvant chemotherapy were similar . Mean duration of follow-up was 60.3 months ( st and ard deviation 26.2 ) . DFS was similar for the combined group of stage I-III patients ( P = 0.244 ) . For stage III patients , prehabilitation was associated with improved DFS ( 73.4 % vs 50.9 % , P = 0.044 ) . There were no differences in OS ( P = 0.226 ) . Prehabilitation independently predicted improved DFS ( hazard ratio 0.45 ; 95 % confidence interval , 0.21 - 0.93 ) , adjusting for stage and other confounders . Prehabilitation did not independently predict OS . CONCLUSION In this report , prehabilitation is associated with improved 5-year DFS in stage III colorectal cancer . This finding should be confirmed in future trials BACKGROUND Post-thoracotomy non-small cell lung cancer ( NSCLC ) patients report cancer-related fatigue ( CRF ) as a severe symptom that may increase the occurrence and severity of other symptoms while decreasing functional status and quality of life ( QOL ) . The aim of this pilot study was to describe the effects of a home-based rehabilitative exercise intervention on CRF , other symptoms , functional status , and QOL for post-surgical NSCLC patients starting within days after hospital discharge . METHODS Seven post-thoracotomy NSCLC patients completed the  Brief Fatigue Inventory ( BFI ) measuring CRF severity , and the  M.D. And erson Symptom Inventory measuring symptom severity at pre- and post-surgery , and at the end of each week of the six-week intervention . Additionally , the Medical Outcomes Short-Form-36 measuring physical and mental functional status ; and the Quality of Life Index ( QLI ) measuring QOL were completed pre- and post-surgery , after week 3 , and at the end of the intervention ( week 6 ) . RESULTS Participants had a mean age of 65 years , a mean of 6 co-morbid conditions , and initiated the intervention within 4 days after hospital discharge . Participants ' CRF severity scores were reduced to mild levels while the mean number of symptoms decreased from 10.4 post-surgery to 7.0 at week 6 with lower levels of severity and interference . Likewise , participants ' post-intervention functional status and QOL improved to near or above pre-surgical levels . CONCLUSIONS The exercise intervention for post-surgical NSCLC patients showed promising preliminary efficacy in improving CRF , other symptom severity , functional status , and QOL . Further testing via a two-arm r and omized controlled trial is being conducted Background Of all older patients that opt for elective colorectal surgery , approximately one-third has one or more postoperative complications , particularly those patients with a low cardiorespiratory fitness ( ventilatory anaerobic threshold ( VAT ) < 11 mL/kg/min ) . A physical exercise training program prior to surgery ( prehabilitation ) can improve their cardiorespiratory fitness . It remains to be seen whether prehabilitation also reduces postoperative complications , as most of the studies so far were rather underpowered , heterogeneous , and biased toward selection of patients with a lower risk of postoperative complications . The primary objective of this study is to evaluate the effects of a three-week prehabilitation program on 30-day postoperative complications in patients with a VAT < 11 mL/kg/min planned for elective colorectal resection for colorectal cancer or dysplasia . Methods In this multicenter prospect i ve r and omized controlled trial , patients ≥ 60 years with colorectal cancer or dysplasia grade I , II , or III , planned for elective colorectal resection in two hospitals in the Netherl and s , will be recruited . Eligible patients must have a score ≤ 7 metabolic equivalents on the veterans-specific activity question naire , and should be able to perform a cardiopulmonary exercise test . A total of 86 patients will be r and omized ( block-stratified r and omization ) to prehabilitation ( intervention group ) or usual care ( control group ) . For final inclusion , VAT should be < 11 mL/kg/min . Three times a week for 3 weeks , a 60-min supervised prehabilitation session will be completed in community physical therapy practice s by the 43 patients in the prehabilitation group , consisting of moderate-to-high intensity interval training to improve cardiorespiratory fitness , and resistance training to improve peripheral muscle strength . Additionally , patients perform home exercises twice a week on a moderate intensity level . The 43 patients in the usual care group will receive usual care . Discussion Optimizing preoperative physical fitness may decrease the postoperative complication rate , may lead to fewer reoperations , less intense clinical care , a shorter length of stay , a more effective surgical planning ( process-optimization ) , fewer readmissions , less intense rehabilitation , shorter rehabilitation period , earlier resumption of work , enhance patient perceived health-related quality of life , and promote performance in daily life . Cost-effectiveness should therefore be expected and evaluated . Trial registration Medical Ethics Committee Twente , Enschede , the Netherl and s ( NL45001.044.13 , September 3 , 2013 ) ; Netherl and s Trial Register ( NTR ; NTR4032 , June 14 , 2013 ) Background Colorectal cancer ( CRC ) is the second most prevalent type of cancer in the world . Surgery is the only curative option . However , postoperative complications occur in up to 50 % of patients and are associated with higher morbidity and mortality rates , lower health related quality of life ( HRQoL ) and increased expenditure in health care . The number and severity of complications are closely related to preoperative functional capacity , nutritional state , psychological state , and smoking behavior . Traditional approaches have targeted the postoperative period for rehabilitation and lifestyle changes . However , recent evidence shows that the preoperative period might be the optimal moment for intervention . This study will determine the impact of multimodal prehabilitation on patients ’ functional capacity and postoperative complications . Methods / design This international multicenter , prospect i ve , r and omized controlled trial will include 714 patients undergoing colorectal surgery for cancer . Patients will be allocated to the intervention group , which will receive 4 weeks of prehabilitation ( group 1 , prehab ) , or the control group , which will receive no prehabilitation ( group 2 , no prehab ) . Both groups will receive perioperative care in accordance with the enhanced recovery after surgery ( ERAS ) guidelines . The primary outcomes for measurement will be functional capacity ( as assessed using the six-minute walk test ( 6MWT ) ) and postoperative status determined with the Comprehensive Complication Index ( CCI ) . Secondary outcomes will include HRQoL , length of hospital stay ( LOS ) and a cost-effectiveness analysis . Discussion Multimodal prehabilitation is expected to enhance patients ’ functional capacity and to reduce postoperative complications . It may therefore result in increased survival and improved HRQoL. This is the first international multicenter study investigating multimodal prehabilitation for patients undergoing colorectal surgery for cancer . Trial registration Trial Registry : NTR5947 – date of registration : 1 August 2016 Background Patients undergoing colorectal cancer resections are at risk for delayed recovery . Prehabilitation aims to enhance functional capacity preoperatively for better toleration of surgery and to facilitate recovery . The authors previously demonstrated the limited impact of a prehabilitation program using exercise alone . They propose an exp and ed trimodal prehabilitation program that adds nutritional counseling , protein supplementation , and anxiety reduction to a moderate exercise program . This study aim ed to estimate the impact of this trimodal program on the recovery of functional capacity compared with st and ard surgical care . Methods Consecutive patients were enrolled in this pre- and postintervention study over a 23-month period . The postoperative recovery for 42 consecutive patients enrolled in the prehabilitation program was compared with that of 45 patients assessed before the intervention began . The primary outcome was functional walking capacity ( 6-min walk test [ 6MWT ] ) . The secondary outcomes included self-reported physical activity ( CHAMPS question naire ) and health-related quality of life ( SF-36 ) . Data are expressed as mean ± st and ard deviation or median ( interquartile range [ IQR ] ) and were analyzed using Chi-square and Student ’s t test . All p values lower than 0.05 were considered significant . Results The prehabilitation and control groups were comparable in terms of age , gender , body mass index ( BMI ) and American Society of Anesthesiology ( ASA ) class . There was no difference in walking capacity at the first assessment ( 6MWT distance , 422 ± 87 vs 402 ± 57 m ; p = 0.21 ) . During the prehabilitation period lasting a median of 33 days ( range , 21–46 days ) , functional walking capacity improved by 40 ± 40 m ( p < 0.01 ) . The postoperative complication rates and the hospital length of stay were similar . The patients in the prehabilitation program had better postoperative walking capacity at both 4 weeks ( mean difference , 51.5 ± 93 m ; p = 0.01 ) and 8 weeks ( mean difference , 84.5 ± 83 m ; p < 0.01 ) . At 8 weeks , 81 % of the prehabilitated patients were recovered compared with 40 % of the control group ( p < 0.01 ) . The prehabilitation group also reported higher levels of physical activity before and after surgery . Conclusion In this pilot study , a 1-month trimodal prehabilitation program improved postoperative functional recovery . A r and omized trial is ongoing ( NCT01356264 ) Lung cancer is the leading cause of cancer death in the world , causing more than one million deaths each year . The incidence and mortality rates are highest in the United States and Europe and continue to increase in developing nations . Non-small cell lung cancer ( NSCLC ) accounts for 80 to 85 % of all new cases of lung cancer . The majority of patients with NSCLC present with advanced disease at the time of diagnosis . Although the prognosis of advanced NSCLC is very poor , current chemotherapy combinations have been shown to improve 1-year survival and quality of life for these patients . Approximately one third of patients with NSCLC are diagnosed with locally advanced disease . Although cure rates are modest and variable in locally advanced NSCLC , multimodality therapy ( chemotherapy in combination with surgery or radiotherapy ) has result ed in statistically significant improvement in 5-year survival when compared with surgery or radiotherapy alone . Patients with early-stage NSCLC have the best long-term survival rates following surgical resection ; however , systemic recurrences remain a problem in the majority of these patients . The rationale for treating patients with early-stage NSCLC with combined-modality therapy ( chemotherapy and surgery ) is compelling , and several r and omized trials are currently in progress . Although progress has been slow , when we consider the recent advances in smoking prevention , smoking cessation , staging classification , imaging and diagnostic techniques , screening and therapeutic modalities , and multidisciplinary care , as well as in the underst and ing of the molecular pathogenesis of lung cancer , the future , in my opinion , is very promising Recent advances in the treatment of non-small cell lung cancer ( NSCLC ) have led to improvements in patient survival and quality of life . It is unclear whether molecular abnormalities associated with NSCLC cell survival , growth and proliferation are useful in predicting treatment benefit . We conducted a systematic review to establish which biomarkers contribute meaningfully to the management of NSCLC . A team of research ers search ed PubMed and conference proceedings ( ASCO , ESMO , IASLC , USCAP ) using MESH terms for NSCLC and r and omized trials ( RCT ) , plus keywords for variables of interest . Evidence from multiple RCTs confirmed that histologic subtype is prognostic for survival and predictive of treatment efficacy and /or toxicity in NSCLC . Likewise , activating mutations of the epidermal growth factor receptor ( EGFR ) are associated with benefit from EGFR tyrosine kinase inhibitors in patients with advanced non-squamous NSCLC and should be assessed routinely . No biomarkers to date reliably predict response to anti-Vascular Endothelial Growth Factor ( VEGF ) therapies . There are inconsistent data on the role of ERCC1 , BRCA , Beta tubulin III , RRM1 , K-RAS , or TP-53 in treatment decisions . These tests should not be routinely used in selecting treatment at this time , whereas EML4/ALK translocations predict responses to specific targeted agents , the optimal assessment of this molecular abnormality has yet to be established . Personalized care of patients with NSCLC based on biomarkers is increasingly important to both clinical practice and research Background The Lung Cancer Exercise Training Study ( LUNGEVITY ) is a r and omized trial to investigate the efficacy of different types of exercise training on cardiorespiratory fitness ( VO2peak ) , patient-reported outcomes , and the organ components that govern VO2peak in post-operative non-small cell lung cancer ( NSCLC ) patients . Methods / Design Using a single-center , r and omized design , 160 subjects ( 40 patients / study arm ) with histologically confirmed stage I-IIIA NSCLC following curative-intent complete surgical resection at Duke University Medical Center ( DUMC ) will be potentially eligible for this trial . Following baseline assessment s , eligible participants will be r and omly assigned to one of four conditions : ( 1 ) aerobic training alone , ( 2 ) resistance training alone , ( 3 ) the combination of aerobic and resistance training , or ( 4 ) attention-control ( progressive stretching ) . The ultimate goal for all exercise training groups will be 3 supervised exercise sessions per week an intensity above 70 % of the individually determined VO2peak for aerobic training and an intensity between 60 and 80 % of one-repetition maximum for resistance training , for 30 - 45 minutes/session . Progressive stretching will be matched to the exercise groups in terms of program length ( i.e. , 16 weeks ) , social interaction ( participants will receive one-on-one instruction ) , and duration ( 30 - 45 mins/session ) . The primary study endpoint is VO2peak . Secondary endpoints include : patient-reported outcomes ( PROs ) ( e.g. , quality of life , fatigue , depression , etc . ) and organ components of the oxygen cascade ( i.e. , pulmonary function , cardiac function , skeletal muscle function ) . All endpoints will be assessed at baseline and postintervention ( 16 weeks ) . Sub studies will include genetic studies regarding individual responses to an exercise stimulus , theoretical determinants of exercise adherence , examination of the psychological mediators of the exercise - PRO relationship , and exercise-induced changes in gene expression . Discussion VO2peak is becoming increasingly recognized as an outcome of major importance in NSCLC . LUNGEVITY will identify the optimal form of exercise training for NSCLC survivors as well as provide insight into the physiological mechanisms underlying this effect . Overall , this study will contribute to the establishment of clinical exercise therapy rehabilitation guidelines for patients across the entire NSCLC continuum . Trial Registration OBJECTIVE To evaluate the effect of a combined hospital plus home exercise programme following curative surgery for non-small cell lung cancer ( NSCLC ) . DESIGN R and omised controlled trial . SETTING Teaching hospital . PARTICIPANTS One hundred and thirty-one subjects with NSCLC admitted for curative surgery . INTERVENTIONS Participants were r and omised to usual care or a hospital plus home exercise programme . OUTCOMES The primary outcome was the between-group difference in physical activity 4 weeks after surgery . Secondary outcomes were the difference in quadriceps strength , exercise tolerance and quality of life [ Short Form-36 ( SF-36 ) and European Organisation for Research and Treatment of Cancer ( EORTC ) QLQ-LC13 ] from pre-operatively ( baseline ) to 4 weeks after surgery . RESULTS The participants ( n=131 ) had a mean age of 68 [ st and ard deviation ( SD ) 11 ] years and mean forced expiratory volume in 1 second of 2.4 ( SD 1.1)l . There were no significant differences in physical activity between the groups 4 weeks after surgery [ mean difference adjusted for baseline 12minutes/day , 95 % confidence interval ( CI ) -20.2 to 44.1 ] . In addition , there were no significant differences in total SF-36 or EORTC QLQ-LC13 scores from baseline to 4 weeks after surgery . Both groups had recovered their pre-operative walking distance 4 weeks after surgery , and there were no differences between the groups ( mean difference in Incremental Shuttle Walk Test from baseline to 4 weeks after surgery ( -26 m , 95 % CI -94.2 to 42.3 ) . CONCLUSIONS A hospital plus home exercise programme showed little benefit in unselected patients with NSCLC following surgery . Regardless of group allocation , the patients had recovered their pre-operative exercise tolerance levels by 4 weeks after surgery BACKGROUND Video-assisted thoracic surgery ( VATS ) lobectomy for non-small cell lung cancer ( NSCLC ) is increasingly popular . However , the oncologic soundness of VATS for patients with NSCLC as measured by long-term survival has not been proven . The objective here is to determine the overall survival ( OS ) and disease-free survival ( DFS ) in two well-matched groups of patients with NSCLC resected by VATS or thoracotomy .  METHODS We conducted a retrospective review of a prospect i ve data base to identify patients who had a lobectomy for NSCLC . A propensity score-matched analysis was done with variables of age , sex , smoking history , Charlson comorbidity index , forced expiratory volume in 1 second , lung diffusing capacity for carbon monoxide , histology , and clinical T and N status . Medical records were review ed and survival was analyzed . RESULTS After matching , there were 208 patients in each group . Patient and tumor characteristics were similar . The VATS group had a shorter length of stay . More nodes ( 14.3 versus 11.3 ; p=0.001 ) and more nodal stations ( 3.8 versus 3.1 ; p<0.001 ) were removed by thoracotomy . No differences were seen in OS and DFS . Median follow-up was 36 months . More than 90 % of patients had clinical stage I disease , with 3- and 5-year OS of 87.4 % and 76.5 % , respectively , for VATS , and 81.6 % and 77.5 % , respectively , for thoracotomy ( p=0.672 ) . Both the incidence and distribution of recurrence were similar . Multivariate Cox regression analyses of OS and DFS confirmed the noninferiority of VATS . CONCLUSIONS For patients with clinical stage I NSCLC , VATS lobectomy offered similar OS and DFS compared with thoracotomy . Thoracotomy offers a more thorough lymph node evaluation , and may be appropriate for patients with more advanced clinical disease BACKGROUND A previous comprehensive prehabilitation program , providing nutrition counseling with whey protein supplementation , exercise , and psychological care , initiated 4 weeks before colorectal surgery for cancer , improved functional capacity before surgery and accelerated functional recovery . Those receiving st and ard of care deteriorated . The specific role of nutritional prehabilitation alone on functional recovery is unknown . OBJECTIVE This study was undertaken to estimate the impact of nutrition counseling with whey protein on preoperative functional walking capacity and recovery in patients undergoing colorectal resection for cancer . DESIGN We conducted a double-blinded r and omized controlled trial at a single university-affiliated tertiary center located in Montreal , Quebec , Canada . Colon cancer patients ( n=48 ) awaiting elective surgery for nonmetastatic disease were r and omized to receive either individualized nutrition counseling with whey protein supplementation to meet protein needs or individualized nutrition counseling with a nonnutritive placebo . Counseling and supplementation began 4 weeks before surgery and continued for 4 weeks after surgery . MAIN OUTCOME MEASURE The primary outcome was change in functional walking capacity as measured with the 6-minute walk test . The distance was recorded at baseline , the day of surgery , and 4 weeks after surgery . A change of 20 m was considered clinical ly meaningful . RESULTS The whey group experienced a mean improvement in functional walking capacity before surgery of + 20.8 m , with a st and ard deviation of 42.6 m , and the placebo group improved by + 1.2 ( 65.5 ) m ( P=0.27 ) . Four weeks after surgery , recovery rates were similar between groups ( P=0.81 ) . CONCLUSION Clinical ly meaningful improvements in functional walking capacity were achieved before surgery with whey protein supplementation . These pilot results are encouraging and justify larger-scale trials to define the specific role of nutrition prehabilitation on functional recovery after surgery OBJECTIVES Peak VO2 , as measure of physical performance is central to a correct preoperative evaluation in patients with both non-small-cell lung cancer ( NSCLC ) and chronic obstructive pulmonary disease ( COPD ) because it is closely related both to operability criteria and the rate of postoperative complications . Strategies to improve peak VO2 , as a preoperative pulmonary rehabilitation programme ( PRP ) , should be considered favourably in these patients . In order to clarify the role of pulmonary rehabilitation , we have evaluated the effects of 3-week preoperative high-intensity training on physical performance and respiratory function in a group of patients with both NSCLC and COPD who underwent lobectomy . METHODS We studied 40 patients with both NSCLC and COPD , age < 75 years , TNM stages I-II , who underwent lobectomy . Patients were r and omly divided into two groups ( R and S ) : Group R underwent an intensive preoperative PRP , while Group S underwent only lobectomy . We evaluated peak VO2 in all patients at Time 0 ( T0 ) , after PRP/before surgery in Group R/S ( T1 ) and 60 days after surgery , respectively , in both groups ( T2 ) . RESULTS There was no difference between groups in peak VO2 at T0 , while a significant difference was observed both at T1 and T2 . In Group R , peak VO2 improves significantly from T0 to T1 : 14.9 ± 2.3 - 17.8 ± 2.1 ml/kg/min ± st and ard deviation ( SD ) , P < 0.001 ( 64.5 ± 16.5 - 76.1 ± 14.9 % predicted ± SD , P < 0.05 ) and deteriorates from T1 to T2 : 17.8 ± 2.1 - 15.1 ± 2.4 , P < 0.001 ( 76.1 ± 14.9 - 64.6 ± 15.5 , P < 0.05 ) , reverting to a similar value to that at T0 , while in Group S peak VO2 did not change from T0 to T1 and significantly deteriorates from T1 to T2 : 14.5 ± 1.2 - 11.4 ± 1.2 ml/kg/min ± SD , P < 0.00001 ( 60.6 ± 8.4 - 47.4 ± 6.9 % predicted ± SD , P < 0.00001 ) . CONCLUSIONS PRP was a valid preoperative strategy to improve physical performance in patients with  both NSCLC and COPD and this advantage was also maintained after surgery PURPOSE This study aim ed to evaluate the safety , feasibility , and effects of an 8-wk combined resistance and endurance exercise program in patients with advanced non-small cell lung cancer ( NSCLC ) during in- and outpatient care . METHODS In this intervention study , 40 patients with predominantly advanced NSCLC receiving simultaneous or sequential radiochemotherapy or chemotherapy alone were enrolled . For a period of 8 wk , patients were instructed to exercise at least five times per week during the inpatient setting and at least three times per week in the outpatient setting . Physical performance status ( endurance capacity : 6-min walk test ; strength capacity : h and held dynamometry ) , quality -of-life ( Functional Assessment of Cancer Therapy-Lung ) , fatigue ( Multidimensional Fatigue Inventory ) , and depression ( Patient Health Question naire ) were assessed at baseline ( T0 ) , after the exercise intervention ( T1 ) , and at a follow-up time point 8 wk later ( T2 ) . The primary end point was adequate adherence ( feasibility ) defined as completing at least two training sessions per week during a minimum of 6 wk . RESULTS Of 40 patients , 31 ( 77.5 % ) completed the postexercise assessment ( T1 ) and 22 ( 55 % ) completed follow-up ( T2 ) . The stages were IIA ( 5 % ) , IIIA ( 8 % ) , IIIB ( 20 % ) , and IV ( 67 % ) , and the median age was 63 yr ( range = 22 - 75 yr ) . Overall , adherence was 82 % for those patients who completed T1 , and 55 % of the 40 participating patients fulfilled the adequate adherence criterion . Those who completed the intervention showed a significant improvement in the 6-min walk distance and in knee , elbow , and hip muscle strength after the intervention ( T1 ) . Quality of life , fatigue , and depression scores remained stable or declined slightly . Significant improvements in knee-muscle strength were also observed at T2 . CONCLUSIONS Exercise training is feasible in advanced and metastatic NSCLC patients during anticancer treatment . In this pilot study , endurance and strength capacity improved over time , indicating the rehabilitative importance of the applied intervention . To investigate the potential impact of exercise training in this patient group , a larger r and omized trial is warranted Objectives : This umbrella review aim ed to determine the effectiveness of exercise interventions , alone or in combination with other interventions , in improving physical function in community-dwelling older people identified as pre-frail or frail . Introduction : Exercise is said to have a positive impact on muscle mass and strength which improves physical function and hence is beneficial for the treatment of frailty . Several systematic review s discuss the effects of exercise interventions on physical function parameters , such as strength , mobility , gait , balance and physical performance , and indicate that multi-component exercise , including resistance , aerobic , balance and flexibility training , appears to be the best way in which to improve physical function parameters in frail older people . However , there is still uncertainty as to which exercise characteristics ( type , frequency , intensity , duration and combinations ) are the most effective and sustainable over the long-term . Inclusion criteria : Participants were adults , 60 years or over , living in the community and identified as pre-frail or frail . Quantitative systematic review s , with or without meta- analysis that examined the effectiveness of exercise interventions of any form , duration , frequency and intensity , alone or in combination with other interventions design ed to alter physical function parameters in frail older people , were considered . The quantitative outcome measures were physical function , including muscular strength , gait , balance , mobility and physical performance . Methods : An iterative search strategy for ten bibliometric data bases and gray literature was developed . Critical appraisal of seven systematic review s was conducted independently by two review ers using a st and ard Joanna Briggs Institute tool . Data was extracted independently by two review ers using a st and ard Joanna Briggs Institute data extraction tool and summarized using a narrative synthesis approach . Results : Seven systematic review s were included in this umbrella review , with a total of 58 relevant r and omized controlled trials and 6927 participants . Five systematic review s examined the effects of exercise only , while two systematic review s reported on exercise in combination with a nutritional approach , including protein supplementations , as well as fruit and dairy products . The average  exercise frequency was 2–3 times per week ( mean 3.0 ± 1.5 times per week ; range 1–7 weekly ) for 10–90 minutes per session ( mean of 52.0 ± 16.5 mins ) and a total duration of 5–72 weeks with the majority lasting a minimum of 2.5 months ( mean 22.7 ± 17.7 weeks ) . Multi-component exercise interventions can currently be recommended for pre-frail and frail older adults to improve muscular strength , gait speed , balance and physical performance , including resistance , aerobic , balance and flexibility tasks . Resistance training alone also appeared to be beneficial , in particular for improving muscular strength , gait speed and physical performance . Other types of exercise were not sufficiently studied and their effectiveness is yet to be established . Conclusions : Interventions for pre-frail and frail older adults should include multi-component exercises , including in particular resistance training , as well as aerobic , balance and flexibility tasks . Future research should adopt a consistent definition of frailty and investigate the effects of other types of exercise alone or in combination with nutritional interventions so that more specific recommendations can be made Purpose Peak oxygen consumption ( VO2peak ) is an important predictive factor for long-term prognosis in patients with non-small cell lung cancer ( NSCLC ) . The purpose of this study was to investigate whether 8 weeks of exercise training improves exercise capacity , as assessed by VO2peak , and other related factors in patients with NSCLC receiving targeted therapy . Methods A total of 24 participants with adenocarcinoma were r and omly assigned to either the control group ( n = 11 ) or the exercise group ( n = 13 ) . Subjects in the exercise group participated in individualized , high-intensity aerobic interval training of exercise . The outcome measures assessed at baseline and after 8 weeks were as follows : VO2peak and the percentage of predicted VO2peak ( % predVO2peak ) , muscle strength and endurance of the right quadriceps , muscle oxygenation during exercise , insulin resistance as calculated by the homeostasis model , high-sensitivity C-reactive protein , and quality of life ( QoL ) question naire inventory . Results No exercise-related adverse events were reported . After exercise training , VO2peak and % predVO2peak increased by 1.6 mL kg−1 min−1 and 5.3 % ( p < 0.005 ) , respectively ; these changes were associated with improvements in circulatory , respiratory , and muscular functions at peak exercise ( all p = 0.001 ) . The exercise group also had less dyspnea ( p = 0.01 ) and favorably lower fatigue ( p = 0.05 ) than baseline . Conclusions Patients with NSCLC receiving targeted therapy have quite a low exercise capacity , even with a relatively high QoL. Exercise training appears to improve exercise capacity and alleviate some cancer-related symptoms OBJECTIVES Stage III non-small cell lung cancer ( NSCLC ) describes a heterogeneous population with disease presentation ranging from apparently resectable tumors with occult microscopic nodal metastases to unresectable , bulky nodal disease . This review up date s the published clinical trials since the last American College of Chest Physicians guidelines to make treatment recommendations for this controversial subset of patients . METHODS Systematic search es were conducted through MEDLINE , Embase , and the Cochrane Data base for Systematic Review up to December 2011 , focusing primarily on r and omized trials , selected meta-analyses , practice guidelines , and review s. RESULTS For individuals with stage IIIA or IIIB disease , good performance scores , and minimal weight loss , treatment with combined chemoradiotherapy results in better survival than radiotherapy alone . Consolidation chemotherapy or targeted therapy following definitive chemoradiation for stage IIIA is not supported . Neoadjuvant therapy followed by surgery is neither clearly better nor clearly worse than definitive chemoradiation . Most of the arguments made regarding patient selection for neoadjuvant therapy and surgical resection provide evidence for better prognosis but not for a beneficial impact of this treatment strategy ; however , weak comparative data suggest a possible role if only lobectomy is needed in a center with a low perioperative mortality rate . The evidence supports routine platinum-based adjuvant chemotherapy following complete resection of stage IIIA lung cancer encountered unexpectedly at surgery . Postoperative radiotherapy  improves local control without improving survival . CONCLUSIONS Multimodality therapy is preferable in most subsets of patients with stage III lung cancer . Variability in the patients included in r and omized trials limits the ability to combine results across studies and thus limits the strength of recommendations in many scenarios . Future trials are needed to investigate the roles of individualized chemotherapy , surgery in particular cohorts or setting s , prophylactic cranial radiation , and adaptive radiation AIM To investigate the safety and feasibility of a six-week supervised structured exercise and relaxation training programme on estimated peak oxygen consumption , muscle strength and health related quality of life ( HRHRQOL ) in patients with inoperable lung cancer , undergoing chemotherapy . METHODS A prospect i ve , single-arm intervention study of supervised , hospital based muscle and cardiovascular group training and individual home-based training . Peak oxygen consumption ( VO(2peak ) ) was assessed using an incremental exercise test . Muscle strength was measured with one repetition maximum test ( 1RM ) . HRQOL was assessed using the Functional Assessment of Cancer Therapy-Lung ( FACT-L ) scale . RESULTS Twenty-five patients with non-small cell cancer ( NSCLC ) stage III-IV and four patients with extensive disease small cell lung cancer ( SCLC-ED ) were recruited . Six patients ( 20.7 % ) dropped out leaving 23 patients for analysis .  Exercise adherence in the group training was 73.0 % and 8.7 % in the home-based training . There were improvements in estimated VO(2peak ) and six-minute walk distance ( 6 MWD ) as well as increased muscle strength measurements ( p<0.05 ) . There was significant improvement in the " emotional well-being " parameter ( FACT-L ) while there were no significant changes in HRQOL . CONCLUSION Exercise training produces significant improvements in physiological indices and emotional HRQOL and is safe and feasible in patients with advanced stage lung cancer , undergoing chemotherapy .  No analysis on home-based training was done because of low adherence Objective The objective of this pilot study was to describe the effects of a 16-week home-based rehabilitative exercise program on cancer-related fatigue ( CRF ) , other symptoms , functional status , and quality of life ( QOL ) for patients with non-small cell lung cancer ( NSCLC ) after thoracotomy starting within days after hospital discharge and continuing through the initiation and completion of chemotherapy .  Material s and methods Five patients with NSCLC completed the Brief Fatigue Inventory ( measuring CRF severity ) and the MD And erson Symptom Inventory ( measuring symptom severity ) before and after thoractomy , and at the end of each week of the 16-week exercise program . Additionally , the Medical Outcomes Study Short Form-36 ( measuring physical and mental functional status ) and the Quality of Life Index ( measuring QOL ) were completed before and after thoracotomy , after weeks 3 , 6 , 12 , and 16 ( the end of the exercise program ) . Further , the 6-minute walk test  ( measuring functional capacity ) was administered before thoracotomy , prior to the initiation of chemotherapy and /or radiation therapy , and at the end of the 16-week exercise program , after completion of chemotherapy . Results Participants had a mean age of 63 years and a mean of five comorbid conditions ; the exercise program was initiated within 4 days after hospital discharge . Participants ’ CRF severity scores were reduced to mild levels , while the mean number of symptoms decreased from 9 postthoracotomy to 6 after the exercise program , with mean levels of severity and interference decreasing to below prethoracotomy levels . Likewise , participants ’ functional status and QOL after completing the exercise program improved to near or above prethoracotomy levels . Conclusion The home-based , light-intensity exercise program for NSCLC patients receiving and completing adjuvant chemotherapy postthoracotomy showed promising trends in improving CRF severity , other symptom severity , functional status , and QOL . Further testing via a two-arm r and omized controlled trial is being conducted PURPOSE : Although rehabilitation after treatment for non-small cell lung cancer ( NSCLC ) was found to have a beneficial effect on exercise capacity in a number of studies , insight into its effect on quality of life ( QoL ) and fatigue is limited . The aim of this study was to examine the outcome of pulmonary rehabilitation ( PR ) regarding fatigue , QoL , and exercise capacity in adult patients curatively treated for NSCLC stages I to IIIa . METHODS : Study data were prospect ively and routinely gathered in daily practice in patients taking part in an outpatient PR program after treatment for NSCLC stages I to IIIa . PR consisted of 12 weeks of supervised exercises 3 times a week , supplemented with scheduled visits with members of a multidisciplinary team . Data were gathered at initial assessment and discharge . Outcomes included fatigue ( the Functional Assessment of Cancer Therapy-Fatigue and the fatigue domain of the Chronic Respiratory Disease Question naire ) ; QoL ( total CRQ score ) , Functional Assessment of Cancer Therapy-Lung , and the Short Form 36 ; and exercise capacity ( cardiopulmonary exercise testing ) . RESULTS : Fifty patients started the program out of the 70 patients referred to PR and 43 ( 86 % ) completed the program . Significant ( P ⩽ .01 ) and clinical ly relevant improvements were observed for all outcome measures . CONCLUSIONS : Rehabilitation after treatment for NSCLC stages I to IIIa showed promising improvements regarding patient fatigue , QoL , and exercise capacity . PR should be considered for patients after treatment for NSCLC stages I to IIIa OBJECTIVE health-related quality of life ( HRQOL ) and mental well-being are associated with healthy ageing . Physical activity positively impacts both HRQOL and mental well-being .  Yoga is a physical activity that can be modified to suits the needs of older people and is growing in popularity . We conducted a systematic review with meta- analysis to determine the impact of yoga-based exercise on  HRQOL and mental well-being in people aged 60 + . METHODS search es were conducted for relevant trials in the following electronic data bases ; MEDLINE , EMBASE , Cochrane Central Register of Controlled Trials , CINAHL , Allied and Complementary Medicine Data base , PsycINFO and the Physiotherapy Evidence Data base ( PEDro ) from inception to January 2017 . Trials that evaluated the effect of physical yoga on HRQOL and /or on mental well-being  in people aged 60 + years were included . Data on HRQOL and mental well-being were extracted . St and ardised mean differences and 95 % confidence intervals ( CI ) were calculated using r and om effects models . Method ological quality of trials was assessed using the PEDro scale . RESULTS twelve trials of high method ological quality ( mean PEDro score 6.1 ) , totalling 752 participants , were identified and provided data for the meta- analysis . Yoga produced a medium effect on HRQOL ( Hedges ' g = 0.51 , 95 % CI 0.25 - 0.76 , 12 trials ) and a small effect on mental well-being ( Hedges ' g = 0.38 , 95 % CI 0.15 - 0.62 , 12 trials ) . CONCLUSION yoga interventions result ed in small to moderate improvements in both HRQOL and mental well-being in people aged 60 + years . Further , research is needed to determine the optimal dose of yoga to maximise health impact . PROSPERO REGISTRATION NUMBER ( CRD42016052458 ) BACKGROUND Physicians are often asked about complementary therapies by patients with cancer , and data show that the interest in and use of these therapies among patients with cancer is common . Therefore , it is important to assess the current evidence base on the benefits and risks of complementary therapies ( modalities not historically used in modern Western medicine ) . METHODS A systematic literature review was carried out and recommendations were made according to the American College of Chest Physicians Evidence -Based Clinical Practice Guidelines development methodology . RESULTS A large number of r and omized controlled trials , systematic review s , and meta-analyses , as well as a number of prospect i ve cohort studies , met the predetermined inclusion criteria . These trials addressed many different issues pertaining to patients with lung cancer , such as symptoms of anxiety , mood disturbance , pain , quality of life , and treatment-related side effects . The available data cover a variety of interventions , including acupuncture , nutrition , mind-body therapies , exercise , and massage . The body of evidence supports a series of recommendations . An evidence d-based approach to modern cancer care should integrate complementary therapies with st and ard cancer therapies such as surgery , radiation , chemotherapy , and best supportive care measures . CONCLUSIONS Several complementary therapy modalities can be helpful in improving the overall care of patients with lung cancer AIMS Oesophageal cancer is an aggressive disease and the optimal therapy for patients with resectable tumours remains unclear . A systematic review and companion practice guideline were published in 2004 ; however , new evidence has become available since the publication of the original report . An up date of the literature search and a revision of the recommendations were undertaken to incorporate the new data . The following research question was addressed : should patients with resectable oesophageal cancer receive preoperative or postoperative therapy together with surgery ? The outcomes of interest were survival , adverse effects and quality of life . MATERIAL S AND METHODS The literature search of the original systematic review was up date d to April 2007 . MEDLINE , EMBASE , Cochrane Library and abstract s from the American Society of Clinical Oncology and the American Society for Therapeutic Radiology and Oncology were search ed for reports of r and omised controlled trials and meta-analyses comparing preoperative or postoperative therapy with surgery alone or other preoperative or postoperative therapy . After the completion of the draft systematic review and practice guideline , the report was distributed through a mailed survey to 133 health care providers in Ontario for review and feedback . RESULTS The up date d literature search yielded eight new r and omised controlled trial reports and seven new meta- analysis reports for consideration , together with the evidence review ed in the original review publication . Of the 31 practitioners who responded to the mailed survey , 80 % agreed with the draft recommendations as stated , 83 % agreed that the report should be approved as a practice guideline and 86 % indicated that they would probably use the guideline in their own practice . CONCLUSIONS Preoperative cisplatin-based chemotherapy plus radiotherapy is recommended as the preferred modality for the management of surgically resectable patients with oesophageal cancer .  Preoperative cisplatin-based chemotherapy alone is an alternative choice for the management of these patients We attempted to determine the feasibility of study ing prehabilitation exercises to improve shoulder pain and abduction range of motion ( ROM ) after breast cancer surgery . We evaluated methods of exercise teaching and assessed effect on postsurgical seroma formation . This was a feasibility study with two non-blinded groups of subjects r and omized by timing of appointment . This single-site study was performed at an academic tertiary medical center . Sixty cancer patients were r and omly assigned to either group 1 , in-person teaching arm , n = 36 , or group 2 , video-only teaching arm , n = 24 . Forty-five patients completed the study .  Shoulder exercises were assigned to both groups 1 month prior to surgery during evaluation . Group 1 received in-person instruction on exercises , plus an information sheet with exercises and a link to an online video . Group 2 received only the information sheet with exercises and a link to the online video . The primary outcomes considered are as follows : exercise compliance , shoulder pain ( via visual analog scale ) , shoulder abduction ROM ( via goniometer ) , and presence or absence of seroma . Seventy-six percent of study patients chose to exercise . There was no difference in exercise compliance between in-person teaching versus video teaching ( 75 % , 24/32 vs. 77 % , 10/13 , OR = 1.03 ) . Sixty-six of patients ( 20/30 ) lost greater than 10 ° shoulder abduction ROM at 1 month post surgery . Twenty-nine of patients ( 9/31 ) had worse shoulder pain than baseline at 1 month post surgery ( 24 % , 6/25 exercisers , and 50 % , 3/6 non-exercisers ) . Fifteen percent of patients ( 4/27 ) had worse shoulder pain than baseline at 3 months post surgery ( 8 % , 2/23 exercisers , and 100 % , 2/2 non-exercisers ) . Prehabilitation exercise program inferred no additional risk of seroma formation ( Exercisers 21 % , 7/33 vs. non-exercisers 22 % , 2/9 , OR = 0.94 ) . Our subjects were able to perform three exercises independently in the preoperative period . A high- quality r and omized controlled trial is necessary to assess the appropriate timing and efficacy of this intervention Fast-track surgery , also named enhanced recovery after surgery ( ERAS ) , is in my opinion the most important innovation after the advent of laparoscopy ( in the 1990s ) in the field of  colorectal surgery  ( as in other fields of surgery ) . It is defined as a multimodal pathway aim ing to reduce surgical stress by using pain-free procedures with less organ dysfunction , less morbidity and better recovery . ERAS has been popularized by Henrik Kehlet and his team since the early 2000s [ 1 ] and has rapidly gained popularity around the world because of its remarkable benefits and safety . The concept of ERAS is to make use of the improvement of anaesthetic and analgesic techniques , the development of minimally invasive surgery and evidence -based perioperative care . It involves a number of items , beginning from the first medical visit before surgery to discharge . The items are all evidence based being derived from r and omized controlled trials or meta-analyses . The reader can find the references related to the ERAS items in the valuable consensus review published by the European ERAS group [ 2 ] and the paper of Kehlet and Wilmore [ 3 ] . Through this pathway , the patient can benefit from the best available evidence in anaesthesia , analgesia , perioperative fluid management , surgical procedures , nutrition and ambulation . I will focus in this editorial on the role of ERAS in colorectal surgery , but readers should be aware that ERAS has been applied and vali date d in other abdominal procedures , and in urology , gynaecology , vascular sugery , endocrine surgery , orthopaedic surgery , etc . [ 3 ] . The numerous items or components ( Figure 1 ) involve the preoperative , intra-operative and postoperative periods , necessitating close collaboration between surgeons ( no bowel preparation , no routine nasogastric tube , minimally invasive surgery , no routine abdominal drainage and early postoperative diet ) , anaesthesiologists ( fasting duration of two hours for liquids and six hours for solids , carbohydrate loading , no routine preoperative sedation , avoiding long-acting opioids , epidural analgesia , preventing postoperative nausea and vomiting , preventing intra-operative hypothermia , perioperative fluid restriction and postoperative analgesia ) and nurses and physiotherapists ( early nutrition and mobilisation ) . Several r and omized trials and four meta-analyses [ 4–7 ] have demonstrated the safety and efficacy of ERAS , not only in reducing total length of hospital stay and morbidity , but also in improving patient satisfaction when compared with conventional care . The metaanalyses included both r and omized and non-r and omized studies , the most recent and the largest [ 6 ] showing a reduction of 2.5 days in total hospital stay and significantly less morbidity ( OR 0.54 [ 0.45–0.69 ] ) in favour of the ERAS group , with no difference in readmission rate . A recent meta- analysis focusing on major colorectal surgery demonstrated that the ERAS programme can reduce morbidity by up to 50 % [ 7 ] . ERAS raises three questions . ( i ) What is the respective role of each ERAS item ? ( ii ) Does the ERAS protocol increase the workload of ward nursing staff ? ( iii ) How should this new paradigm be implemented ? Several anaesthesiologists are reluctant to use epidural analgesia in daily practice , mainly when patients are undergoing laparoscopic surgery . Epidural analgesia ( well known to be associated with less pain ) during laparoscopic surgery has been assessed in meta-analyses and r and omized trials but the conclusions are not concordant [ 8,9 ] . In my own daily practice , epidural analgesia is safe and efficacious in relieving pain and allowing early oral intake and mobilization , but it is obvious that its proper role in the ERAS protocol compared with other analgesic regimens such as non-opioid multimodal analgesia , local anaesthesia and continuous wound perfusion , in the era of laparoscopic surgery needs further evaluation . The roleof laparoscopyhas also been debated [ 10 ] . Two small r and omized trials have shown conflicting results [ 11,12 ] , but a recent large r and omized trial [ 13 ] involving four arms ( laparoscopy with ERAS vs laparoscopy with conventional care , vs open surgery with ERAS vs open surgery with conventional care ) has demonstrated a shorter hospital stay after laparoscopic colonic surgery with ERAS , the other outcomes being similar . The conclusion of the authors was that ‘ the most optimal perioperative treatment for patients requiring segmental colectomy for coloncancer is laparoscopic resection embedded in an ERAS program ’ , suggesting that laparoscopic surgery is an important component of ERAS . The same team has performed a futher multivariate linear regression analysis on the same data and showed that the components significantly associated with a successful ERAS programme were laparoscopic surgery , normal diet at postoperative days one , two and three and enforced mobilization at postoperative days one , two and three ( Vlug M , personal communication ) . There is a feeling that the ERAS programme could increase the workload of nursing staff . The nursing Complete surgical resection is the most effective curative treatment for lung cancer . However , many patients with lung cancer also have severe COPD which increases their risk of postoperative complications and their likelihood of being considered " inoperable . " Preoperative pulmonary rehabilitation ( PR ) has been proposed as an intervention to decrease surgical morbidity but there is no established protocol and no r and omized study has been published to date . We tested two preoperative PR interventions in patients undergoing lung cancer resection and with moderate-severe COPD in a r and omized single blinded design . Outcomes were length of hospital stay and postoperative complications . The first study tested 4 weeks of guideline -based PR vs. usual care : that study proved to be very difficult to recruit as patients and providers were reluctant to delay surgery . Nine patients were r and omized and no differences were found between arms . The second study tested ten preoperative PR sessions using a customized protocol with nonst and ard components ( exercise prescription based on self efficacy , inspiratory muscle training , and the practice of slow breathing ) ( n=10 ) vs. usual care ( n=9 ) . The PR arm had shorter length of hospital stay by 3 days ( p=0.058 ) , fewer prolonged chest tubes ( 11 % vs. 63 % , p=0.03 ) and fewer days needing a chest tube ( 8.8 vs. 4.3 days p=0.04 ) compared to the controlled arm . A ten-session preoperative PR intervention may improve post operative lung reexpansion evidence d by shorter chest tube times and decrease the length of hospital stay , a crude estimator of post operative morbidity and costs . Our results suggest the potential for short term preoperative pulmonary rehabilitation interventions in patients with moderate-severe COPD undergoing curative lung resection . 4 weeks of conventional preoperative PR seems non feasible BACKGROUND The efficacy of surgery for patients with non-small-cell lung cancer is limited , although recent studies suggest that preoperative chemotherapy may improve survival . We conducted a r and omized trial to examine the possible benefit of preoperative chemotherapy and surgery for the treatment of patients with non-small-cell lung cancer . METHODS We studied 60 patients ( 59 men and 1 woman ) with stage IIIA non-small-cell lung cancer . The patients were r and omly assigned to receive either surgery alone or three courses of chemotherapy ( 6 mg of mitomycin per square meter of body-surface area , 3 g of ifosfamide per square meter , and 50 mg of cisplatin per square meter ) given intravenously at three-week intervals and followed by surgery . All patients received mediastinal radiation after surgery . The resected tumors were evaluated by means of K-ras oncogene analysis and flow cytometry . RESULTS The median period of survival was 26 months in the patients treated with chemotherapy plus surgery , as compared with 8 months in the patients treated with surgery alone ( P < 0.001 ) ; the median period of disease-free survival was 20 months in the former group , as compared with 5 months in the latter ( P < 0.001 ) . The rate of recurrence was 56 percent in the group treated with chemotherapy plus surgery and 74 percent in the group treated with surgery alone . The prevalence of mutated K-ras oncogenes was 15 percent among the patients receiving preoperative chemotherapy and 42 percent among those treated with surgery alone ( P = 0.05 ) . Most of the patients treated with chemotherapy plus surgery had tumors that consisted of diploid cells , whereas the patients treated with surgery alone had tumors with aneuploid cells . CONCLUSIONS Preoperative chemotherapy increases the median survival in patients with non-small-cell lung cancer
For the functional capacity and medical care parameters , preoperative combined aerobic , resistance , and inspiratory muscle training was shown to be effective if comprising one to four weeks , performing 1 - 3 sessions per week , with moderate intensity ( 50 % for endurance capacity ) .
Preoperative physical exercise protocol s prior to cancer surgery increased in popularity over recent years ; however , the beneficial effect of such protocol s is not well established , with conflicting results reported .
We conducted a systematic review and meta- analysis of r and omized controlled trials ( RCTs ) to assess the effects of different modalities or combinations of preoperative exercise interventions and /or prehabilitation multicomponent training in patients with non-small-cell lung cancer ( NSCLC ) after surgery on the outcomes related to functional capacity , mental wellness and medical care .