Discussion
fatigue, cancer, pain, lung cancer, appetite loss
LUNG DISEASE, POSTOPERATIVE COMPLICATIONS, ADVERSE EVENTS, CANCER, RECRUITMENT, LUNG CANCER, SECONDARY, APPETITE LOSS, STS
The novel findings of this study were that PHET is clinically effective in improving the HRQoL of lung cancer patients awaiting surgical resection and preventing its deterioration after surgery. Specifically, the PHET group showed improvements in preoperative global QoL, physical function, and fatigue compared with the CG. More importantly, these beneficial effects were maintained postoperatively, with the patients who participated in PHET reporting a significantly and clinically better global QoL than the patients in the CG. Furthermore, 1 month after surgery, the PHET group exhibited significantly better physical, emotional, and role functions, together with fewer symptoms of pain and appetite loss than the CG.These findings are clinically relevant given that the preoperative HRQoL of lung cancer patients is significantly worse than in the general population,The beneficial effects observed on global QoL, physical function, and fatigue are aligned with the strong evidence that exercise training is effective in improving these domains of HRQoL among cancer patients.In the context of lung resection, only a few trials have examined the effects of prehabilitation on postoperative HRQoL. Ferreira et al.These results are partially aligned with a clinical trial involving patients who underwent resection for benign and malignant lung disease.Another important finding of the current study was that the patients in the PHET group had significantly better role function and fewer symptoms of pain and appetite loss after surgery than those in the CG. These results are impactful given that most lung cancer patients had a clinical deterioration in role function and experienced significantly more pain and appetite loss 1 month after surgery compared with preoperative levels.The secondary purpose of this study was to determine the effects of PHET on physical performance and LOS. We found that PHET resulted in significantly better performance in the preoperative 5STS test than CG. This represents an important finding because poor performance in the STS test before lung cancer surgery has been linked to a greater risk of postoperative complications.Although previous meta-analyses showed that preoperative exercise training reduces the LOS after lung cancer surgery,The high adherence rate and absence of serious adverse events during the intervention are consistent with the results of previous feasibility trials.The strengths of this study included the multicenter design, the comprehensive synthesis of the effects from PHET in the different domains of HRQoL, and the high recruitment, retention, and adherence rates. The study limitations included the small sample, although it was adequately powered for the primary outcome; exercise adherence assessed on the basis of self-reported diaries, which are susceptible to social desirability bias;