Pre And Post-operative Exercise Training For Patients With Non-Small Cell Lung Cancer:A Systematic Review And Meta-analysis

Background Surgical resection remains to be the best option for early stage non-small cell lung cancer(NSCLC).But some patients with NSCLC could not tolerate surgery because of poor lung function.There were several studies suggested that preoperative exercise could improve lung function and the quality of life after surgery.For the reason of lacking of higher evidence,the aim of this meta-analysis is to figure out the effectiveness of perioperative exercise for NSCLC patients who were eligible for surgery.Methods MEDLINE,Embase,and the Cochrane Library were searched.And the results were screened according to index of postoperative pulmonary complications(PPCs),lung function and activity tolerance(peak of oxygen consumption(VO2peak),peak power output(Wpeak),forced vital capacity(FVC),6-minute walk distance(6MWD)and peak expiratory flow(PEF)were included).Review Manager 5.3 was used for the statistical analyses.Result:14 RCTs about pre-operative exercise and 9 RCTs about post-operative exercise were selected.The results in pre-operative exercise training group showed the length of hospital stay was shorten 0.34 days(95%CI=-0.97 to 0.28)after exercise training(P=0.28)with no significant difference,and PPCs was also reduced significantly(OR=0.43,95%CI=0.26 to 0.72,P=0.001,I2=0%,Phet=0.65).The lung function was improved,VO2peak(MD=0.34,95%CI=0.12 to 0.56,P=0.002),PEF(MD=34.39,95%CI=10.50 to 58.28.P=0.005),FVC(MD=0.71,95%CI=0.59 to 0.82,P=0.0001).The activity tolerance was significantly improved,6MWD(95%CI=44.85 to 65.31,P<0.00001),Wpeak(MD=7.25,95%CI=4.99 to 9.52,P<0.00001).In post-operative training group,FEV1(MD=0.05,95%CI=-0.02 to 0.11,P=0.16)and 6MWD(MD=15.22,95%CI=-10.15 to 40.79,P=0.24)were improved with no statistically significant difference.Network meta-analysis was done with PPCs,and the result that pre-operative could be better than post-operative exercise training,but the difference had no statistically significant was concluded.Conclusion The pre and post-operative exercise training might be safe and beneficial to patients with early stage NSCLC who received surgical resection.Further studies with larger samples and higher quality are needed.