Comparison of lung volume reduction surgery and physical training on health status and physiologic outcomes: a randomized controlled clinical trial.
OBJECTIVE
In 1996, researchers in Sweden initiated a collaborative randomized study comparing lung volume reduction surgery (LVRS) and physical training with physical training alone. The primary end point was health status; secondary end points included survival and physiologic measurements.


METHODS
After an initial 6-week physical training program, researchers' patients were randomized to either LVRS (surgical group [SG]) with continued training for 3 months, or to continued training alone (training group [TG]) for 1 year.


METHODS
All seven thoracic surgery centers in Sweden.


METHODS
All patients in Sweden with severe emphysema fulfilling inclusion criteria for LVRS.


METHODS
Patients randomized to surgery underwent a median sternotomy, except for a few patients in whom thoracotomy or video-assisted thoracoscopy were performed. In the TG, supervised physical training continued for 1 year; in the SG, supervised physical training continued for 3 months postoperatively.


RESULTS
Fifty-three patients were included in each group. Six in-hospital deaths occurred after surgery (12%), and one more death occurred during follow-up. Two deaths occurred in the TG. The difference in death rates between the groups was not statistically significant. Health status, as measured by St. George Respiratory Questionnaire (SGRQ) [total scale score mean difference at 1 year, 14.7; 95% confidence interval (CI), 9.8 to 19.7] as well as by the Medical Outcomes Study Short-Form General Health Survey (physical function scale score mean difference at 1 year, 19.7; 95% CI, 12.1 to 27.3) was improved from baseline in the SG compared with the TG. FEV(1), residual volume, and shuttle walking test values also improved in the SG but not in the TG after 6 months and 12 months.


CONCLUSIONS
In severe emphysema, LVRS can improve health status in survivors but is associated with mortality risk. The effects are stable for at least 1 year. Physical training alone failed to achieve a similar improvement.
Hillerdal
Gunnar
G
Department of Pulmonary Medicine, Karolinska Hospital, Stockholm, Sweden. gunnar.hillerdal@karolinska.se
Löfdahl
Claes-Göran
CG
Ström
Kerstin
K
Skoogh
Bengt-Eric
BE
Jorfeldt
Lennart
L
Nilsson
Folke
F
Forslund-Stiby
Dycke
D
Ranstam
Jonas
J
Gyllstedt
Erik
E
D005081:Exercise Therapy; D017079:Exercise Tolerance; D005260:Female; D006304:Health Status; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D011656:Pulmonary Emphysema / Q000601:surgery*; D012129:Respiratory Function Tests