title: Preoperative pulmonary rehabilitation versus chest physical therapy in patients undergoing lung cancer resection: a pilot randomized controlled trial.
abstract: OBJECTIVE
  To evaluate the effect of 4 weeks of pulmonary rehabilitation (PR) versus chest physical therapy (CPT) on the preoperative functional capacity and postoperative respiratory morbidity of patients undergoing lung cancer resection.
  
  
  METHODS
  Randomized single-blinded study.
  
  
  METHODS
  A teaching hospital.
  
  
  METHODS
  Patients undergoing lung cancer resection (N=24).
  
  
  METHODS
  Patients were randomly assigned to receive PR (strength and endurance training) versus CPT (breathing exercises for lung expansion). Both groups received educational classes.
  
  
  METHODS
  Functional parameters assessed before and after 4 weeks of PR or CPT (phase 1), and pulmonary complications assessed after lung cancer resection (phase 2).
  
  
  RESULTS
  Twelve patients were randomly assigned to the PR arm and 12 to the CPT arm. Three patients in the CPT arm were not submitted to lung resection because of inoperable cancer. During phase 1 evaluation, most functional parameters in the PR group improved from baseline to 1 month: forced vital capacity (FVC) (1.47L [1.27-2.33L] vs 1.71L [1.65-2.80L], respectively; P=.02); percentage of predicted FVC (FVC%; 62.5% [49%-71%] vs 76% [65%-79.7%], respectively; P<.05); 6-minute walk test (425.5±85.3m vs 475±86.5m, respectively; P<.05); maximal inspiratory pressure (90±45.9cmH(2)O vs 117.5±36.5cmH(2)O, respectively; P<.05); and maximal expiratory pressure (79.7±17.1cmH(2)O vs 92.9±21.4cmH(2)O, respectively; P<.05). During phase 2 evaluation, the PR group had a lower incidence of postoperative respiratory morbidity (P=.01), a shorter length of postoperative stay (12.2±3.6d vs 7.8±4.8d, respectively; P=.04), and required a chest tube for fewer days (7.4±2.6d vs 4.5±2.9d, respectively; P=.03) compared with the CPT arm.
  
  
  CONCLUSIONS
  These findings suggest that 4 weeks of PR before lung cancer resection improves preoperative functional capacity and decreases the postoperative respiratory morbidity.
authors.affiliation: Universidade Federal do Ceará (UFC), Fortaleza, Brazil.
authors.forename: Maria T
authors.initials: MT
authors.lastname: Morano
authors.forename: Amanda S
authors.initials: AS
authors.lastname: Araújo
authors.forename: Francisco B
authors.initials: FB
authors.lastname: Nascimento
authors.forename: Guilherme F
authors.initials: GF
authors.lastname: da Silva
authors.forename: Rafael
authors.initials: R
authors.lastname: Mesquita
authors.forename: Juliana S
authors.initials: JS
authors.lastname: Pinto
authors.forename: Manoel O
authors.initials: MO
authors.lastname: de Moraes Filho
authors.forename: Eanes D
authors.initials: ED
authors.lastname: Pereira
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001945:Breathing Exercises; D002289:Carcinoma, Non-Small-Cell Lung / Q000503:physiopathology / Q000534:rehabilitation* / Q000601:surgery*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008175:Lung Neoplasms / Q000503:physiopathology / Q000534:rehabilitation* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010807:Physical Endurance; D026741:Physical Therapy Modalities; D010865:Pilot Projects; D012129:Respiratory Function Tests; D016037:Single-Blind Method; D018709:Statistics, Nonparametric; D020775:Thoracic Surgery, Video-Assisted; D013908:Thoracotomy; D016896:Treatment Outcome