title: High-intensity training and cardiopulmonary exercise testing in patients with chronic obstructive pulmonary disease and non-small-cell lung cancer undergoing lobectomy.
abstract: OBJECTIVE
  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 randomly 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 ± standard 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.
authors.affiliation: Division of Pneumology, AORN Dei Colli 'Monaldi Hospital', Naples, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Stefanelli
authors.forename: Ilernando
authors.initials: I
authors.lastname: Meoli
authors.forename: Raffaele
authors.initials: R
authors.lastname: Cobuccio
authors.forename: Carlo
authors.initials: C
authors.lastname: Curcio
authors.forename: Dario
authors.initials: D
authors.lastname: Amore
authors.forename: Dino
authors.initials: D
authors.lastname: Casazza
authors.forename: Maura
authors.initials: M
authors.lastname: Tracey
authors.forename: Gaetano
authors.initials: G
authors.lastname: Rocco
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis* / Q000503:physiopathology / Q000534:rehabilitation* / Q000601:surgery; D003131:Combined Modality Therapy; D005080:Exercise Test; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000503:physiopathology / Q000534:rehabilitation* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D011013:Pneumonectomy; D057234:Preoperative Period; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000503:physiopathology / Q000534:rehabilitation* / Q000601:surgery; D012129:Respiratory Function Tests; D018570:Risk Assessment
keywords: Chronic obstructive pulmonary disease; Lung cancer; Preoperative risk assessment; Rehabilitation; VO2max