Short and long-term effects of supervised versus unsupervised exercise training on health-related quality of life and functional outcomes following lung cancer surgery - a randomized controlled trial.
OBJECTIVE
Surgical resection enhances long-term survival after lung cancer, but survivors face functional deficits and report on poor quality of life long time after surgery. This study evaluated short and long-term effects of supervised group exercise training on health-related quality of life and physical performance in patients, who were radically operated for lung cancer.


METHODS
A randomized, assessor-blinded, controlled trial was performed on 78 patients undergoing lung cancer surgery. The intervention group (IG, n=41) participated in supervised out-patient exercise training sessions, one hour once a week for ten weeks. The sessions were based on aerobic exercises with target intensity of 60-80% of work capacity, resistance training and dyspnoea management. The control group (CG, n=37) received one individual instruction in exercise training. Measurements consisted of: health-related quality of life (SF36), six minute walk test (6MWT) and lung function (spirometry), assessed three weeks after surgery and after four and twelve months.


RESULTS
Both groups were comparable at baseline on demographic characteristic and outcome values. We found a statistically significant effect after four months in the bodily pain domain of SF36, with an estimated mean difference (EMD) of 15.3 (95% CI:4 to 26.6, p=0.01) and a trend in favour of the intervention for role physical functioning (EMD 12.04, 95% CI: -1 to 25.1, p=0.07) and physical component summary (EMD 3.76, 95% CI:-0.1 to 7.6, p=0.06). At 12 months, the tendency was reversed, with the CG presenting overall slightly better measures. We found no effect of the intervention on 6MWT or lung volumes at any time-point.


CONCLUSIONS
Supervised compared to unsupervised exercise training resulted in no improvement in health-related quality of life, except for the bodily pain domain, four months after lung cancer surgery. No effects of the intervention were found for any outcome after one year.
Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Denmark; School of Health and Medical Sciences, Örebro University, Sweden. Electronic address: bcb@rn.dk.
Barbara Cristina
BC
Brocki
Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Denmark. Electronic address: jaan@rn.dk.
Jane
J
Andreasen
Department of Cardiothoracic Surgery, Aalborg University Hospital, Denmark. Electronic address: lrn@rn.dk.
Lene Rodkjaer
LR
Nielsen
Department of Cardiothoracic Surgery, Aalborg University Hospital, Denmark. Electronic address: vyn@rn.dk.
Vytautas
V
Nekrasas
Centre for Cardiovascular Research, Department of Cardiothoracic Surgery, Aalborg University Hospital, Denmark. Electronic address: a.gorst@rn.dk.
Anders
A
Gorst-Rasmussen
School of Health and Medical Sciences, Örebro University, Sweden; Department of Physiotherapy, Örebro University Hospital, Sweden. Electronic address: elisabeth.westerdahl@orebroll.se.
Elisabeth
E
Westerdahl
D000368:Aged; D015444:Exercise; D005081:Exercise Therapy / Q000706:statistics & numerical data*; D005260:Female; D006304:Health Status; D006801:Humans; D008175:Lung Neoplasms / Q000453:epidemiology / Q000534:rehabilitation* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009934:Organization and Administration / Q000706:statistics & numerical data*; D013510:Pulmonary Surgical Procedures; D011788:Quality of Life; D013997:Time Factors; D016896:Treatment Outcome
Exercise; Lung cancer; Quality of life; Rehabilitation; Surgery