title: Exercise intervention for patients surgically treated for Non-Small Cell Lung Cancer (NSCLC): a systematic review.
abstract: BACKGROUND
  Surgery remains the best curative option for appropriately selected patients with lung cancer. Evidence suggests that improving cardiovascular fitness and functional capacity can accelerate post-surgery recovery and reduce mortality. However, the effect of exercise intervention for patients surgically treated for Non-Small Cell Lung Cancer [NCSLC] has not been fully examined.
  
  
  OBJECTIVE
  This review examines the literature regarding exercise intervention for patients who are surgically treated for NSCLC focussing on three key areas: methodological quality, intervention design (e.g. duration, frequency, type) and outcomes measured.
  
  
  METHODS
  A search of Medline, EMBASE, CINAHL and PsychINFO was undertaken. Randomised Controlled Trials [RCTs] and non-RCTs including exercise training pre or post lung cancer resection were included. Descriptive characteristics were extracted and methodological quality assessed using Downs and Black appraisal checklist.
  
  
  RESULTS
  Twenty studies (eight RCT's) were included: nine pre-surgical, nine post-surgical and two pre to post-surgical. The quality of evidence is questionable with many limitations (e.g. small samples, inadequate allocation concealment and a lack of clear reporting on timing, adverse events and follow-up). Regarding design of exercise intervention and outcomes measured, there was much variation between studies producing a disparate set of data. An optimal programme is still to be determined; however, suggestions are made relating to type of exercise (i.e. mixing aerobic, resistance and breathing exercises). Preliminary work from this review suggests that exercise intervention compared with usual care both pre and post-surgery is associated with improved cardiopulmonary exercise capacity, increased muscle strength and reduced fatigue, post-operative complications and hospital length of stay. Results concerning pulmonary function, quality of life, and blood gas analysis were variable and inconsistent.
  
  
  CONCLUSIONS
  In order to implement exercise intervention appropriate for patients surgically treated for NCSLC, more high quality randomised controlled trials are required and more work concerning feasibility, acceptability and effectiveness of specific interventions on outcomes is warranted.
authors: University of Dundee, School of Nursing and Midwifery, 11 Airlie Place, Dundee DD1 4HJ, Scotland, UK. Electronic address: k.crandall@surrey.ac.uk.
authors: Katy
authors: K
authors: Crandall
authors: University of Surrey, School of Health and Social Care, Faculty of Health and Medical Sciences, Duke of Kent Building, Guildford GU2 7TE, Surrey, UK.
authors: Roma
authors: R
authors: Maguire
authors: University of Dundee, Institute of Sport and Exercise, Dundee DD1 4HN, Scotland, UK.
authors: Anna
authors: A
authors: Campbell
authors: University of Dundee, School of Nursing and Midwifery, 11 Airlie Place, Dundee DD1 4HJ, Scotland, UK.
authors: Nora
authors: N
authors: Kearney
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000534:rehabilitation* / Q000601:surgery; D005081:Exercise Therapy; D006801:Humans; D008175:Lung Neoplasms / Q000534:rehabilitation* / Q000601:surgery; D011788:Quality of Life
keywords: Exercise; Lung cancer; Oncology; Pulmonary rehabilitation; Surgical; Systematic review