title: Preoperative exercise therapy in lung surgery patients: A systematic review.
abstract: OBJECTIVE
  The impact of postoperative complications after lung surgery for cancer is substantial, with the increasing age of patients and the presence of comorbidities. This systematic review summarises the effects of Preoperative Exercise Therapy (PET) in patients scheduled for lung surgery on aerobic capacity, physical fitness, postoperative complications, length of hospital stay, quality of life and recovery.
  
  
  METHODS
  A systematic search on PET prior to lung surgery was conducted. The methodological quality of the included studies was rated using the Physiotherapy Evidence Database (PEDro) scale. The agreement between the reviewers was assessed with Cohen's kappa.
  
  
  RESULTS
  A total of eleven studies were included with a methodological quality ranging from poor to good. The agreement between the reviewers, assessed with the Cohen's kappa, was 0.79. Due to substantial heterogeneity in the interventions across the included studies, it was impossible to conduct a meta-analysis. The most important finding of this systematic review was that PET based on moderate to intense exercise in patients scheduled for lung surgery has beneficial effects on aerobic capacity, physical fitness and quality of life. Also PET may reduce postoperative complications and length of hospital stay.
  
  
  CONCLUSIONS
  PET may have beneficial effects on various physical fitness variables and postoperative complications in patients with lung cancer scheduled for surgery. Future research must focus on developing patient tailored exercise programs and investigate the influence of co-existing comorbidities on the outcome measures. Definitions of PET, including timing, (acceptable) duration, intensity and exercise training methods should be determined and compared.
authors: Department of Surgery, Catharina Hospital, Michelangelolaan 2, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands; Department of Epidemiology, CAPHRI Research School, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands. Electronic address: sjaak.pouwels@catharinaziekenhuis.nl.
authors: Sjaak
authors: S
authors: Pouwels
authors: Department of Respiratory Medicine, Michelangelolaan 2, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands.
authors: Jeroen
authors: J
authors: Fiddelaers
authors: Department of Surgery, Catharina Hospital, Michelangelolaan 2, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands; Department of Epidemiology, CAPHRI Research School, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
authors: Joep A W
authors: JA
authors: Teijink
authors: Department of Cardio-Thoracic Surgery, Michelangelolaan 2, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands.
authors: Joost F Ter
authors: JF
authors: Woorst
authors: Department of Surgery, Atrium Medical Centre, Henri Dunantstraat 5, 6419 PC Heerlen, The Netherlands.
authors: Jan
authors: J
authors: Siebenga
authors: Department of Respiratory Medicine, Michelangelolaan 2, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands; SHE School of Health Professions Education, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
authors: Frank W J M
authors: FW
authors: Smeenk
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D008175:Lung Neoplasms / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology; D018482:Muscle, Skeletal / Q000502:physiology; D010101:Oxygen Consumption / Q000502:physiology; D010809:Physical Fitness / Q000502:physiology; D011183:Postoperative Complications / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods*; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D014797:Vital Capacity / Q000502:physiology
keywords: Complications; Exercise training; Lung resection; Physical fitness; Preconditioning; Thoracic surgery