title: Seven-day intensive preoperative rehabilitation for elderly patients with lung cancer: a randomized controlled trial.
abstract: As a newly developed treatment, preoperative pulmonary rehabilitation (PR) has been studied in depth. However, few studies have assessed the relationship between advanced age and a shorter term intensive pattern of preoperative PR in patients with lung cancer (LC) and especially those patients waiting for therapeutic LC surgeries. This study investigated short-term preoperative PR combined with inspiratory muscle training (IMT) and aerobic endurance training in elderly patients scheduled to undergo LC lobectomy.
  
  
  
  A prospective randomized controlled trial with a total of 60 subjects aged ≥70 y was conducted. The intervention group (PR group) was treated for 1 wk with systematic and highly intensive preoperative PR training before lobectomy, and the control group (NPR group) was treated with conventional preoperative respiratory management. We analyzed the 6-min walking distance (6-MWD), the peak expiratory flow (PEF), and quality-of-life scores before and after the rehabilitation regimen as well as the incidence of postoperative pulmonary complications (PPCs).
  
  
  
  In total, 30 patients (PR group) completely executed the 7-d intensive preoperative PR, and 30 patients (NPR group) served as the control group. The two groups were comparable at baseline. During the preoperative PR, a significantly longer 6-MWD (increase: 28.6 ± 18.2 versus 9.4 ± 27.0 m; between-groups difference: 19.2 m, P = 0.029) and an increased PEF (increase: 26.2 ± 22.5 versus 8.2 ± 10.3 L/min; between-groups difference: 18.0 L/min, P < 0.001) were noted in the PR group compared with the NPR group. After LC surgery, the mean postoperative length of stay (6.9 ± 4.4 versus 10.7 ± 6.4 d, P = 0.010) and total hospital stay (16.0 ± 4.5 versus 19.7 ± 6.5 d, P = 0.012) were significantly reduced in the PR group. Thirty-day PPCs were noted in four (13.3%) patients in the PR group and 11 (36.7%) patients in the NPR group, with a significant difference between the two groups (P = 0.037).
  
  
  
  For elderly LC patients scheduled to undergo surgery in China, a 7-d intensive pattern of preoperative PR combined with IMT and aerobic endurance training may be a feasible rehabilitation strategy with positive physical and psychological effects.
authors.affiliation: Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, P.R. China.
authors.forename: Yutian
authors.initials: Y
authors.lastname: Lai
authors.affiliation: Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, P.R. China. Electronic address: scuhuangjian@yahoo.com.
authors.forename: Jian
authors.initials: J
authors.lastname: Huang
authors.affiliation: Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, P.R. China.
authors.forename: Mei
authors.initials: M
authors.lastname: Yang
authors.affiliation: Rehabilitation Department, West China Hospital, Sichuan University, Chengdu, P.R. China.
authors.forename: Jianhua
authors.initials: J
authors.lastname: Su
authors.affiliation: Department of Postgraduates, West China School of Public Health, Sichuan University, Chengdu, P.R. China.
authors.forename: Jing
authors.initials: J
authors.lastname: Liu
authors.affiliation: Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, P.R. China. Electronic address: guowei_che@yahoo.com.
authors.forename: Guowei
authors.initials: G
authors.lastname: Che
mesh_terms: D000368:Aged; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D011300:Preoperative Care / Q000379:methods*; D012138:Respiratory Therapy; D016896:Treatment Outcome
keywords: Elderly; Lung cancer; Preoperative pulmonary rehabilitation