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Physiotherapy and physical activity in patients undergoing cardiac or lung cancer surgery
Örebro University, School of Medical Sciences.
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Cardiovascular diseases are the leading cause of death worldwide. Cardiac surgery is performed to improve prognosis, relieve symptoms and increase functional capacity in patients with cardiac disease. Postoperative pulmonary complications are common after cardiac surgery and a reduced lung function can persist a long time after surgery. A positive association between level of physical activity and lung function has been proposed in both healthy individuals and people with different disabilities. It is not clear if there is an association between level of physical activity and recovery of lung function after cardiac surgery. Lung cancer is one of the most frequently diagnosed forms of cancer worldwide, and a leading cause of cancer deaths. Surgical resection is the primary approach for curative treatment. Despite the fact that physical activity has many positive effects on health, patients undergoing lung cancer surgery often report a low level of physical activity. Measuring physical activity is not easy, self-reported physical activity remains the most clinically applicable type of measurement, and a simple and valid questionnaire for screening patients would be valuable. Patients undergoing lung cancer surgery are often routinely treated by physiotherapists, but this kind of treatment has not been thoroughly investigated. The purpose of this thesis was to investigate the effect of physiotherapy and physical activity in patients undergoing cardiac or lung cancer surgery. This thesis include one cohort study of physical activity and recovery of lung function in patients undergoing cardiac surgery, one validation study of two self-reported physical activity instruments in patients undergoing lung cancer surgery, and two randomized controlled trials investigating the effect of physiotherapy for patients undergoing lung cancer surgery. In study I, patients who remained active or increased their level of physical activity had better recovery of lung function, compared to patients who remained sedentary or reported a lower level of physical activity postoperatively. In study II, two self-reported physical activity instruments were validated against accelerometer data in patients three and twelve months after lung cancer surgery. Both instruments were found able to identify patients not meeting recommendations on physical activity. In study III, patients treated by physiotherapists were significantly more active during the first three days after lung cancer surgery, compared to an untreated control group. In study IV, no between-group differences three months after surgery were found between patients receiving in-hospital physiotherapy compared to an untreated control group. However, the patients in the treatment group reported an increase of physical activity three months after surgery compared to preoperatively, while the patients in the control group did not.

Place, publisher, year, edition, pages
Örebro: Örebro University , 2019. , p. 59
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 192
Keywords [en]
Physiotherapy, Physical Activity, Cardiac surgery, Lung Cancer, Randomized Controlled Trial, Thoracic surgery, Physical Function, Lung Function
National Category
Surgery
Identifiers
URN: urn:nbn:se:oru:diva-72411ISBN: 978-91-7529-282-3 (print)OAI: oai:DiVA.org:oru-72411DiVA, id: diva2:1288223
Public defence
2019-05-03, Örebro universitet, Campus USÖ, hörsal C2, Södra Grev Rosengatan 32, Örebro, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2019-02-12 Created: 2019-02-12 Last updated: 2019-06-03Bibliographically approved
List of papers
1. Self-reported physical activity and lung function two months after cardiac surgery: a prospective cohort study
Open this publication in new window or tab >>Self-reported physical activity and lung function two months after cardiac surgery: a prospective cohort study
2014 (English)In: Journal of Cardiothoracic Surgery, ISSN 1749-8090, E-ISSN 1749-8090, Vol. 9, article id 59Article in journal (Refereed) Published
Abstract [en]

Background: Physical activity has well-established positive health-related effects. Sedentary behaviour has been associated with postoperative complications and mortality after cardiac surgery. Patients undergoing cardiac surgery often suffer from impaired lung function postoperatively. The association between physical activity and lung function in cardiac surgery patients has not previously been reported.

Methods: Patients undergoing cardiac surgery were followed up two months postoperatively. Physical activity was assessed on a four-category scale (sedentary, moderate activity, moderate regular exercise, and regular activity and exercise), modified from the Swedish National Institute of Public Health's national survey. Formal lung function testing was performed preoperatively and two months postoperatively.

Results: The sample included 283 patients (82% male). Two months after surgery, the level of physical activity had increased (p < 0.001) in the whole sample. Patients who remained active or increased their level of physical activity had significantly better recovery of lung function than patients who remained sedentary or had decreased their level of activity postoperatively in terms of vital capacity (94 +/- 11% of preoperative value vs. 91 (+/-) 9%; p = 0.03), inspiratory capacity (94 +/- 14% vs. 88 +/- 19%; p = 0.008), and total lung capacity (96 +/- 11% vs. 90 +/- 11%; p = 0.01).

Conclusions: An increased level of physical activity, compared to preoperative level, was reported as early as two months after surgery. Our data shows that there could be a significant association between physical activity and recovery of lung function after cardiac surgery. The relationship between objectively measured physical activity and postoperative pulmonary recovery needs to be further examined to verify these results.

Place, publisher, year, edition, pages
London: BioMed Central, 2014
Keywords
Cardiac surgery, Lung function, Physical activity
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:oru:diva-35213 (URN)10.1186/1749-8090-9-59 (DOI)000335462200001 ()24678691 (PubMedID)2-s2.0-84901980219 (Scopus ID)
Funder
Swedish Heart Lung FoundationSwedish Research Council
Note

Funding Agencies:

Research Committee of Orebro County Council

Swedish Heart and Lung Patients National Association

Uppsala University

Uppsala-Orebro Regional Research Council, Sweden

Available from: 2014-06-03 Created: 2014-06-02 Last updated: 2019-04-10Bibliographically approved
2. Validation of two self-reported physical activity instruments for patients who have undergone lung cancer surgery
Open this publication in new window or tab >>Validation of two self-reported physical activity instruments for patients who have undergone lung cancer surgery
(English)Manuscript (preprint) (Other academic)
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-73595 (URN)
Available from: 2019-04-10 Created: 2019-04-10 Last updated: 2019-04-10Bibliographically approved
3. In-hospital physiotherapy improves physical activity level after lung cancer surgery: a randomized controlled trial
Open this publication in new window or tab >>In-hospital physiotherapy improves physical activity level after lung cancer surgery: a randomized controlled trial
Show others...
2018 (English)In: Physiotherapy, ISSN 0031-9406, E-ISSN 1873-1465Article in journal (Refereed) Epub ahead of print
Abstract [en]

OBJECTIVES: Patients undergoing lung cancer surgery are routinely offered physiotherapy. Despite its routine use, effects on postoperative physical recovery have yet not been demonstrated. The aim of this study was to investigate whether physiotherapy could improve postoperative in-hospital physical activity level and physical capacity.

DESIGN: Single-blind randomized controlled trial.

SETTING: Thoracic surgery department at a University Hospital.

PARTICIPANTS: Patients undergoing elective thoracic surgery (n=94) for confirmed or suspected lung cancer were assessed during hospital stay.

INTERVENTION: Daily physiotherapy, consisting of mobilization, ambulation, shoulder exercises and breathing exercises. The control group received no physiotherapy treatment.

OUTCOMES: In-hospital physical activity assessed with the Actigraph GT3X+ accelerometer, six-minute walk test, spirometry and dyspnea scores.

RESULTS: The treatment group reached significantly more accelerometer counts (2010 (1508) vs 1629 (1146), mean difference 495 [95% CI 44 to 1109]), and steps per hour (49 (47) vs 37 (34), mean difference 14 [95% CI 3 to 30]), compared to the control group, during the first three postoperative days. No significant differences in six-minute walk test (percent of preoperative 71% vs 79%, P=0.13), spirometry (FEV1 percent of preoperative 69% vs 69%, P=0.83) or dyspnoea (M-MRC 2 vs 2, P=0.74) between the groups were found.

CONCLUSIONS: Patients receiving in-hospital physiotherapy showed increased level of physical activity during the first days after lung cancer surgery, compared to an untreated control group. However, no effects on the six-minute walk test or spirometric values were found. The clinical importance of an increased physical activity level during the early postoperative period needs to be further evaluated.

CLINICAL TRIAL REGISTRATION NUMBER: NCT01961700.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Lung cancer, Physical activity, Physical therapy, Randomized clinical trial
National Category
Surgery Cancer and Oncology
Identifiers
urn:nbn:se:oru:diva-73624 (URN)10.1016/j.physio.2018.11.001 (DOI)30871894 (PubMedID)
Available from: 2019-04-10 Created: 2019-04-10 Last updated: 2019-04-10Bibliographically approved
4. In-hospital physiotherapy and physical recovery three months after lung cancer surgery: a randomized controlled trial
Open this publication in new window or tab >>In-hospital physiotherapy and physical recovery three months after lung cancer surgery: a randomized controlled trial
Show others...
(English)Manuscript (preprint) (Other academic)
National Category
Cancer and Oncology Surgery
Identifiers
urn:nbn:se:oru:diva-73625 (URN)
Available from: 2019-04-10 Created: 2019-04-10 Last updated: 2019-04-10Bibliographically approved

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