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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
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Aalborg, Denmark.ORCID iD: 0000-0001-7085-6507
Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Aalborg, Denmark.
Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark.
Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark.
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2014 (English)In: Lung Cancer, ISSN 0169-5002, E-ISSN 1872-8332, Vol. 83, no 1, p. 102-108Article in journal (Refereed) Published
Abstract [en]

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.

CONCLUSION:

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.

Place, publisher, year, edition, pages
Elsevier, 2014. Vol. 83, no 1, p. 102-108
Keywords [en]
physical therapy, thoracic surgery, coronary artery bypass, post-operative complications, positivepressure respiration, respiratory function tests
National Category
Cancer and Oncology
Research subject
Rehabilitation Medicine; Oncology
Identifiers
URN: urn:nbn:se:oru:diva-34131DOI: 10.1016/j.lungcan.2013.10.015ISI: 000330153200017PubMedID: 24246508Scopus ID: 2-s2.0-84891738419OAI: oai:DiVA.org:oru-34131DiVA, id: diva2:704221
Note

Funding Agencies:

Danish Cancer Research Foundation

Danish Physiotherapist Association and Aalborg University Hospital

Available from: 2014-03-11 Created: 2014-03-11 Last updated: 2018-06-05Bibliographically approved
In thesis
1. Physiotherapy interventions and outcomes following lung cancer surgery
Open this publication in new window or tab >>Physiotherapy interventions and outcomes following lung cancer surgery
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim of this thesis was to evaluate the effect of exercise training and inspiratory muscle training and to describe pulmonary function, respiratory muscle strength, physical performance and health-related quality of life (HRQoL) following lung cancer surgery.

Study I was a randomised controlled trial including 78 patients radically operated for lung cancer. The intervention group received 10 sessions of supervised exercise training in addition to home-based exercise; the control group was instructed on home-exercise alone. Supervised compared to non-supervised exercise training did not result in differences between groups in HRQoL, except for the SF-36 bodily pain domain four months after the surgery. No effects of supervised training were found for any outcome after one year.

Study II was descriptive and was based on the study I sample. We evaluated the course of recovery of HRQoL and physical performance up to one year following surgery. All patients improved HRQoL and physical performance one year after the surgery, reaching values comparable to a reference healthy population. The walked distance was positively associated with the SF-36 domain for physical functioning.

Study III was descriptive, included 81 patients and evaluated the influence of surgery on respiratory muscle strength, lung function and physical performance two weeks and six months after surgery. We found that respiratory muscle strength was not affected after the second postoperative week and that muscle-sparring thoracotomy did not deteriorate respiratory muscle strength, compared to video-assisted thoracic surgery. Compared to preoperative values, physical performance was recovered, whereas lung function remained reduced six months postoperatively.

Study IV was a randomised controlled trial including 68 patients at high risk of developing postoperative pulmonary complications (PPC). This study evaluated the effects of two weeks of postoperative inspiratory muscle training in addition to breathing exercises and early mobilisation on respiratory muscle strength and the incidence of PPC. Additional inspiratory muscle training did not increase respiratory muscle strength, but improved postoperative oxygenation. Respiratory muscle strength was recovered in both groups two weeks postoperatively.

Place, publisher, year, edition, pages
Örebro: Örebro university, 2015. p. 66
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 129
Keywords
lung cancer, surgery, quality of life, exercise, inspiratory muscle training, physical performance, pulmonary complications
National Category
Surgery Medical and Health Sciences
Research subject
Surgery
Identifiers
urn:nbn:se:oru:diva-45728 (URN)978-91-7529-097-3 (ISBN)
Public defence
2015-11-23, Universitetssjukhuset, hörsal C1, Södra Grev Rosengatan, Örebro, 09:00 (English)
Opponent
Supervisors
Available from: 2015-09-07 Created: 2015-09-07 Last updated: 2017-10-17Bibliographically approved

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Brocki, Barbara CristinaWesterdahl, Elisabeth

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