ORIGINAL ARTICLE High-intensity training following lung cancer surgery: a randomised controlled trial E Edvardsen, 1,2 O H Skjønsberg, 1,3 I Holme, 2 L Nordsletten, 3 F Borchsenius, 1 S A Anderssen 2 1 Department of Pulmonary Medicine, Oslo University Hospital, Oslo, Norway 2 Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway 3 Faculty of Medicine, University of Oslo, Norway Correspondence to Elisabeth Edvardsen, Department of Pulmonary Medicine, Oslo University Hospital, Ullevål, P.O. Box 4953 Nydalen, 0424 Oslo, Norway; elisabeth.edvardsen@nih.no Received 24 June 2014 Revised 18 September 2014 Accepted 25 September 2014 Published Online First 16 October 2014 To cite: Edvardsen E, Skjønsberg OH, Holme I, et al. Thorax 2015;70: 244–250. ABSTRACT Background Many patients with lung cancer are deconditioned with poor physical fitness. Lung resection reduces physical fitness further, impairing the patient’s ability to function in daily life. Methods We conducted a single-blind randomised controlled trial of high-intensity endurance and strength training (60 min, three times a week, 20 weeks), starting 5–7 weeks after surgery. The control group received standard postoperative care. The primary outcome was the change in peak oxygen uptake measured directly during walking until exhaustion. Other outcomes included changes in pulmonary function, muscular strength by one-repetition maximum (1RM), total muscle mass measured by dual energy X-ray absorptiometry, daily physical functioning and quality of life (QoL). Results The intention-to-treat analysis of the 61 randomised patients showed that the exercise group had a greater increase in peak oxygen uptake (3.4 mL/kg/min between-group difference, p=0.002), carbon monoxide transfer factor (Tlco) (5.2% predicted, p=0.007), 1RM leg press (29.5 kg, p<0.001), chair stand (2.1 times p<0.001), stair run (4.3 steps, p=0.002) and total muscle mass (1.36 kg, p=0.012) compared with the controls. The mean±SD QoL (SF-36) physical component summary score was 51.8±5.5 and 43.3±11.3 (p=0.006), and the mental component summary score was 55.5±5.3 and 46.6±14.0 (p=0.015) in the exercise and control groups, respectively. Conclusions In patients recently operated for lung cancer, high-intensity endurance and strength training was well tolerated and induced clinically significant improvements in peak oxygen uptake, Tlco, muscular strength, total muscle mass, functional fitness and QoL. This study may provide a basis for exercise therapy after lung cancer surgery. Trial registration number NCT01748981. INTRODUCTION Patients with non-small-cell lung cancer (NSCLC) are often deconditioned and may have a poor car- diorespiratory fitness (CRF). 1 This probably reflects cardiopulmonary comorbidities and a sedentary lifestyle with subsequent loss of muscle mass. 2 Lung resection surgery reduces the CRF further, 3 leading to persistent dyspnoea and lower functional outcome. 4 Chemotherapy and/or radiation therapy are associated with additional impairment which affects all pathways involved in oxygen transport from the lungs to the working muscles. 5 Taken together, these aspects may markedly reduce the patient’s ability to function in daily life. The gold standard for measurement of CRF is a direct measure of the maximal or peak oxygen uptake. 6 In general, a minimum peak oxygen uptake of 12–15 mL/kg/min is the threshold for the ability to perform activities of daily independent living. 7 Unfortunately, a number of patients with lung cancer do not achieve this threshold, especially after surgery. 3 Furthermore, a low peak oxygen uptake is associated with increased morbidity and mortality, 8 9 also in patients with lung cancer undergoing surgery. 1 An increase in peak oxygen uptake may increase the survival 10 as well as the functional ability and quality of life (QoL). 11 A few studies have previously examined the effects of exercise in patients after lung resection. 12 To our knowledge, only a small number of studies used a randomised design, 13–16 and the results have been conflicting. 12 In addition, the duration of the intervention in these studies has been short. 13 14 16 Given the clinical importance of CRF, 10 none of these studies measured peak oxygen uptake directly. We conducted a single-blind randomised con- trolled trial to evaluate the effects of high-intensity endurance and strength training shortly after lung cancer surgery. Our primary hypothesis was that patients who perform endurance and strength Key messages What is the key question? ▸ What are the effects of high-intensity endurance and strength training after lung cancer surgery? What is the bottom line? ▸ Compared with standard postoperative care, high-intensity endurance and strength training is well tolerated and improves cardiorespiratory fitness, carbon monoxide transfer factor, muscular strength, daily physical functioning, total muscle mass and quality of life. Why read on? ▸ Because it is not possible to compensate for the loss of lung tissue after lung resection, clinicians should encourage patients to improve cardiorespiratory fitness and skeletal muscle strength to increase their physical fitness after lung resection. Lung cancer 244 Edvardsen E, et al. Thorax 2015;70:244–250. doi:10.1136/thoraxjnl-2014-205944 on January 20, 2022 by guest. Protected by copyright. http://thorax.bmj.com/ Thorax: first published as 10.1136/thoraxjnl-2014-205944 on 16 October 2014. Downloaded from