Effects of exercise training in people with non-small cell lung cancer before lung resection: a systematic review and meta-analysis

Introduction: Exercise training (ET) before resection of non-small cell lung cancer is proposed to decrease postoperative complications (POC) by improving cardiorespiratory fitness. However, this intervention lacks a strong evidence-base. Aim: To assess the effectiveness of preoperative ET compared with usual care on POC and other secondary outcomes in patients with scheduled lung resection. Methods: A systematic search of randomized trials was performed. Meta-analysis was performed, and the effect of exercise training was estimated by the risk ratios (RR) and mean differences (MD) with their confidence intervals (CI). Results: 14 studies involving 791 participants were included. Compared with usual care, ET reduced overall POC (10 studies, 617 participants, RR 0.54, 95% CI 0.42 to 0.69) and clinically relevant POC (5 studies, 453 participants, Clavien-Dindo score ≥ 2 RR 0.561, 95% CI 0.41 to 0.76). The estimate of the effect of ET on mortality was very imprecise (6 studies, 456 participants, RR 0.66, 95% CI 0.20 to 2.22). The main risks of bias were a lack of participant blinding and selective reporting. ET may improve exercise capacity, pulmonary function and also quality of life and depression, although the degree of clinical usefulness of these results is unclear. Conclusion: Preoperative ET leads to a clinically worthwhile reduction in POC. Study Registration: CRD42021224192