Preoperative Exercise to Improve Fitness in Patients Undergoing Complex Surgery for Cancer of the Lung or Esophagus (PRE-HIIT)

Objective: This randomized controlled trial (RCT) compared the impact of high-intensity interval training (HIIT) versus standard care (SC) on preoperative cardiopulmonary fitness in patients before esophageal or lung cancer surgery. Background: Exercise prehabilitation aims to optimise preoperative condition and attenuate postoperative risks. Although intuitive, defining the optimal training parameters to impact physiologically before surgery with attendant clinical benefit remains challenging. Methods: Utilising a parallel, 2-armed RCT design, n=79 participants [(mean age (SD): 64 (9.3) years, 67% males] scheduled for curative resection for lung (50.6%) or esophageal (49.6%) cancer with ≥2-weeks preoperative lead-in, were recruited and randomised to HIIT (n=41) or SC (n=38). HIIT was completed on an electronically braked cycle ergometer consisting of 30 minutes of 15-second intervals at 100% peak power output alternating with 15-second active recovery for 5 days/week. The SC arm was offered moderate-intensity exercises 2 to 3 days/week. The primary outcome was peak oxygen consumption (VO 2 peak), measured by cardiopulmonary exercise testing. Secondary outcomes included lower limb strength and physical functioning. Results: Baseline cardiopulmonary fitness was predominantly very poor [n=75 (95%)]. Adjusting for baseline in a linear model, VO 2 peak increased significantly ( P =0.05) in the HIIT group versus SC (6.6% between-group difference). HIIT increased VO 2 peak from 18.7 (5.0) to 21.7 (5.7) ml/kg/min, whereas with SC it remained unchanged at 19.6 (5.4) to 20.1 (5.7) ml/kg/min from pre-intervention to post-intervention. Sit-to-stand scores were significantly ( P =0.02) improved with HIIT. Conclusions: HIIT is effective for eliciting meaningful gains in preoperative fitness in a deconditioned cohort within short timeframes.