HIIT Improves Cardiorespiratory Fitness in Patients With Resectable NSCLC

High-intensity interval testing (HIIT) during the presurgical waiting period improved aerobic performances in patients with non-small cell lung cancer (NSCLC) undergoing lung resection but did not reduce early complications after lung cancer surgery, according to a study published in the Journal of Thoracic Oncology.¹

Impaired aerobic fitness is predictive of potential postoperative complications in patients with NSCLC who are scheduled for resection. Therefore, researchers sought to demonstrate that a short-term program of high-intensity interval training (HIIT) during the wait period before surgery improves patients’ cardiorespiratory fitness thereby reducing the risk of postoperative complications (ClinicalTrials.gov identifier: NCT01258478).

For the study, a group of Swiss researchers randomized 151 patients with resectable lung cancer to receive usual care (UC, N = 77) or preoperative rehabilitation based on HIIT (Rehab, N = 74) between October 2011 and October 2014. Time from date of enrollment to surgery was 25 days for the UC group and 26 days for the Rehab group; both time periods were within the British Thoracic Society’s recommended 28 days. Participants underwent maximal cardiopulmonary exercise testing (CPET) and the 6 minute walk test (6MWT) twice before surgery.

Cardiopulmonary exercise testing parameters included peak oxygen consumption (peakVo₂), anaerobic threshold, and peak heart rate.

Outcomes were a composite of 30-day mortality or any complications with TMM grade 2 or higher. Preoperative changes in CPET parameters, the incidence of postoperative complications with TMM grade 2 or higher, length of stay in the postanesthesia care unit (PACU), and the rate of admission to the intensive care unit were secondary outcomes measures.

Increases in the peak oxygen consumption (peakVO₂; median +15% [IQ 25%-75%, +9% to +22%]; P =.005) and the 6-minute walking distance (+15% [IQ25%-75%, +8% to +28%]; P <.001) were seen in the Rehab group during the waiting period, whereas the UC group experienced a decline in peak VO₂ (median –8% [IQ25%-75%, –16 to 0%], P =.005).

At least one postoperative complication was reported in 27 of the 74 patients (35.5%) in the Rehab group and 39 of 77 patients (50.6%) in the UC group (P =.080). The Rehab group experienced a lower incidence of pulmonary complications compared with the UC group (23% vs 44%, P =.018) due to a significant reduction in atelectasis (12.2% vs 36.4%, P <.001) accompanied by a shorter length of stay in the PACU (median –7 hours, IQ25%-75% –4 to –10).

A short-term HIIT program for patients with NSCLC during the waiting period before surgery was found to improve aerobic performances in these patients. However, no difference in composite morbidity-mortality index was seen between HIIT and usual care, concluded the authors.

Reference

1. Licker M, Karenovics W, Diaper J, et al. Short-term preoperative high-intensity interval training in patients awaiting lung cancer surgery: a randomized controlled trial. J Thorac Oncol. 2016 Oct 19. doi: 10.1016/j.jtho.2016.09.125. [Epub ahead of print]