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.
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]