PEP
Trial question
What is the role of a perioperative exercise program in patients with primary lung cancer or oligometastatic disease to the lung undergoing surgery?
Study design
Single center
Open label
RCT
Population
Characteristics of study participants
59.0% female
41.0% male
N = 182
182 patients (108 female, 74 male).
Inclusion criteria: adult patients with primary lung cancer or oligometastatic disease to the lung undergoing surgery.
Key exclusion criteria: deemed ineligible for surgery by the enrolling physician; alcohol or drug abuse; significant mental or emotional problems that would interfere with study participation; abnormalities on screening physical examination that would contraindicate participation in exercise program compliance.
Interventions
N=92 perioperative exercise prescription (home-based exercise monitored remotely by a physical therapist 2 week before surgery through 2 months after surgery).
N=90 standard care (provided incentive spirometer and encouraged to increase walking).
Primary outcome
Improvement in 6-minute walk test at 2 months
14.3 m
-9.9 m
14.3 m
10.7 m
7.2 m
3.6 m
0.0 m
-3.6 m
-7.2 m
-10.7 m
Perioperative exercise
prescription
Standard
care
No significant
difference ↔
No significant difference in improvement in 6-minute walk test at 2 months (14.3 m vs. -9.9 m; MD 22.7, 95% CI -2.75 to 48.15).
Secondary outcomes
Significantly greater improvement in Functional Assessment of Chronic Illness Therapy-Fatigue score at 2 months (2.2 points vs. -2.4 points; MD 3.7, 95% CI 0.92 to 6.48).
No significant difference in decline in Short Physical Performance Battery scores at 2 months (0.3 points vs. 0.2 points; MD 0.1, 95% CI -0.48 to 0.68).
Significantly greater improvement in 6-minute walk test at 2 months in females (20.9 m vs. -18.8 m; MD 37.8, 95% CI 3.61 to 71.99).
Conclusion
In adult patients with primary lung cancer or oligometastatic disease to the lung undergoing surgery, perioperative exercise prescription was not superior to standard care with respect to improvement in 6-minute walk test at 2 months.
Reference
Cornelia M Ulrich, Caroline Himbert, Christopher A Barnes et al. Precision Exercise Effect on Fatigue and Function in Lung Cancer Surgery: A Randomized Clinical Trial. JAMA Surg. 2025 Mar 12:e250130. Online ahead of print.
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