Evaluation of teleguided high-intensity exercise rehabilitation at home before lung-cancer surgery (PREPACHIR Study)

Abstract

Introduction: Preoperative rehabilitation lowers the surgical morbidity-mortality risk of patients with non-small cell lung cancer (NSCLC). This study evaluated the feasibility of a preoperative-rehabilitation program consisting of high-intensity exercises, at home, teleguided by physical trained sports coach.

Methods: This monocenter study included patients diagnosed with resectable NSCLC, scheduled segmentectomy or lobectomy, and FEV1 < 80 % and/or DLCO < 80 %. The main exclusion criteria were neoadjuvant chemotherapy, contraindication for high-intensity physical activity, poor understanding of connected-watch use, without a smartphone and cognitive or psychiatric disorder(s).The program combines 1-hour daily high-intensity training at home, teleguided, associated with non-supervised activity advice, with tracing via an internet-connected watch. T. Program-efficacy evaluation was based on the number of patients completing the entire program, mean increase of the maximum oxygen uptake (VO₂ max) and postoperative complications assessed with the Clavien-Dindo classification.

Results: Among the 76 patients eligible for surgery during the inclusion period, 29 (38 %) satisfied inclusion criteria and 24 (83 %) accomplished at least 7 days of training for a mean ± standard deviation of 17.8 ± 9 sessions; 44 % also executed non-scheduled supplementary sessions; 96 % used the internet-connected watch. VO₂ max increased significantly from 19.3 ± 3.1 to 20.4 ± 3.5 ml/kg/min (p = 0.04). Postoperatively, 9/25 (36 %) experienced a grade 1-3 adverse event, without grade 4/5.

Conclusion: Preoperative rehabilitation with teleguided, high-intensity exercises at home is feasible and significantly increased VO₂ max. Prospective, randomized studies are needed to evaluate the benefit compared to current care practices.

Keywords: Lung cancer; Outcomes; Rehabilitation; Smoking cessation; Surgery.