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Combined aerobic exercise and high-intensity respiratory muscle training in patients surgically treated for non-small cell lung cancer: a pilot randomized clinical trial [with consumer summary]
Messaggi-Sartor M, Marco E, Martinez-Tellez E, Rodriguez-Fuster A, Palomares C, Chiarella S, Muniesa JM, Orozco-Levi M, Barreiro E, Guell MR
European Journal of Physical and Rehabilitation Medicine 2019 Feb;55(1):113-122
clinical trial
6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: No; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: Lung resection surgery further decreases exercise capacity and negatively affects respiratory muscle function in patients with non-small cell lung cancer (NSCLC). The best design for exercise interventions in these patients has not been determined yet. AIM: To assess the impact of aerobic exercise and high-intensity respiratory muscle training on patient outcomes following lung cancer resection surgery. DESIGN: Prospective, single-blind, pilot randomized controlled trial. SETTING: Outpatient cardiopulmonary rehabilitation unit of two university hospitals. POPULATION: Thirty-seven patients with NSCLC after tumor resection. METHODS: Patients were randomly assigned to exercise training or usual post-operative care. The training program consisted of aerobic exercises and high-intensity respiratory muscle training (24 supervised sessions, 3 per week, 8 weeks). Primary outcome was exercise capacity assessed with peak oxygen uptake (VO2peak) during cardiopulmonary exercise test. Secondary outcomes included changes in respiratory muscle strength, levels of serum insulin growth factor I (IGF-I) and IGF binding protein 3 (IGFBP-3), and quality of life assessed with the European Organization for Research and Treatment of Cancer (EORTC QLQ-C30) questionnaire. RESULTS: The 8-week training program was associated with significant improvement in VO2peak (2.13 mL/Kg/min (95%CI 0.06 to 4.20)), maximal inspiratory and expiratory pressures (18.96 cmH2O (95% CI 2.7 to 24.1) and 18.58 cmH2O (95% CI 4.0 to 33.1), respectively) and IGFBP-3 (0.61 micro g/mL (%95 CI 0.1 to 1.12)). No significant differences were observed in the EORTC QLQ-C30. CONCLUSIONS: An 8-week exercise program consisting of aerobic exercise and high-intensity respiratory muscle training improved exercise capacity, respiratory muscle strength, and serum IGFBP-3 levels in NSCLC patients after lung resection. There was no impact on the other outcomes assessed.

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