OBJECTIVES: The goal of this study was to assess the impact of a preoperative 1-week, systematic, high-intensity inpatient exercise regimen on patients with lung cancer who had risk factors for postoperative pulmonary complications (PPCs). METHODS: We conducted a randomized controlled trial with 101 subjects of a preoperative, 7-day systematic, integrated, high-intensity pulmonary exercise regimen. The control group received standard preoperative care. We analysed the occurrence of PPCs in both groups as the primary outcome; other outcomes included changes in blood gas, quality of life, peak expiratory flow rate, the 6-min walk distance and others. RESULTS: The 6-min walk distance showed an increase of 22.9 +/- 25.9 m in the intervention group compared with 4.2 +/- 9.2 m in the control group, giving a between-group difference of 18.7 m (95% confidence interval 8.8 to 28.6; p < 0.001); the peak expiratory flow increased by 25.2 +/- 24.6l/min, compared with 4.2 +/- 7.7l/min (between-group difference: 21.0 m, 95% confidence interval 7.2 to 34.8; p = 0.003). The intervention group had a shorter average total (15.6 +/- 3.6 versus 17.7 +/- 5.3 days, p = 0.023) and postoperative length of stay (6.1 +/- 3.0 versus 8.7 +/- 4.6 days, p = 0.001) than the control group; the incidence of PPCs (9.8%, 5/51 versus 28.0%, 14/50, p = 0.019) was significantly lower. A multivariable analysis of the risk of PPCs identified short-term rehabilitation intervention to be an independent risk factor (odds ratio 0.156, 95% confidence interval 0.037 to 0.649, p = 0.011). CONCLUSIONS: The study results suggested that a systematic, high-intensity pulmonary exercise programme was a practical strategy when performed preoperatively in patients with lung cancer with risk factors for PPCs. CLINICAL TRIAL REGISTRATION: ChiCTR-IOR-16008109.

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