IMPORTANCE: Patients with lung cancer have poor physical functioning and quality of life. Despite promising outcomes for those who undertake exercise programs, implementation into practice of previously tested hospital-based programs is rare. OBJECTIVE: To evaluate a home-based exercise and self-management program for patients after lung resection. DESIGN, SETTING, AND PARTICIPANTS: A randomized clinical trial with assessor blinding was conducted among 116 patients undergoing surgery for non-small cell lung cancer from November 23 2017 to July 31 2023 at tertiary hospitals in Australia. Patients were followed up for 12 months postoperatively. INTERVENTION: Patients randomized to the intervention group received a postoperative 3-month home-based exercise and self-management program supported by weekly physiotherapist-led telephone consultations. Patients randomized to the control group received usual care. MAIN OUTCOMES AND MEASURES: The primary outcome was self-reported physical function (30-item European Organization for the Research and Treatment of Cancer Core Quality of Life Questionnaire EORTC QLQ-C30 score) at 3 months. Secondary outcomes included objective measures of physical function and exercise capacity (at 3 and 6 months) and patient-reported outcomes including quality of life (at 3 and 6 months, with some questionnaires completed at 12 months). Analysis was performed on an intent-to-treat basis. RESULTS: A total of 1370 patients were screened, with 177 eligible and 116 consented (mean age 66.4 +/- 9.6 years, 68 women 58.6%). Of these 116 patients, 58 were randomized to the intervention and 58 to the control. A total of 103 patients (88.8%) completed assessments at 3 months, 95 (81.9%) at 6 months, and 95 (81.9%) at 12 months. There were no statistically significant differences between the intervention and control groups for self-reported physical function (EORTC QLQ-C30 physical functioning domain score) at the 3-month primary end point (mean score 77.3 +/- 20.9 versus 76.3 +/- 18.8, mean difference 1.0 point, 95% CI -6.0 to 8.0 points). Patients in the intervention group, compared with the control group, had significantly greater exercise capacity (6-minute walk distance: mean difference 39.7 m, 95% CI 6.8 to 72.6 m), global quality of life (mean difference 7.1 points, 95% CI 0.4 to 13.8 points), and exercise self-efficacy (mean difference 16.0 points, 95% CI 7.0 to 24.9 points) at 3 months as well as greater objectively measured physical function (Short Physical Performance Battery score: mean difference 0.8 points, 95% CI 0.1 to 1.6 points), exercise capacity (6-minute walk distance: mean difference 50.9 m, 95% CI 6.7 to 95.1 m), and exercise self-efficacy (mean difference 10.1 points, 95% CI 1.9 to 18.2 points) at 6 months. One minor adverse event and no serious adverse events occurred. CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, a postoperative home-based exercise and self-management program did not improve self-reported physical function in patients with lung cancer. However, it did improve other important clinical outcomes. Implementation of this program into lung cancer care should be considered. TRIAL REGISTRATION: http://anzctr.org.au Identifier: ACTRN12617001283369.

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