Poor exercise capacity and physical function in patients awaiting lung cancer surgery

RATIONALE: There is substantial evidence now supporting the benefits of supervised centre-basedexercise training for patients with lung cancer both before and after surgery to improve outcomes. However, exercise programs are not frequently part of routine clinical care worldwide. This study aimed to describe the exercise capacity, physical function, and physical activity levels of patients with lung cancer awaiting surgery who were not involved in an exercise program before surgery. METHODS: This was a prospective, multi-site, observational study embedded within a larger randomised controlled trial investigating the efficacy of home-based exercise training for patients after surgery for lung cancer (the randomised trial is ongoing). The study was conducted at two major teaching public hospitals in Melbourne, Australia. Patients were eligible for inclusion if they were adults scheduled to receive surgery for lung cancer and were not already meeting the aerobic and resistance physical activity guidelines. For this investigation, baseline data (pre-randomisation and pre-intervention) of first 100 participants enrolled into the randomised trial were included. The primary outcome of this investigation was exercise capacity measured with the six-minute walk test. Secondary outcomes were physical function measured with the 4-meter gait speed test and short physical performance battery, and self-reported physical activity levels measured with the International Physical Activity Questionnaire (IPAQ). The IPAQ was used to estimate physical activity levels in Metabolic Equivalent (MET) minutes per week, and participants were categorised into ‘low’, ‘moderate’ and ‘high’ physical activity based on the published IPAQ cut-points. All participants completed testing prior to surgery. RESULTS: 100 patients (63% female; age mean (SD) 65 +/- 9 years; FEV1 mean (SD) 90 +/- 20 percent predicted) were included. Full demographics are provided in Table 1. Before surgery patients exhibited limited exercise capacity on the six-minute walk test (mean (SD) 468 +/- 111 meters), physical function on 4-meter gait speed (median [IQR] 0.89 [0.81 - 1.05] meters/seconds]) and short physical performance battery (median [IQR] 11 [9 - 11] out of 12 points); all of which were below normative values. Sixty percent of participants reported ‘low’ physical activity levels (Table 1). CONCLUSIONS: Patients awaiting surgical treatment for lung cancer have limited exercise capacity and physical function (both below normative values), and most patients report low physical activity levels. Patients should be offered the opportunity to participate in an exercise program whilst waiting for surgery.