Preoperative high-intensity interval training is effective and safe in deconditioned patients with lung cancer: A randomized clinical trial
Chetna Bhatia, Bengt Kayser
Respiratory Care Service, University Hospitals of Geneva, 1205 Geneva, Switzerland
Background: The outcome of surgery in deconditioned patients can be improved through prehabilitation. This study examined the effect of prehabilitation in patients diagnosed with lung cancer.
Methods: Candidates for lung cancer resection were assigned to high-intensity interval training (n = 74) or usual care (n = 77). Cardiopulmonary exercise testing and 6-min walk test were performed before and after training. High-intensity interval training consisted of 2–3-weekly, 2 × 10-min series of cycling at peak power, measured with cardiopulmonary exercise testing prior to training, with a 15-s on-off duty cycle, preceded by a 5-min warm-up and followed by a 5-min cool-down. Work-rate, heart-rate, saturation, dyspnoea and leg effort were monitored.
Results: Waiting time (median 25 days) allowed a median of 8 high-intensity interval training sessions to be performed. Adherence to mean high-intensity interval training was 87% (18% standard deviation; SD). High-intensity interval training power increased (23 watt, 95% confidence interval (95% CI): 20–26 watt), as did heart rate (14 bpm, 95% CI 11–16 bpm). Resting heart rate (–6 bpm, 95% CI –4 to –7 bpm) and heart rate 1 min post-cool-down decreased (–5 bpm, 95% CI –4 to –7 bpm). Aerobic capacity increased after high-intensity interval training (14%, 95% CI 3–26%), as did peak power output (median 7%, 95% CI 2–13%), but not after usual care. Six-min walk test score increased after high-intensity interval training (median 20%, 95% CI 14–26%), but not after usual care.
Conclusion: Short-term high-intensity interval training is feasible in deconditioned patients and increases cardio-respiratory fitness and walking capacity.
High-intensity interval training is used increasingly in patient care. Various training patterns are used. For patients diagnosed with lung cancer, the first choice intervention is surgery. There is a wait of approximately a mean of 3 weeks between the clinical decision to operate and the intervention. A high-intensity interval training protocol was designed, to be performed during this time-window, to improve the physical condition of these patients before surgery. Patients cycled 3 times per week under supervision, performing 2 × 10-min series of 15-s sprints at peak power, interspersed with 15-s pauses. Compared to usual care, just before surgery, after 8 sessions of high-intensity interval training, the patients’ physical fitness was significantly improved while after surgery the outcome was improved.
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