Crandall Katy, Maguire Roma, Campbell Anna, Kearney Nora
University of Dundee, School of Nursing and Midwifery, 11 Airlie Place, Dundee DD1 4HJ, Scotland, UK.
University of Surrey, School of Health and Social Care, Faculty of Health and Medical Sciences, Duke of Kent Building, Guildford GU2 7TE, Surrey, UK.
Surg Oncol. 2014 Mar;23(1):17-30. doi: 10.1016/j.suronc.2014.01.001. Epub 2014 Jan 24.
Surgery remains the best curative option for appropriately selected patients with lung cancer. Evidence suggests that improving cardiovascular fitness and functional capacity can accelerate post-surgery recovery and reduce mortality. However, the effect of exercise intervention for patients surgically treated for Non-Small Cell Lung Cancer [NCSLC] has not been fully examined.
This review examines the literature regarding exercise intervention for patients who are surgically treated for NSCLC focussing on three key areas: methodological quality, intervention design (e.g. duration, frequency, type) and outcomes measured.
A search of Medline, EMBASE, CINAHL and PsychINFO was undertaken. Randomised Controlled Trials [RCTs] and non-RCTs including exercise training pre or post lung cancer resection were included. Descriptive characteristics were extracted and methodological quality assessed using Downs and Black appraisal checklist.
Twenty studies (eight RCT's) were included: nine pre-surgical, nine post-surgical and two pre to post-surgical. The quality of evidence is questionable with many limitations (e.g. small samples, inadequate allocation concealment and a lack of clear reporting on timing, adverse events and follow-up). Regarding design of exercise intervention and outcomes measured, there was much variation between studies producing a disparate set of data. An optimal programme is still to be determined; however, suggestions are made relating to type of exercise (i.e. mixing aerobic, resistance and breathing exercises). Preliminary work from this review suggests that exercise intervention compared with usual care both pre and post-surgery is associated with improved cardiopulmonary exercise capacity, increased muscle strength and reduced fatigue, post-operative complications and hospital length of stay. Results concerning pulmonary function, quality of life, and blood gas analysis were variable and inconsistent.
In order to implement exercise intervention appropriate for patients surgically treated for NCSLC, more high quality randomised controlled trials are required and more work concerning feasibility, acceptability and effectiveness of specific interventions on outcomes is warranted.
对于经过适当选择的肺癌患者，手术仍然是最佳的治愈选择。有证据表明，改善心血管健康状况和功能能力可加速术后恢复并降低死亡率。然而，运动干预对接受手术治疗的非小细胞肺癌（NSCLC）患者的影响尚未得到充分研究。
本综述研究了有关接受手术治疗的NSCLC患者运动干预的文献，重点关注三个关键领域：方法学质量、干预设计（如持续时间、频率、类型）和所测量的结果。
对Medline、EMBASE、CINAHL和PsychINFO进行了检索。纳入了包括肺癌切除术前或术后运动训练的随机对照试验（RCT）和非RCT。提取描述性特征，并使用唐斯和布莱克评估清单评估方法学质量。
纳入了20项研究（8项RCT）：9项术前研究、9项术后研究和2项术前至术后研究。证据质量存在问题，有许多局限性（如样本量小、分配隐藏不足以及在时间安排、不良事件和随访方面缺乏清晰报告）。关于运动干预设计和所测量的结果，研究之间存在很大差异，产生了一组不同的数据。最佳方案仍有待确定；然而，针对运动类型（即有氧运动、抗阻运动和呼吸运动相结合）提出了建议。本综述的初步工作表明，与术前和术后常规护理相比，运动干预与心肺运动能力改善、肌肉力量增加以及疲劳、术后并发症和住院时间减少有关。关于肺功能、生活质量和血气分析的结果各不相同且不一致。
为了实施适合接受手术治疗的NSCLC患者的运动干预，需要更多高质量的随机对照试验，并且有必要针对特定干预措施对结果的可行性、可接受性和有效性开展更多工作。
