Gravier Francis-Edouard, Smondack Pauline, Prieur Guillaume, Medrinal Clement, Combret Yann, Muir Jean-François, Baste Jean-Marc, Cuvelier Antoine, Boujibar Fairuz, Bonnevie Tristan
ADIR Association, University Hospital Centre Rouen, Rouen, France
UPRES EA 3830, Haute Normandie Research and Biomedical Innovation, Rouen University, Rouen, France.
Thorax. 2022 May;77(5):486-496. doi: 10.1136/thoraxjnl-2021-217242. Epub 2021 Aug 24.
Exercise training before lung resection for non-small cell lung cancer is believed to decrease postoperative complications (POC) by improving cardiorespiratory fitness. However, this intervention lacks a strong evidence base.
To assess the effectiveness of preoperative exercise training compared with usual care on POC and other secondary outcomes in patients with scheduled lung resection.
A systematic search of randomised trials was conducted by two authors. Meta-analysis was performed, and the effect of exercise training was estimated by risk ratios (RR) and mean differences, with their CIs. Clinical usefulness was estimated according to minimal important difference values (MID).
Fourteen studies involving 791 participants were included. Compared with usual care, exercise training reduced overall POC (10 studies, 617 participants, RR 0.58, 95% CI 0.45 to 0.75) and clinically relevant POC (4 studies, 302 participants, Clavien-Dindo score ≥2 RR 0.42, 95% CI 0.25 to 0.69). The estimate of the effect of exercise training on mortality was very imprecise (6 studies, 456 participants, RR 0.66, 95% CI 0.20 to 2.22). The main risks of bias were a lack of participant blinding and selective reporting. Exercise training appeared to improve exercise capacity, pulmonary function and also quality of life and depression, although the clinical usefulness of the changes was unclear. The quality of the evidence was graded for each outcome.
Preoperative exercise training leads to a worthwhile reduction in postoperative complications. These estimates were both accurate and large enough to make recommendations for clinical practice.
对于非小细胞肺癌患者，术前进行运动训练被认为可通过改善心肺功能来降低术后并发症（POC）。然而，这一干预措施缺乏有力的证据基础。
评估与常规护理相比，术前运动训练对计划接受肺切除术患者的术后并发症及其他次要结局的有效性。
两位作者对随机试验进行了系统检索。进行了荟萃分析，并通过风险比（RR）和均值差及其置信区间来估计运动训练的效果。根据最小重要差异值（MID）评估临床实用性。
纳入了14项研究，共791名参与者。与常规护理相比，运动训练降低了总体术后并发症（10项研究，617名参与者，RR 0.58，95%CI 0.45至0.75）和临床相关术后并发症（4项研究，302名参与者，Clavien-Dindo评分≥2，RR 0.42，95%CI 0.25至0.69）。运动训练对死亡率影响的估计非常不精确（6项研究，456名参与者，RR 0.66，95%CI 0.20至2.22）。主要的偏倚风险是缺乏参与者盲法和选择性报告。运动训练似乎改善了运动能力、肺功能，还改善了生活质量和抑郁状况，尽管这些变化的临床实用性尚不清楚。对每个结局的证据质量进行了分级。
术前运动训练可显著降低术后并发症。这些估计既准确又足够大，可为临床实践提供建议。
