Prehabilitation sessions can be provided more frequently in a shortened regimen with similar or better efficacy in people with non-small cell lung cancer: a randomised trial.

QUESTION

In people with non-small cell lung cancer, what is the effect of condensing 15 prehabilitation sessions into a 3-week regimen compared with a 5-week regimen?

DESIGN

Randomised controlled trial with concealed allocation, intention-to-treat analysis and blinded assessment of the primary outcome.

PARTICIPANTS

People with diagnosed or suspected non-small cell lung cancer and moderate-to-high risk of postoperative complications.

INTERVENTION

Fifteen supervised prehabilitation sessions delivered with either a dense regimen of five sessions/week for 3 weeks (experimental group) or a non-dense regimen of three sessions/week for 5 weeks (control group).

OUTCOME MEASURES

The primary outcome was the change in cardiorespiratory fitness measured by the V̇O in ml/kg/min. The secondary outcomes were the change in other variables of interest measured during cardiopulmonary exercise testing, non-invasive nutritional markers, quadriceps maximal voluntary isometric contractions, maximal inspiratory pressure, quality of life, adherence and postoperative complications.

RESULTS

Changes with the experimental regimen were similar to or better than changes with the control regimen for: V̇O (MD 1.2 ml/kg/min, 95% CI -0.1 to 2.6); V̇E/V̇CO slope (MD -3.6 points, 95% CI -8.7 to 1.5); and work rate at ventilatory threshold (MD 3.7 W, 95% CI -5.6 to 13.0). The two regimens had similar effects on: peak work rate (MD 1.3 W, 95% CI -6.4 to 9.0), V̇O at ventilatory threshold (MD 0.0 ml/kg/min, 95% CI -1.4 to 1.4); body mass index (MD -0.2 kg/m, 95% CI -0.5 to 0.1); and maximal inspiratory pressure (MD -0.7 cmHO, 95% CI -9.8 to 8.4). The relative effect was uncertain for quadriceps maximal voluntary isometric contractions, quality of life and complications.

CONCLUSION

Condensing prehabilitation sessions led to similar or better improvement in cardiorespiratory fitness and did not decrease adherence or increase adverse events. This could increase the number of patients who can be referred for prehabilitation, despite short presurgical periods.

TRIAL REGISTRATION

NCT03936764.