Short-term Effects of Preoperative Exercise in Moderate-to-high Perioperative Risk Lung Cancer Patients

Official title

Short-term Effects of Preoperative Exercise in Moderate-to-high Perioperative Risk Lung Cancer Patients(PRE-EXELUCA): a Prospective Randomized Controlled Clinical Trial

Overview

The goal of this clinical trail is to compare the effects of preoperative exercise training of different intensities on short-term cardiorespiratory function and postoperative outcomes in patients scheduled for lung resections.

Detailed description

Guangdong Provincial People's Hospital will recruit a total of 100 consenting patients. Following informed consent and baseline testing, participants will be randomized into one of the three groups in a 2:2:1 ratio: MICT, HIIT, or usual care (UC).

Participants in the MICT and HIIT groups perform a total of 12 sessions of supervised exercise training, while participants randomized to the UC group receive no extra rehabilitation or physical activity. All participants are followed-up at the completion of the intervention period.Primary outcomes including cardiopulmonary exercise function and pulmonary function will be measured at diagnosis (lung cancer patients scheduled for surgical treatment) (V1), baseline (V2), and post-intervention (V3). The baseline assessment includes medical history and examination. To lessen the psychological burden of the study on the patients, the baseline examination phase could not be repeated if the examinations had been completed during the screening phase and the date of completion was within 7 days prior to enrollment. The patient's postoperative complications, chest tube removal time and hospital length of stay (LOS) will be recorded on the day of discharge (V4). Patient-reported outcomes (PROs) will be measured at baseline (V2), post-intervention (V3), day of discharge (V4), 1 month postoperative (V5), and 3 months postoperative (V6) with ongoing follow-up.

Interventions

• Behavioral moderate-intensity continuous training
  Each MICT session consists of 30 minutes of cycling. Workload will be gradually titrated from 50% to 60% peak WR throughout training to sustain a target RPE of 12-14 on the Borg 6-20 scale.
• Behavioral high-intensity interval training
  Each HIIT session consists of15 cycles, includes a 60-second high-intensity interval at 80-95% peak WR (target RPE 15-17) followed by a 60-second active recovery phase at 25% peak WR.

Primary outcome measures

• cardiopulmonary fitness [Time frame: baseline，2 weeks]

Secondary outcome measures (4)

• pulmonary function [Time frame: baseline，2 weeks]
• postoperative complications [Time frame: postoperative hospital stay, 1 month after surgery]
• postoperative mortality [Time frame: 3 months, 1 year, 3 years and 5 years postoperative]
• patient-reported outcomes [Time frame: baseline，2 weeks, 1 week postoperative, 1 month postoperative and 3 months postoperative]

Eligibility criteria

Inclusion criteria

• Age>18 years.
• Suspected or confirmed primary lung cancer with scheduled surgical treatment.
• Moderate-to-high perioperative risk, defined as FEV1<60% of predicted value (wedge) or ppo FEV1<60% of predicted value (lobectomy/segmentectomy) or VO2peak<20 ml/kg/ min.
• Sign informed consent and accept to comply with the requirements of the study protocol.
• Completion of a baseline Complete cardiopulmonary exercise testing (CPET).

Exclusion criteria

• Concurrent or previous history of other malignant tumors.
• Life expectancy less than 1 year.
• Dementia; infirmity; or inability to participate in sports (musculoskeletal limitations, namely, injuries, frailty, and weakness).
• Inability to maintain exercise training.
• Irregular vital signs (heart rate: < 40 or > 120 bpm at rest; blood pressure: systolic blood pressure > 200 mm Hg or diastolic pressure > 110 mm Hg; T: ≥ 38.5 or ≤ 36◦C; SpO2 ≤ 90%).
• Currently enrolling in any other clinical trials.
• Patient refusal.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Single blind

Primary purpose

Treatment

Study locations

China · 1 center

• Guangdong Provincial People's Hospital — Guangzhou

Publications

• Drevet G, Belaroussi Y, Duruisseaux M, Chalabreysse L, Grima R, Maury JM, Tronc F. Futile lobectomies following video-thoracoscopic exploration for indeterminate pulmonary nodules: a retrospective study. J Thorac Dis. 2022 Aug;14(8):2826-2834. doi: 10.21037/jtd-21-1789. PMID 36071782
• Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021 May;71(3):209-249. doi: 10.3322/caac.21660. Epub 2021 Feb 4. PMID 33538338
• Xia C, Dong X, Li H, Cao M, Sun D, He S, Yang F, Yan X, Zhang S, Li N, Chen W. Cancer statistics in China and United States, 2022: profiles, trends, and determinants. Chin Med J (Engl). 2022 Feb 9;135(5):584-590. doi: 10.1097/CM9.0000000000002108. PMID 35143424
• Howington JA, Blum MG, Chang AC, Balekian AA, Murthy SC. Treatment of stage I and II non-small cell lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013 May;143(5 Suppl):e278S-e313S. doi: 10.1378/chest.12-2359. PMID 23649443
• Brunelli A, Refai MA, Salati M, Sabbatini A, Morgan-Hughes NJ, Rocco G. Carbon monoxide lung diffusion capacity improves risk stratification in patients without airflow limitation: evidence for systematic measurement before lung resection. Eur J Cardiothorac Surg. 2006 Apr;29(4):567-70. doi: 10.1016/j.ejcts.2006.01.014. Epub 2006 Feb 14. PMID 16481190
• Brunelli A, Charloux A, Bolliger CT, Rocco G, Sculier JP, Varela G, Licker M, Ferguson MK, Faivre-Finn C, Huber RM, Clini EM, Win T, De Ruysscher D, Goldman L; European Respiratory Society and European Society of Thoracic Surgeons joint task force on fitness for radical therapy. ERS/ESTS clinical guidelines on fitness for radical therapy in lung cancer patients (surgery and chemo-radiotherapy). Eu PMID 19567600
• Berry MF, Villamizar-Ortiz NR, Tong BC, Burfeind WR Jr, Harpole DH, D'Amico TA, Onaitis MW. Pulmonary function tests do not predict pulmonary complications after thoracoscopic lobectomy. Ann Thorac Surg. 2010 Apr;89(4):1044-51; discussion 1051-2. doi: 10.1016/j.athoracsur.2009.12.065. PMID 20338305
• Licker M, Schnyder JM, Frey JG, Diaper J, Cartier V, Inan C, Robert J, Bridevaux PO, Tschopp JM. Impact of aerobic exercise capacity and procedure-related factors in lung cancer surgery. Eur Respir J. 2011 May;37(5):1189-98. doi: 10.1183/09031936.00069910. Epub 2010 Sep 16. PMID 20847073

Identifiers

NCT: NCT06215326 · KY2023-535

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗