Effect of postsurgical rehabilitation programmes in patients operated for lung cancer: A systematic review and meta-analysis.

Objective: To review the evidence concerning the effects of postoperative exercise interventions on exercise capacity and health-related quality of life following resection for non-small cell lung cancer, and to review whether different initiation times of exercise produce different effects on exercise capacity. Data sources: Comprehensive literature search of MEDLINE, Embase, CENTRAL, CINAHL and PEDro. Study selection: Randomized controlled trials examining the effects of exercise interventions were eligible for inclusion. Data extraction: Postoperative outcome measurements were extracted and the quality of evidence was graded using Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group. Data synthesis: Four randomized controlled trials were identified involving 262 participants. Shortterm follow-up (12-20 weeks) showed significantly higher exercise capacity and physical component of health-related quality of life in the intervention group (standardized mean difference (SMD) 0.48; 95% confidence interval (CI) 0.04-0.93) compared with the control group (SMD 0.50; 95% CI 0.19-0.82). There was no difference between the effect of late and early-initiated exercise intervention. Conclusion: Exercise has a small-to-moderate effect at short-term follow-up on exercise capacity and the physical component of health-related quality of life in patients operated for lung cancer. The long-term effects of exercise capacity are unknown. Early-initiated exercise programmes (2 weeks post-operation) did not show an effect on exercise capacity. These findings should be interpreted with caution.