Effects of Preoperative High-Intensity Interval Training Combined With Team Empowerment Education in Lung Cancer Patients With Surgery

Background Cancer itself and surgery put a heavy burden on lung cancer patients, physiologically and psychologically. Enhancing self-efficacy during high-intensity interval training is essential for achieving the full benefit of pulmonary rehabilitation in lung cancer patients.This study aimed to explore the effects of high-intensity interval training combined with team empowerment education on patients with lung resection.This is a quasi-experimental trial with a pretest-posttest design. Participants were assigned to one of the 3 groups according to the order of admission: (1) combined intervention group, (2) intervention group, or (3) routine care group. The outcome measures included dyspnea, exercise capacity, exercise self-efficacy, anxiety, depression, postoperative indwelling time of thoracic drainage tube, and total in-hospital stay.Per-protocol results showed that dyspnea, exercise capacity, exercise self-efficacy, anxiety, and depression of the patients in the combined intervention group were significantly improved. However, no significant difference was observed in postoperative indwelling time of thoracic drainage tube or total in-hospital stay among the 3 groups.This hospital-based short-term high-intensity interval training combined with team empowerment education for lung cancer patients undergoing surgery was safe and feasible, indicating this program can be a promising strategy to manage perioperative symptoms.This study provides evidence supporting preoperative high-intensity interval training as a promising method to make the best use of preoperative time, thus improving adverse symptoms in lung cancer patients undergoing surgery, and also provides a new strategy to raise exercise self-efficacy and promote patients' rehabilitation.Lung cancer is the second most common cancer worldwide, taking up 11.4% cancer diagnoses and 18.0% cancer deaths.1 Non-small-cell lung cancer (NSCLC) accounts for 85% of new lung cancer diagnoses.2,3 Surgical resection remains the primary treatment for patients with NSCLC, especially stages I to IIIA.4 Lung cancer patients commonly experience a series of adverse symptoms because of lung lesions and malignant tumor consumption before surgery.5,6 It is worth noting that preoperative symptoms of lung cancer patients will significantly affect their postoperative recovery.7 Surgical trauma can lead to respiratory physiological dysfunction and lung tissue reduction, resulting in diminished respiratory function, secretion retention, and prolonged hospitalization.8 Moreover, because of the fear of surgery and the uncertainty about the disease prognosis, NSCLC resection patients are prone to experience anxiety and depression during hospitalization, which has an adverse impact on rehabilitation.9 Therefore, it is imperative to find a strategy to improve both physical and psychological outcomes of patients undergoing NSCLC surgery.Exercise training is the cornerstone of pulmonary rehabilitation, and traditional low- or moderate-intensity exercise training commonly used in clinical practice have certain effects in promoting rehabilitation of patients with lung cancer.10,11 However, rehabilitation is largely underused because of uncertainties regarding the exercise modalities and the limited preoperative period. Traditional exercise training requires long-period exercise, and it is difficult to achieve the expected rehabilitation effect without delaying operation or completing the established training program. Recent reviews suggested that preoperative, but not postoperative, exercise training may help improve functional capacity and the tolerance to surgery, and reduce postoperative length of hospital stay.12,13 High-intensity interval training (HIIT) may be a promising method to make the best use of not long preoperative time. It is an exercise training that is characterized by short high-intensity intervals of activity (no less than 70% of the maximum heart rate) and interspersed by recovery periods (between 10 seconds and several minutes).14 Some studies have showed that HIIT was superior to low- and moderate-intensity exercise.15 However, patients tend to be reluctant to conduct exercise due to the influence of traditional concepts, lack of exercise-related knowledge, and decline of their own physical functions. Therefore, enhancing their exercise self-efficacy is important in performing HIIT.Exercise self-efficacy refers to people's confidence in their ability to conduct specific physical activities under specific conditions.16 It has been proven that exercise self-efficacy is a predictor of physical activity. A higher level of self-efficacy expectations enables people to gain a greater sense of energy and feel more revitalized.17 Self-efficacy-enhancing pulmonary rehabilitation is strongly recommended.18,19 Empowerment education refers to the provision of disease-related knowledge and disease management supported by educators to help patients face up to their own diseases and enable patients to make behavior changes independently, thus improving their disease management ability and promoting rehabilitation.20 Team empowerment education (TEE) not only is a patient-centered education but also provides peer support to patients in the form of teams. Peer support can enable patients to provide their own successful experience to peers, and at the same time, they can also obtain psychological support from peers, both of which can encourage patients to manage their disease more confidently.21 Our TEE program is based on empowerment theory and comprises 5 parts (expression of emotion, problem identification, analysis of problems, goal setting and implementation, and evaluation). The strategies used in the 5 steps are as follows: the step of analysis of problems enabled patients to engage in effective discussions and improve their personal management experience; the step of goal setting and implementation made patients actively participate in the formulation of the rehabilitation plans, which allowed them to follow their own actual situation, personalize the designed pulmonary function rehabilitation plan, and have a high degree of practicality; and the step of evaluation facilitated patients to discuss their goal achievement with each other and share the factors of failure and effective experiences so that they can gain reflection, improve their problem-solving abilities, and make reasonable adjustments to their goals and plans. During the whole program, they gained peer support and were given the power to participate in developing a personalized rehabilitation plan. The program has been proven effective in patients with chronic obstructive pulmonary diseases.22,23To the best of our knowledge, previous research has mostly focused on cardiorespiratory fitness, and there have been few studies into the use of the HIIT by NSCLC resection patients that included the outcomes of psychological symptoms. Moreover, whether HIIT combined with TEE is more effective than HITT alone remains unclear. Background Cancer itself and surgery put a heavy burden on lung cancer patients, physiologically and psychologically. Enhancing self-efficacy during high-intensity interval training is essential for achieving the full benefit of pulmonary rehabilitation in lung cancer patients.This study aimed to explore the effects of high-intensity interval training combined with team empowerment education on patients with lung resection.This is a quasi-experimental trial with a pretest-posttest design. Participants were assigned to one of the 3 groups according to the order of admission: (1) combined intervention group, (2) intervention group, or (3) routine care group. The outcome measures included dyspnea, exercise capacity, exercise self-efficacy, anxiety, depression, postoperative indwelling time of thoracic drainage tube, and total in-hospital stay.Per-protocol results showed that dyspnea, exercise capacity, exercise self-efficacy, anxiety, and depression of the patients in the combined intervention group were significantly improved. However, no significant difference was observed in postoperative indwelling time of thoracic drainage tube or total in-hospital stay among the 3 groups.This hospital-based short-term high-intensity interval training combined with team empowerment education for lung cancer patients undergoing surgery was safe and feasible, indicating this program can be a promising strategy to manage perioperative symptoms.This study provides evidence supporting preoperative high-intensity interval training as a promising method to make the best use of preoperative time, thus improving adverse symptoms in lung cancer patients undergoing surgery, and also provides a new strategy to raise exercise self-efficacy and promote patients' rehabilitation.Lung cancer is the second most common cancer worldwide, taking up 11.4% cancer diagnoses and 18.0% cancer deaths.1 Non-small-cell lung cancer (NSCLC) accounts for 85% of new lung cancer diagnoses.2,3 Surgical resection remains the primary treatment for patients with NSCLC, especially stages I to IIIA.4 Lung cancer patients commonly experience a series of adverse symptoms because of lung lesions and malignant tumor consumption before surgery.5,6 It is worth noting that preoperative symptoms of lung cancer patients will significantly affect their postoperative recovery.7 Surgical trauma can lead to respiratory physiological dysfunction and lung tissue reduction, resulting in diminished respiratory function, secretion retention, and prolonged hospitalization.8 Moreover, because of the fear of surgery and the uncertainty about the disease prognosis, NSCLC resection patients are prone to experience anxiety and depression during hospitalization, which has an adverse impact on rehabilitation.9 Therefore, it is imperative to find a strategy to improve both physical and psychological outcomes of patients undergoing NSCLC surgery.Exercise training is the cornerstone of pulmonary rehabilitation, and traditional low- or moderate-intensity exercise training commonly used in clinical practice have certain effects in promoting rehabilitation of patients with lung cancer.10,11 However, rehabilitation is largely underused because of uncertainties regarding the exercise modalities and the limited preoperative period. Traditional exercise training requires long-period exercise, and it is difficult to achieve the expected rehabilitation effect without delaying operation or completing the established training program. Recent reviews suggested that preoperative, but not postoperative, exercise training may help improve functional capacity and the tolerance to surgery, and reduce postoperative length of hospital stay.12,13 High-intensity interval training (HIIT) may be a promising method to make the best use of not long preoperative time. It is an exercise training that is characterized by short high-intensity intervals of activity (no less than 70% of the maximum heart rate) and interspersed by recovery periods (between 10 seconds and several minutes).14 Some studies have showed that HIIT was superior to low- and moderate-intensity exercise.15 However, patients tend to be reluctant to conduct exercise due to the influence of traditional concepts, lack of exercise-related knowledge, and decline of their own physical functions. Therefore, enhancing their exercise self-efficacy is important in performing HIIT.Exercise self-efficacy refers to people's confidence in their ability to conduct specific physical activities under specific conditions.16 It has been proven that exercise self-efficacy is a predictor of physical activity. A higher level of self-efficacy expectations enables people to gain a greater sense of energy and feel more revitalized.17 Self-efficacy-enhancing pulmonary rehabilitation is strongly recommended.18,19 Empowerment education refers to the provision of disease-related knowledge and disease management supported by educators to help patients face up to their own diseases and enable patients to make behavior changes independently, thus improving their disease management ability and promoting rehabilitation.20 Team empowerment education (TEE) not only is a patient-centered education but also provides peer support to patients in the form of teams. Peer support can enable patients to provide their own successful experience to peers, and at the same time, they can also obtain psychological support from peers, both of which can encourage patients to manage their disease more confidently.21 Our TEE program is based on empowerment theory and comprises 5 parts (expression of emotion, problem identification, analysis of problems, goal setting and implementation, and evaluation). The strategies used in the 5 steps are as follows: the step of analysis of problems enabled patients to engage in effective discussions and improve their personal management experience; the step of goal setting and implementation made patients actively participate in the formulation of the rehabilitation plans, which allowed them to follow their own actual situation, personalize the designed pulmonary function rehabilitation plan, and have a high degree of practicality; and the step of evaluation facilitated patients to discuss their goal achievement with each other and share the factors of failure and effective experiences so that they can gain reflection, improve their problem-solving abilities, and make reasonable adjustments to their goals and plans. During the whole program, they gained peer support and were given the power to participate in developing a personalized rehabilitation plan. The program has been proven effective in patients with chronic obstructive pulmonary diseases.22,23To the best of our knowledge, previous research has mostly focused on cardiorespiratory fitness, and there have been few studies into the use of the HIIT by NSCLC resection patients that included the outcomes of psychological symptoms. Moreover, whether HIIT combined with TEE is more effective than HITT alone remains unclear. Background Cancer itself and surgery put a heavy burden on lung cancer patients, physiologically and psychologically. Enhancing self-efficacy during high-intensity interval training is essential for achieving the full benefit of pulmonary rehabilitation in lung cancer patients.This study aimed to explore the effects of high-intensity interval training combined with team empowerment education on patients with lung resection.This is a quasi-experimental trial with a pretest-posttest design. Participants were assigned to one of the 3 groups according to the order of admission: (1) combined intervention group, (2) intervention group, or (3) routine care group. The outcome measures included dyspnea, exercise capacity, exercise self-efficacy, anxiety, depression, postoperative indwelling time of thoracic drainage tube, and total in-hospital stay.Per-protocol results showed that dyspnea, exercise capacity, exercise self-efficacy, anxiety, and depression of the patients in the combined intervention group were significantly improved. However, no significant difference was observed in postoperative indwelling time of thoracic drainage tube or total in-hospital stay among the 3 groups.This hospital-based short-term high-intensity interval training combined with team empowerment education for lung cancer patients undergoing surgery was safe and feasible, indicating this program can be a promising strategy to manage perioperative symptoms.This study provides evidence supporting preoperative high-intensity interval training as a promising method to make the best use of preoperative time, thus improving adverse symptoms in lung cancer patients undergoing surgery, and also provides a new strategy to raise exercise self-efficacy and promote patients' rehabilitation.Lung cancer is the second most common cancer worldwide, taking up 11.4% cancer diagnoses and 18.0% cancer deaths.1 Non-small-cell lung cancer (NSCLC) accounts for 85% of new lung cancer diagnoses.2,3 Surgical resection remains the primary treatment for patients with NSCLC, especially stages I to IIIA.4 Lung cancer patients commonly experience a series of adverse symptoms because of lung lesions and malignant tumor consumption before surgery.5,6 It is worth noting that preoperative symptoms of lung cancer patients will significantly affect their postoperative recovery.7 Surgical trauma can lead to respiratory physiological dysfunction and lung tissue reduction, resulting in diminished respiratory function, secretion retention, and prolonged hospitalization.8 Moreover, because of the fear of surgery and the uncertainty about the disease prognosis, NSCLC resection patients are prone to experience anxiety and depression during hospitalization, which has an adverse impact on rehabilitation.9 Therefore, it is imperative to find a strategy to improve both physical and psychological outcomes of patients undergoing NSCLC surgery.Exercise training is the cornerstone of pulmonary rehabilitation, and traditional low- or moderate-intensity exercise training commonly used in clinical practice have certain effects in promoting rehabilitation of patients with lung cancer.10,11 However, rehabilitation is largely underused because of uncertainties regarding the exercise modalities and the limited preoperative period. Traditional exercise training requires long-period exercise, and it is difficult to achieve the expected rehabilitation effect without delaying operation or completing the established training program. Recent reviews suggested that preoperative, but not postoperative, exercise training may help improve functional capacity and the tolerance to surgery, and reduce postoperative length of hospital stay.12,13 High-intensity interval training (HIIT) may be a promising method to make the best use of not long preoperative time. It is an exercise training that is characterized by short high-intensity intervals of activity (no less than 70% of the maximum heart rate) and interspersed by recovery periods (between 10 seconds and several minutes).14 Some studies have showed that HIIT was superior to low- and moderate-intensity exercise.15 However, patients tend to be reluctant to conduct exercise due to the influence of traditional concepts, lack of exercise-related knowledge, and decline of their own physical functions. Therefore, enhancing their exercise self-efficacy is important in performing HIIT.Exercise self-efficacy refers to people's confidence in their ability to conduct specific physical activities under specific conditions.16 It has been proven that exercise self-efficacy is a predictor of physical activity. A higher level of self-efficacy expectations enables people to gain a greater sense of energy and feel more revitalized.17 Self-efficacy-enhancing pulmonary rehabilitation is strongly recommended.18,19 Empowerment education refers to the provision of disease-related knowledge and disease management supported by educators to help patients face up to their own diseases and enable patients to make behavior changes independently, thus improving their disease management ability and promoting rehabilitation.20 Team empowerment education (TEE) not only is a patient-centered education but also provides peer support to patients in the form of teams. Peer support can enable patients to provide their own successful experience to peers, and at the same time, they can also obtain psychological support from peers, both of which can encourage patients to manage their disease more confidently.21 Our TEE program is based on empowerment theory and comprises 5 parts (expression of emotion, problem identification, analysis of problems, goal setting and implementation, and evaluation). The strategies used in the 5 steps are as follows: the step of analysis of problems enabled patients to engage in effective discussions and improve their personal management experience; the step of goal setting and implementation made patients actively participate in the formulation of the rehabilitation plans, which allowed them to follow their own actual situation, personalize the designed pulmonary function rehabilitation plan, and have a high degree of practicality; and the step of evaluation facilitated patients to discuss their goal achievement with each other and share the factors of failure and effective experiences so that they can gain reflection, improve their problem-solving abilities, and make reasonable adjustments to their goals and plans. During the whole program, they gained peer support and were given the power to participate in developing a personalized rehabilitation plan. The program has been proven effective in patients with chronic obstructive pulmonary diseases.22,23To the best of our knowledge, previous research has mostly focused on cardiorespiratory fitness, and there have been few studies into the use of the HIIT by NSCLC resection patients that included the outcomes of psychological symptoms. Moreover, whether HIIT combined with TEE is more effective than HITT alone remains unclear. Background Cancer itself and surgery put a heavy burden on lung cancer patients, physiologically and psychologically. Enhancing self-efficacy during high-intensity interval training is essential for achieving the full benefit of pulmonary rehabilitation in lung cancer patients.This study aimed to explore the effects of high-intensity interval training combined with team empowerment education on patients with lung resection.This is a quasi-experimental trial with a pretest-posttest design. Participants were assigned to one of the 3 groups according to the order of admission: (1) combined intervention group, (2) intervention group, or (3) routine care group. The outcome measures included dyspnea, exercise capacity, exercise self-efficacy, anxiety, depression, postoperative indwelling time of thoracic drainage tube, and total in-hospital stay.Per-protocol results showed that dyspnea, exercise capacity, exercise self-efficacy, anxiety, and depression of the patients in the combined intervention group were significantly improved. However, no significant difference was observed in postoperative indwelling time of thoracic drainage tube or total in-hospital stay among the 3 groups.This hospital-based short-term high-intensity interval training combined with team empowerment education for lung cancer patients undergoing surgery was safe and feasible, indicating this program can be a promising strategy to manage perioperative symptoms.This study provides evidence supporting preoperative high-intensity interval training as a promising method to make the best use of preoperative time, thus improving adverse symptoms in lung cancer patients undergoing surgery, and also provides a new strategy to raise exercise self-efficacy and promote patients' rehabilitation.Lung cancer is the second most common cancer worldwide, taking up 11.4% cancer diagnoses and 18.0% cancer deaths.1 Non-small-cell lung cancer (NSCLC) accounts for 85% of new lung cancer diagnoses.2,3 Surgical resection remains the primary treatment for patients with NSCLC, especially stages I to IIIA.4 Lung cancer patients commonly experience a series of adverse symptoms because of lung lesions and malignant tumor consumption before surgery.5,6 It is worth noting that preoperative symptoms of lung cancer patients will significantly affect their postoperative recovery.7 Surgical trauma can lead to respiratory physiological dysfunction and lung tissue reduction, resulting in diminished respiratory function, secretion retention, and prolonged hospitalization.8 Moreover, because of the fear of surgery and the uncertainty about the disease prognosis, NSCLC resection patients are prone to experience anxiety and depression during hospitalization, which has an adverse impact on rehabilitation.9 Therefore, it is imperative to find a strategy to improve both physical and psychological outcomes of patients undergoing NSCLC surgery.Exercise training is the cornerstone of pulmonary rehabilitation, and traditional low- or moderate-intensity exercise training commonly used in clinical practice have certain effects in promoting rehabilitation of patients with lung cancer.10,11 However, rehabilitation is largely underused because of uncertainties regarding the exercise modalities and the limited preoperative period. Traditional exercise training requires long-period exercise, and it is difficult to achieve the expected rehabilitation effect without delaying operation or completing the established training program. Recent reviews suggested that preoperative, but not postoperative, exercise training may help improve functional capacity and the tolerance to surgery, and reduce postoperative length of hospital stay.12,13 High-intensity interval training (HIIT) may be a promising method to make the best use of not long preoperative time. It is an exercise training that is characterized by short high-intensity intervals of activity (no less than 70% of the maximum heart rate) and interspersed by recovery periods (between 10 seconds and several minutes).14 Some studies have showed that HIIT was superior to low- and moderate-intensity exercise.15 However, patients tend to be reluctant to conduct exercise due to the influence of traditional concepts, lack of exercise-related knowledge, and decline of their own physical functions. Therefore, enhancing their exercise self-efficacy is important in performing HIIT.Exercise self-efficacy refers to people's confidence in their ability to conduct specific physical activities under specific conditions.16 It has been proven that exercise self-efficacy is a predictor of physical activity. A higher level of self-efficacy expectations enables people to gain a greater sense of energy and feel more revitalized.17 Self-efficacy-enhancing pulmonary rehabilitation is strongly recommended.18,19 Empowerment education refers to the provision of disease-related knowledge and disease management supported by educators to help patients face up to their own diseases and enable patients to make behavior changes independently, thus improving their disease management ability and promoting rehabilitation.20 Team empowerment education (TEE) not only is a patient-centered education but also provides peer support to patients in the form of teams. Peer support can enable patients to provide their own successful experience to peers, and at the same time, they can also obtain psychological support from peers, both of which can encourage patients to manage their disease more confidently.21 Our TEE program is based on empowerment theory and comprises 5 parts (expression of emotion, problem identification, analysis of problems, goal setting and implementation, and evaluation). The strategies used in the 5 steps are as follows: the step of analysis of problems enabled patients to engage in effective discussions and improve their personal management experience; the step of goal setting and implementation made patients actively participate in the formulation of the rehabilitation plans, which allowed them to follow their own actual situation, personalize the designed pulmonary function rehabilitation plan, and have a high degree of practicality; and the step of evaluation facilitated patients to discuss their goal achievement with each other and share the factors of failure and effective experiences so that they can gain reflection, improve their problem-solving abilities, and make reasonable adjustments to their goals and plans. During the whole program, they gained peer support and were given the power to participate in developing a personalized rehabilitation plan. The program has been proven effective in patients with chronic obstructive pulmonary diseases.22,23To the best of our knowledge, previous research has mostly focused on cardiorespiratory fitness, and there have been few studies into the use of the HIIT by NSCLC resection patients that included the outcomes of psychological symptoms. Moreover, whether HIIT combined with TEE is more effective than HITT alone remains unclear. Background Cancer itself and surgery put a heavy burden on lung cancer patients, physiologically and psychologically. Enhancing self-efficacy during high-intensity interval training is essential for achieving the full benefit of pulmonary rehabilitation in lung cancer patients.This study aimed to explore the effects of high-intensity interval training combined with team empowerment education on patients with lung resection.This is a quasi-experimental trial with a pretest-posttest design. Participants were assigned to one of the 3 groups according to the order of admission: (1) combined intervention group, (2) intervention group, or (3) routine care group. The outcome measures included dyspnea, exercise capacity, exercise self-efficacy, anxiety, depression, postoperative indwelling time of thoracic drainage tube, and total in-hospital stay.Per-protocol results showed that dyspnea, exercise capacity, exercise self-efficacy, anxiety, and depression of the patients in the combined intervention group were significantly improved. However, no significant difference was observed in postoperative indwelling time of thoracic drainage tube or total in-hospital stay among the 3 groups.This hospital-based short-term high-intensity interval training combined with team empowerment education for lung cancer patients undergoing surgery was safe and feasible, indicating this program can be a promising strategy to manage perioperative symptoms.This study provides evidence supporting preoperative high-intensity interval training as a promising method to make the best use of preoperative time, thus improving adverse symptoms in lung cancer patients undergoing surgery, and also provides a new strategy to raise exercise self-efficacy and promote patients' rehabilitation.Lung cancer is the second most common cancer worldwide, taking up 11.4% cancer diagnoses and 18.0% cancer deaths.1 Non-small-cell lung cancer (NSCLC) accounts for 85% of new lung cancer diagnoses.2,3 Surgical resection remains the primary treatment for patients with NSCLC, especially stages I to IIIA.4 Lung cancer patients commonly experience a series of adverse symptoms because of lung lesions and malignant tumor consumption before surgery.5,6 It is worth noting that preoperative symptoms of lung cancer patients will significantly affect their postoperative recovery.7 Surgical trauma can lead to respiratory physiological dysfunction and lung tissue reduction, resulting in diminished respiratory function, secretion retention, and prolonged hospitalization.8 Moreover, because of the fear of surgery and the uncertainty about the disease prognosis, NSCLC resection patients are prone to experience anxiety and depression during hospitalization, which has an adverse impact on rehabilitation.9 Therefore, it is imperative to find a strategy to improve both physical and psychological outcomes of patients undergoing NSCLC surgery.Exercise training is the cornerstone of pulmonary rehabilitation, and traditional low- or moderate-intensity exercise training commonly used in clinical practice have certain effects in promoting rehabilitation of patients with lung cancer.10,11 However, rehabilitation is largely underused because of uncertainties regarding the exercise modalities and the limited preoperative period. Traditional exercise training requires long-period exercise, and it is difficult to achieve the expected rehabilitation effect without delaying operation or completing the established training program. Recent reviews suggested that preoperative, but not postoperative, exercise training may help improve functional capacity and the tolerance to surgery, and reduce postoperative length of hospital stay.12,13 High-intensity interval training (HIIT) may be a promising method to make the best use of not long preoperative time. It is an exercise training that is characterized by short high-intensity intervals of activity (no less than 70% of the maximum heart rate) and interspersed by recovery periods (between 10 seconds and several minutes).14 Some studies have showed that HIIT was superior to low- and moderate-intensity exercise.15 However, patients tend to be reluctant to conduct exercise due to the influence of traditional concepts, lack of exercise-related knowledge, and decline of their own physical functions. Therefore, enhancing their exercise self-efficacy is important in performing HIIT.Exercise self-efficacy refers to people's confidence in their ability to conduct specific physical activities under specific conditions.16 It has been proven that exercise self-efficacy is a predictor of physical activity. A higher level of self-efficacy expectations enables people to gain a greater sense of energy and feel more revitalized.17 Self-efficacy-enhancing pulmonary rehabilitation is strongly recommended.18,19 Empowerment education refers to the provision of disease-related knowledge and disease management supported by educators to help patients face up to their own diseases and enable patients to make behavior changes independently, thus improving their disease management ability and promoting rehabilitation.20 Team empowerment education (TEE) not only is a patient-centered education but also provides peer support to patients in the form of teams. Peer support can enable patients to provide their own successful experience to peers, and at the same time, they can also obtain psychological support from peers, both of which can encourage patients to manage their disease more confidently.21 Our TEE program is based on empowerment theory and comprises 5 parts (expression of emotion, problem identification, analysis of problems, goal setting and implementation, and evaluation). The strategies used in the 5 steps are as follows: the step of analysis of problems enabled patients to engage in effective discussions and improve their personal management experience; the step of goal setting and implementation made patients actively participate in the formulation of the rehabilitation plans, which allowed them to follow their own actual situation, personalize the designed pulmonary function rehabilitation plan, and have a high degree of practicality; and the step of evaluation facilitated patients to discuss their goal achievement with each other and share the factors of failure and effective experiences so that they can gain reflection, improve their problem-solving abilities, and make reasonable adjustments to their goals and plans. During the whole program, they gained peer support and were given the power to participate in developing a personalized rehabilitation plan. The program has been proven effective in patients with chronic obstructive pulmonary diseases.22,23To the best of our knowledge, previous research has mostly focused on cardiorespiratory fitness, and there have been few studies into the use of the HIIT by NSCLC resection patients that included the outcomes of psychological symptoms. Moreover, whether HIIT combined with TEE is more effective than HITT alone remains unclear. Background Cancer itself and surgery put a heavy burden on lung cancer patients, physiologically and psychologically. Enhancing self-efficacy during high-intensity interval training is essential for achieving the full benefit of pulmonary rehabilitation in lung cancer patients.This study aimed to explore the effects of high-intensity interval training combined with team empowerment education on patients with lung resection.This is a quasi-experimental trial with a pretest-posttest design. Participants were assigned to one of the 3 groups according to the order of admission: (1) combined intervention group, (2) intervention group, or (3) routine care group. The outcome measures included dyspnea, exercise capacity, exercise self-efficacy, anxiety, depression, postoperative indwelling time of thoracic drainage tube, and total in-hospital stay.Per-protocol results showed that dyspnea, exercise capacity, exercise self-efficacy, anxiety, and depression of the patients in the combined intervention group were significantly improved. However, no significant difference was observed in postoperative indwelling time of thoracic drainage tube or total in-hospital stay among the 3 groups.This hospital-based short-term high-intensity interval training combined with team empowerment education for lung cancer patients undergoing surgery was safe and feasible, indicating this program can be a promising strategy to manage perioperative symptoms.This study provides evidence supporting preoperative high-intensity interval training as a promising method to make the best use of preoperative time, thus improving adverse symptoms in lung cancer patients undergoing surgery, and also provides a new strategy to raise exercise self-efficacy and promote patients' rehabilitation.Lung cancer is the second most common cancer worldwide, taking up 11.4% cancer diagnoses and 18.0% cancer deaths.1 Non-small-cell lung cancer (NSCLC) accounts for 85% of new lung cancer diagnoses.2,3 Surgical resection remains the primary treatment for patients with NSCLC, especially stages I to IIIA.4 Lung cancer patients commonly experience a series of adverse symptoms because of lung lesions and malignant tumor consumption before surgery.5,6 It is worth noting that preoperative symptoms of lung cancer patients will significantly affect their postoperative recovery.7 Surgical trauma can lead to respiratory physiological dysfunction and lung tissue reduction, resulting in diminished respiratory function, secretion retention, and prolonged hospitalization.8 Moreover, because of the fear of surgery and the uncertainty about the disease prognosis, NSCLC resection patients are prone to experience anxiety and depression during hospitalization, which has an adverse impact on rehabilitation.9 Therefore, it is imperative to find a strategy to improve both physical and psychological outcomes of patients undergoing NSCLC surgery.Exercise training is the cornerstone of pulmonary rehabilitation, and traditional low- or moderate-intensity exercise training commonly used in clinical practice have certain effects in promoting rehabilitation of patients with lung cancer.10,11 However, rehabilitation is largely underused because of uncertainties regarding the exercise modalities and the limited preoperative period. Traditional exercise training requires long-period exercise, and it is difficult to achieve the expected rehabilitation effect without delaying operation or completing the established training program. Recent reviews suggested that preoperative, but not postoperative, exercise training may help improve functional capacity and the tolerance to surgery, and reduce postoperative length of hospital stay.12,13 High-intensity interval training (HIIT) may be a promising method to make the best use of not long preoperative time. It is an exercise training that is characterized by short high-intensity intervals of activity (no less than 70% of the maximum heart rate) and interspersed by recovery periods (between 10 seconds and several minutes).14 Some studies have showed that HIIT was superior to low- and moderate-intensity exercise.15 However, patients tend to be reluctant to conduct exercise due to the influence of traditional concepts, lack of exercise-related knowledge, and decline of their own physical functions. Therefore, enhancing their exercise self-efficacy is important in performing HIIT.Exercise self-efficacy refers to people's confidence in their ability to conduct specific physical activities under specific conditions.16 It has been proven that exercise self-efficacy is a predictor of physical activity. A higher level of self-efficacy expectations enables people to gain a greater sense of energy and feel more revitalized.17 Self-efficacy-enhancing pulmonary rehabilitation is strongly recommended.18,19 Empowerment education refers to the provision of disease-related knowledge and disease management supported by educators to help patients face up to their own diseases and enable patients to make behavior changes independently, thus improving their disease management ability and promoting rehabilitation.20 Team empowerment education (TEE) not only is a patient-centered education but also provides peer support to patients in the form of teams. Peer support can enable patients to provide their own successful experience to peers, and at the same time, they can also obtain psychological support from peers, both of which can encourage patients to manage their disease more confidently.21 Our TEE program is based on empowerment theory and comprises 5 parts (expression of emotion, problem identification, analysis of problems, goal setting and implementation, and evaluation). The strategies used in the 5 steps are as follows: the step of analysis of problems enabled patients to engage in effective discussions and improve their personal management experience; the step of goal setting and implementation made patients actively participate in the formulation of the rehabilitation plans, which allowed them to follow their own actual situation, personalize the designed pulmonary function rehabilitation plan, and have a high degree of practicality; and the step of evaluation facilitated patients to discuss their goal achievement with each other and share the factors of failure and effective experiences so that they can gain reflection, improve their problem-solving abilities, and make reasonable adjustments to their goals and plans. During the whole program, they gained peer support and were given the power to participate in developing a personalized rehabilitation plan. The program has been proven effective in patients with chronic obstructive pulmonary diseases.22,23To the best of our knowledge, previous research has mostly focused on cardiorespiratory fitness, and there have been few studies into the use of the HIIT by NSCLC resection patients that included the outcomes of psychological symptoms. Moreover, whether HIIT combined with TEE is more effective than HITT alone remains unclear. Background Cancer itself and surgery put a heavy burden on lung cancer patients, physiologically and psychologically. Enhancing self-efficacy during high-intensity interval training is essential for achieving the full benefit of pulmonary rehabilitation in lung cancer patients.This study aimed to explore the effects of high-intensity interval training combined with team empowerment education on patients with lung resection.This is a quasi-experimental trial with a pretest-posttest design. Participants were assigned to one of the 3 groups according to the order of admission: (1) combined intervention group, (2) intervention group, or (3) routine care group. The outcome measures included dyspnea, exercise capacity, exercise self-efficacy, anxiety, depression, postoperative indwelling time of thoracic drainage tube, and total in-hospital stay.Per-protocol results showed that dyspnea, exercise capacity, exercise self-efficacy, anxiety, and depression of the patients in the combined intervention group were significantly improved. However, no significant difference was observed in postoperative indwelling time of thoracic drainage tube or total in-hospital stay among the 3 groups.This hospital-based short-term high-intensity interval training combined with team empowerment education for lung cancer patients undergoing surgery was safe and feasible, indicating this program can be a promising strategy to manage perioperative symptoms.This study provides evidence supporting preoperative high-intensity interval training as a promising method to make the best use of preoperative time, thus improving adverse symptoms in lung cancer patients undergoing surgery, and also provides a new strategy to raise exercise self-efficacy and promote patients' rehabilitation.Lung cancer is the second most common cancer worldwide, taking up 11.4% cancer diagnoses and 18.0% cancer deaths.1 Non-small-cell lung cancer (NSCLC) accounts for 85% of new lung cancer diagnoses.2,3 Surgical resection remains the primary treatment for patients with NSCLC, especially stages I to IIIA.4 Lung cancer patients commonly experience a series of adverse symptoms because of lung lesions and malignant tumor consumption before surgery.5,6 It is worth noting that preoperative symptoms of lung cancer patients will significantly affect their postoperative recovery.7 Surgical trauma can lead to respiratory physiological dysfunction and lung tissue reduction, resulting in diminished respiratory function, secretion retention, and prolonged hospitalization.8 Moreover, because of the fear of surgery and the uncertainty about the disease prognosis, NSCLC resection patients are prone to experience anxiety and depression during hospitalization, which has an adverse impact on rehabilitation.9 Therefore, it is imperative to find a strategy to improve both physical and psychological outcomes of patients undergoing NSCLC surgery.Exercise training is the cornerstone of pulmonary rehabilitation, and traditional low- or moderate-intensity exercise training commonly used in clinical practice have certain effects in promoting rehabilitation of patients with lung cancer.10,11 However, rehabilitation is largely underused because of uncertainties regarding the exercise modalities and the limited preoperative period. Traditional exercise training requires long-period exercise, and it is difficult to achieve the expected rehabilitation effect without delaying operation or completing the established training program. Recent reviews suggested that preoperative, but not postoperative, exercise training may help improve functional capacity and the tolerance to surgery, and reduce postoperative length of hospital stay.12,13 High-intensity interval training (HIIT) may be a promising method to make the best use of not long preoperative time. It is an exercise training that is characterized by short high-intensity intervals of activity (no less than 70% of the maximum heart rate) and interspersed by recovery periods (between 10 seconds and several minutes).14 Some studies have showed that HIIT was superior to low- and moderate-intensity exercise.15 However, patients tend to be reluctant to conduct exercise due to the influence of traditional concepts, lack of exercise-related knowledge, and decline of their own physical functions. Therefore, enhancing their exercise self-efficacy is important in performing HIIT.Exercise self-efficacy refers to people's confidence in their ability to conduct specific physical activities under specific conditions.16 It has been proven that exercise self-efficacy is a predictor of physical activity. A higher level of self-efficacy expectations enables people to gain a greater sense of energy and feel more revitalized.17 Self-efficacy-enhancing pulmonary rehabilitation is strongly recommended.18,19 Empowerment education refers to the provision of disease-related knowledge and disease management supported by educators to help patients face up to their own diseases and enable patients to make behavior changes independently, thus improving their disease management ability and promoting rehabilitation.20 Team empowerment education (TEE) not only is a patient-centered education but also provides peer support to patients in the form of teams. Peer support can enable patients to provide their own successful experience to peers, and at the same time, they can also obtain psychological support from peers, both of which can encourage patients to manage their disease more confidently.21 Our TEE program is based on empowerment theory and comprises 5 parts (expression of emotion, problem identification, analysis of problems, goal setting and implementation, and evaluation). The strategies used in the 5 steps are as follows: the step of analysis of problems enabled patients to engage in effective discussions and improve their personal management experience; the step of goal setting and implementation made patients actively participate in the formulation of the rehabilitation plans, which allowed them to follow their own actual situation, personalize the designed pulmonary function rehabilitation plan, and have a high degree of practicality; and the step of evaluation facilitated patients to discuss their goal achievement with each other and share the factors of failure and effective experiences so that they can gain reflection, improve their problem-solving abilities, and make reasonable adjustments to their goals and plans. During the whole program, they gained peer support and were given the power to participate in developing a personalized rehabilitation plan. The program has been proven effective in patients with chronic obstructive pulmonary diseases.22,23To the best of our knowledge, previous research has mostly focused on cardiorespiratory fitness, and there have been few studies into the use of the HIIT by NSCLC resection patients that included the outcomes of psychological symptoms. Moreover, whether HIIT combined with TEE is more effective than HITT alone remains unclear. Background Cancer itself and surgery put a heavy burden on lung cancer patients, physiologically and psychologically. Enhancing self-efficacy during high-intensity interval training is essential for achieving the full benefit of pulmonary rehabilitation in lung cancer patients.This study aimed to explore the effects of high-intensity interval training combined with team empowerment education on patients with lung resection.This is a quasi-experimental trial with a pretest-posttest design. Participants were assigned to one of the 3 groups according to the order of admission: (1) combined intervention group, (2) intervention group, or (3) routine care group. The outcome measures included dyspnea, exercise capacity, exercise self-efficacy, anxiety, depression, postoperative indwelling time of thoracic drainage tube, and total in-hospital stay.Per-protocol results showed that dyspnea, exercise capacity, exercise self-efficacy, anxiety, and depression of the patients in the combined intervention group were significantly improved. However, no significant difference was observed in postoperative indwelling time of thoracic drainage tube or total in-hospital stay among the 3 groups.This hospital-based short-term high-intensity interval training combined with team empowerment education for lung cancer patients undergoing surgery was safe and feasible, indicating this program can be a promising strategy to manage perioperative symptoms.This study provides evidence supporting preoperative high-intensity interval training as a promising method to make the best use of preoperative time, thus improving adverse symptoms in lung cancer patients undergoing surgery, and also provides a new strategy to raise exercise self-efficacy and promote patients' rehabilitation.Lung cancer is the second most common cancer worldwide, taking up 11.4% cancer diagnoses and 18.0% cancer deaths.1 Non-small-cell lung cancer (NSCLC) accounts for 85% of new lung cancer diagnoses.2,3 Surgical resection remains the primary treatment for patients with NSCLC, especially stages I to IIIA.4 Lung cancer patients commonly experience a series of adverse symptoms because of lung lesions and malignant tumor consumption before surgery.5,6 It is worth noting that preoperative symptoms of lung cancer patients will significantly affect their postoperative recovery.7 Surgical trauma can lead to respiratory physiological dysfunction and lung tissue reduction, resulting in diminished respiratory function, secretion retention, and prolonged hospitalization.8 Moreover, because of the fear of surgery and the uncertainty about the disease prognosis, NSCLC resection patients are prone to experience anxiety and depression during hospitalization, which has an adverse impact on rehabilitation.9 Therefore, it is imperative to find a strategy to improve both physical and psychological outcomes of patients undergoing NSCLC surgery.Exercise training is the cornerstone of pulmonary rehabilitation, and traditional low- or moderate-intensity exercise training commonly used in clinical practice have certain effects in promoting rehabilitation of patients with lung cancer.10,11 However, rehabilitation is largely underused because of uncertainties regarding the exercise modalities and the limited preoperative period. Traditional exercise training requires long-period exercise, and it is difficult to achieve the expected rehabilitation effect without delaying operation or completing the established training program. Recent reviews suggested that preoperative, but not postoperative, exercise training may help improve functional capacity and the tolerance to surgery, and reduce postoperative length of hospital stay.12,13 High-intensity interval training (HIIT) may be a promising method to make the best use of not long preoperative time. It is an exercise training that is characterized by short high-intensity intervals of activity (no less than 70% of the maximum heart rate) and interspersed by recovery periods (between 10 seconds and several minutes).14 Some studies have showed that HIIT was superior to low- and moderate-intensity exercise.15 However, patients tend to be reluctant to conduct exercise due to the influence of traditional concepts, lack of exercise-related knowledge, and decline of their own physical functions. Therefore, enhancing their exercise self-efficacy is important in performing HIIT.Exercise self-efficacy refers to people's confidence in their ability to conduct specific physical activities under specific conditions.16 It has been proven that exercise self-efficacy is a predictor of physical activity. A higher level of self-efficacy expectations enables people to gain a greater sense of energy and feel more revitalized.17 Self-efficacy-enhancing pulmonary rehabilitation is strongly recommended.18,19 Empowerment education refers to the provision of disease-related knowledge and disease management supported by educators to help patients face up to their own diseases and enable patients to make behavior changes independently, thus improving their disease management ability and promoting rehabilitation.20 Team empowerment education (TEE) not only is a patient-centered education but also provides peer support to patients in the form of teams. Peer support can enable patients to provide their own successful experience to peers, and at the same time, they can also obtain psychological support from peers, both of which can encourage patients to manage their disease more confidently.21 Our TEE program is based on empowerment theory and comprises 5 parts (expression of emotion, problem identification, analysis of problems, goal setting and implementation, and evaluation). The strategies used in the 5 steps are as follows: the step of analysis of problems enabled patients to engage in effective discussions and improve their personal management experience; the step of goal setting and implementation made patients actively participate in the formulation of the rehabilitation plans, which allowed them to follow their own actual situation, personalize the designed pulmonary function rehabilitation plan, and have a high degree of practicality; and the step of evaluation facilitated patients to discuss their goal achievement with each other and share the factors of failure and effective experiences so that they can gain reflection, improve their problem-solving abilities, and make reasonable adjustments to their goals and plans. During the whole program, they gained peer support and were given the power to participate in developing a personalized rehabilitation plan. The program has been proven effective in patients with chronic obstructive pulmonary diseases.22,23To the best of our knowledge, previous research has mostly focused on cardiorespiratory fitness, and there have been few studies into the use of the HIIT by NSCLC resection patients that included the outcomes of psychological symptoms. Moreover, whether HIIT combined with TEE is more effective than HITT alone remains unclear. Background Cancer itself and surgery put a heavy burden on lung cancer patients, physiologically and psychologically. Enhancing self-efficacy during high-intensity interval training is essential for achieving the full benefit of pulmonary rehabilitation in lung cancer patients.This study aimed to explore the effects of high-intensity interval training combined with team empowerment education on patients with lung resection.This is a quasi-experimental trial with a pretest-posttest design. Participants were assigned to one of the 3 groups according to the order of admission: (1) combined intervention group, (2) intervention group, or (3) routine care group. The outcome measures included dyspnea, exercise capacity, exercise self-efficacy, anxiety, depression, postoperative indwelling time of thoracic drainage tube, and total in-hospital stay.Per-protocol results showed that dyspnea, exercise capacity, exercise self-efficacy, anxiety, and depression of the patients in the combined intervention group were significantly improved. However, no significant difference was observed in postoperative indwelling time of thoracic drainage tube or total in-hospital stay among the 3 groups.This hospital-based short-term high-intensity interval training combined with team empowerment education for lung cancer patients undergoing surgery was safe and feasible, indicating this program can be a promising strategy to manage perioperative symptoms.This study provides evidence supporting preoperative high-intensity interval training as a promising method to make the best use of preoperative time, thus improving adverse symptoms in lung cancer patients undergoing surgery, and also provides a new strategy to raise exercise self-efficacy and promote patients' rehabilitation.Lung cancer is the second most common cancer worldwide, taking up 11.4% cancer diagnoses and 18.0% cancer deaths.1 Non-small-cell lung cancer (NSCLC) accounts for 85% of new lung cancer diagnoses.2,3 Surgical resection remains the primary treatment for patients with NSCLC, especially stages I to IIIA.4 Lung cancer patients commonly experience a series of adverse symptoms because of lung lesions and malignant tumor consumption before surgery.5,6 It is worth noting that preoperative symptoms of lung cancer patients will significantly affect their postoperative recovery.7 Surgical trauma can lead to respiratory physiological dysfunction and lung tissue reduction, resulting in diminished respiratory function, secretion retention, and prolonged hospitalization.8 Moreover, because of the fear of surgery and the uncertainty about the disease prognosis, NSCLC resection patients are prone to experience anxiety and depression during hospitalization, which has an adverse impact on rehabilitation.9 Therefore, it is imperative to find a strategy to improve both physical and psychological outcomes of patients undergoing NSCLC surgery.Exercise training is the cornerstone of pulmonary rehabilitation, and traditional low- or moderate-intensity exercise training commonly used in clinical practice have certain effects in promoting rehabilitation of patients with lung cancer.10,11 However, rehabilitation is largely underused because of uncertainties regarding the exercise modalities and the limited preoperative period. Traditional exercise training requires long-period exercise, and it is difficult to achieve the expected rehabilitation effect without delaying operation or completing the established training program. Recent reviews suggested that preoperative, but not postoperative, exercise training may help improve functional capacity and the tolerance to surgery, and reduce postoperative length of hospital stay.12,13 High-intensity interval training (HIIT) may be a promising method to make the best use of not long preoperative time. It is an exercise training that is characterized by short high-intensity intervals of activity (no less than 70% of the maximum heart rate) and interspersed by recovery periods (between 10 seconds and several minutes).14 Some studies have showed that HIIT was superior to low- and moderate-intensity exercise.15 However, patients tend to be reluctant to conduct exercise due to the influence of traditional concepts, lack of exercise-related knowledge, and decline of their own physical functions. Therefore, enhancing their exercise self-efficacy is important in performing HIIT.Exercise self-efficacy refers to people's confidence in their ability to conduct specific physical activities under specific conditions.16 It has been proven that exercise self-efficacy is a predictor of physical activity. A higher level of self-efficacy expectations enables people to gain a greater sense of energy and feel more revitalized.17 Self-efficacy-enhancing pulmonary rehabilitation is strongly recommended.18,19 Empowerment education refers to the provision of disease-related knowledge and disease management supported by educators to help patients face up to their own diseases and enable patients to make behavior changes independently, thus improving their disease management ability and promoting rehabilitation.20 Team empowerment education (TEE) not only is a patient-centered education but also provides peer support to patients in the form of teams. Peer support can enable patients to provide their own successful experience to peers, and at the same time, they can also obtain psychological support from peers, both of which can encourage patients to manage their disease more confidently.21 Our TEE program is based on empowerment theory and comprises 5 parts (expression of emotion, problem identification, analysis of problems, goal setting and implementation, and evaluation). The strategies used in the 5 steps are as follows: the step of analysis of problems enabled patients to engage in effective discussions and improve their personal management experience; the step of goal setting and implementation made patients actively participate in the formulation of the rehabilitation plans, which allowed them to follow their own actual situation, personalize the designed pulmonary function rehabilitation plan, and have a high degree of practicality; and the step of evaluation facilitated patients to discuss their goal achievement with each other and share the factors of failure and effective experiences so that they can gain reflection, improve their problem-solving abilities, and make reasonable adjustments to their goals and plans. During the whole program, they gained peer support and were given the power to participate in developing a personalized rehabilitation plan. The program has been proven effective in patients with chronic obstructive pulmonary diseases.22,23To the best of our knowledge, previous research has mostly focused on cardiorespiratory fitness, and there have been few studies into the use of the HIIT by NSCLC resection patients that included the outcomes of psychological symptoms. Moreover, whether HIIT combined with TEE is more effective than HITT alone remains unclear. Background Cancer itself and surgery put a heavy burden on lung cancer patients, physiologically and psychologically. Enhancing self-efficacy during high-intensity interval training is essential for achieving the full benefit of pulmonary rehabilitation in lung cancer patients.This study aimed to explore the effects of high-intensity interval training combined with team empowerment education on patients with lung resection.This is a quasi-experimental trial with a pretest-posttest design. Participants were assigned to one of the 3 groups according to the order of admission: (1) combined intervention group, (2) intervention group, or (3) routine care group. The outcome measures included dyspnea, exercise capacity, exercise self-efficacy, anxiety, depression, postoperative indwelling time of thoracic drainage tube, and total in-hospital stay.Per-protocol results showed that dyspnea, exercise capacity, exercise self-efficacy, anxiety, and depression of the patients in the combined intervention group were significantly improved. However, no significant difference was observed in postoperative indwelling time of thoracic drainage tube or total in-hospital stay among the 3 groups.This hospital-based short-term high-intensity interval training combined with team empowerment education for lung cancer patients undergoing surgery was safe and feasible, indicating this program can be a promising strategy to manage perioperative symptoms.This study provides evidence supporting preoperative high-intensity interval training as a promising method to make the best use of preoperative time, thus improving adverse symptoms in lung cancer patients undergoing surgery, and also provides a new strategy to raise exercise self-efficacy and promote patients' rehabilitation.Lung cancer is the second most common cancer worldwide, taking up 11.4% cancer diagnoses and 18.0% cancer deaths.1 Non-small-cell lung cancer (NSCLC) accounts for 85% of new lung cancer diagnoses.2,3 Surgical resection remains the primary treatment for patients with NSCLC, especially stages I to IIIA.4 Lung cancer patients commonly experience a series of adverse symptoms because of lung lesions and malignant tumor consumption before surgery.5,6 It is worth noting that preoperative symptoms of lung cancer patients will significantly affect their postoperative recovery.7 Surgical trauma can lead to respiratory physiological dysfunction and lung tissue reduction, resulting in diminished respiratory function, secretion retention, and prolonged hospitalization.8 Moreover, because of the fear of surgery and the uncertainty about the disease prognosis, NSCLC resection patients are prone to experience anxiety and depression during hospitalization, which has an adverse impact on rehabilitation.9 Therefore, it is imperative to find a strategy to improve both physical and psychological outcomes of patients undergoing NSCLC surgery.Exercise training is the cornerstone of pulmonary rehabilitation, and traditional low- or moderate-intensity exercise training commonly used in clinical practice have certain effects in promoting rehabilitation of patients with lung cancer.10,11 However, rehabilitation is largely underused because of uncertainties regarding the exercise modalities and the limited preoperative period. Traditional exercise training requires long-period exercise, and it is difficult to achieve the expected rehabilitation effect without delaying operation or completing the established training program. Recent reviews suggested that preoperative, but not postoperative, exercise training may help improve functional capacity and the tolerance to surgery, and reduce postoperative length of hospital stay.12,13 High-intensity interval training (HIIT) may be a promising method to make the best use of not long preoperative time. It is an exercise training that is characterized by short high-intensity intervals of activity (no less than 70% of the maximum heart rate) and interspersed by recovery periods (between 10 seconds and several minutes).14 Some studies have showed that HIIT was superior to low- and moderate-intensity exercise.15 However, patients tend to be reluctant to conduct exercise due to the influence of traditional concepts, lack of exercise-related knowledge, and decline of their own physical functions. Therefore, enhancing their exercise self-efficacy is important in performing HIIT.Exercise self-efficacy refers to people's confidence in their ability to conduct specific physical activities under specific conditions.16 It has been proven that exercise self-efficacy is a predictor of physical activity. A higher level of self-efficacy expectations enables people to gain a greater sense of energy and feel more revitalized.17 Self-efficacy-enhancing pulmonary rehabilitation is strongly recommended.18,19 Empowerment education refers to the provision of disease-related knowledge and disease management supported by educators to help patients face up to their own diseases and enable patients to make behavior changes independently, thus improving their disease management ability and promoting rehabilitation.20 Team empowerment education (TEE) not only is a patient-centered education but also provides peer support to patients in the form of teams. Peer support can enable patients to provide their own successful experience to peers, and at the same time, they can also obtain psychological support from peers, both of which can encourage patients to manage their disease more confidently.21 Our TEE program is based on empowerment theory and comprises 5 parts (expression of emotion, problem identification, analysis of problems, goal setting and implementation, and evaluation). The strategies used in the 5 steps are as follows: the step of analysis of problems enabled patients to engage in effective discussions and improve their personal management experience; the step of goal setting and implementation made patients actively participate in the formulation of the rehabilitation plans, which allowed them to follow their own actual situation, personalize the designed pulmonary function rehabilitation plan, and have a high degree of practicality; and the step of evaluation facilitated patients to discuss their goal achievement with each other and share the factors of failure and effective experiences so that they can gain reflection, improve their problem-solving abilities, and make reasonable adjustments to their goals and plans. During the whole program, they gained peer support and were given the power to participate in developing a personalized rehabilitation plan. The program has been proven effective in patients with chronic obstructive pulmonary diseases.22,23To the best of our knowledge, previous research has mostly focused on cardiorespiratory fitness, and there have been few studies into the use of the HIIT by NSCLC resection patients that included the outcomes of psychological symptoms. Moreover, whether HIIT combined with TEE is more effective than HITT alone remains unclear. Background Cancer itself and surgery put a heavy burden on lung cancer patients, physiologically and psychologically. Enhancing self-efficacy during high-intensity interval training is essential for achieving the full benefit of pulmonary rehabilitation in lung cancer patients.This study aimed to explore the effects of high-intensity interval training combined with team empowerment education on patients with lung resection.This is a quasi-experimental trial with a pretest-posttest design. Participants were assigned to one of the 3 groups according to the order of admission: (1) combined intervention group, (2) intervention group, or (3) routine care group. The outcome measures included dyspnea, exercise capacity, exercise self-efficacy, anxiety, depression, postoperative indwelling time of thoracic drainage tube, and total in-hospital stay.Per-protocol results showed that dyspnea, exercise capacity, exercise self-efficacy, anxiety, and depression of the patients in the combined intervention group were significantly improved. However, no significant difference was observed in postoperative indwelling time of thoracic drainage tube or total in-hospital stay among the 3 groups.This hospital-based short-term high-intensity interval training combined with team empowerment education for lung cancer patients undergoing surgery was safe and feasible, indicating this program can be a promising strategy to manage perioperative symptoms.This study provides evidence supporting preoperative high-intensity interval training as a promising method to make the best use of preoperative time, thus improving adverse symptoms in lung cancer patients undergoing surgery, and also provides a new strategy to raise exercise self-efficacy and promote patients' rehabilitation.Lung cancer is the second most common cancer worldwide, taking up 11.4% cancer diagnoses and 18.0% cancer deaths.1 Non-small-cell lung cancer (NSCLC) accounts for 85% of new lung cancer diagnoses.2,3 Surgical resection remains the primary treatment for patients with NSCLC, especially stages I to IIIA.4 Lung cancer patients commonly experience a series of adverse symptoms because of lung lesions and malignant tumor consumption before surgery.5,6 It is worth noting that preoperative symptoms of lung cancer patients will significantly affect their postoperative recovery.7 Surgical trauma can lead to respiratory physiological dysfunction and lung tissue reduction, resulting in diminished respiratory function, secretion retention, and prolonged hospitalization.8 Moreover, because of the fear of surgery and the uncertainty about the disease prognosis, NSCLC resection patients are prone to experience anxiety and depression during hospitalization, which has an adverse impact on rehabilitation.9 Therefore, it is imperative to find a strategy to improve both physical and psychological outcomes of patients undergoing NSCLC surgery.Exercise training is the cornerstone of pulmonary rehabilitation, and traditional low- or moderate-intensity exercise training commonly used in clinical practice have certain effects in promoting rehabilitation of patients with lung cancer.10,11 However, rehabilitation is largely underused because of uncertainties regarding the exercise modalities and the limited preoperative period. Traditional exercise training requires long-period exercise, and it is difficult to achieve the expected rehabilitation effect without delaying operation or completing the established training program. Recent reviews suggested that preoperative, but not postoperative, exercise training may help improve functional capacity and the tolerance to surgery, and reduce postoperative length of hospital stay.12,13 High-intensity interval training (HIIT) may be a promising method to make the best use of not long preoperative time. It is an exercise training that is characterized by short high-intensity intervals of activity (no less than 70% of the maximum heart rate) and interspersed by recovery periods (between 10 seconds and several minutes).14 Some studies have showed that HIIT was superior to low- and moderate-intensity exercise.15 However, patients tend to be reluctant to conduct exercise due to the influence of traditional concepts, lack of exercise-related knowledge, and decline of their own physical functions. Therefore, enhancing their exercise self-efficacy is important in performing HIIT.Exercise self-efficacy refers to people's confidence in their ability to conduct specific physical activities under specific conditions.16 It has been proven that exercise self-efficacy is a predictor of physical activity. A higher level of self-efficacy expectations enables people to gain a greater sense of energy and feel more revitalized.17 Self-efficacy-enhancing pulmonary rehabilitation is strongly recommended.18,19 Empowerment education refers to the provision of disease-related knowledge and disease management supported by educators to help patients face up to their own diseases and enable patients to make behavior changes independently, thus improving their disease management ability and promoting rehabilitation.20 Team empowerment education (TEE) not only is a patient-centered education but also provides peer support to patients in the form of teams. Peer support can enable patients to provide their own successful experience to peers, and at the same time, they can also obtain psychological support from peers, both of which can encourage patients to manage their disease more confidently.21 Our TEE program is based on empowerment theory and comprises 5 parts (expression of emotion, problem identification, analysis of problems, goal setting and implementation, and evaluation). The strategies used in the 5 steps are as follows: the step of analysis of problems enabled patients to engage in effective discussions and improve their personal management experience; the step of goal setting and implementation made patients actively participate in the formulation of the rehabilitation plans, which allowed them to follow their own actual situation, personalize the designed pulmonary function rehabilitation plan, and have a high degree of practicality; and the step of evaluation facilitated patients to discuss their goal achievement with each other and share the factors of failure and effective experiences so that they can gain reflection, improve their problem-solving abilities, and make reasonable adjustments to their goals and plans. During the whole program, they gained peer support and were given the power to participate in developing a personalized rehabilitation plan. The program has been proven effective in patients with chronic obstructive pulmonary diseases.22,23To the best of our knowledge, previous research has mostly focused on cardiorespiratory fitness, and there have been few studies into the use of the HIIT by NSCLC resection patients that included the outcomes of psychological symptoms. Moreover, whether HIIT combined with TEE is more effective than HITT alone remains unclear.