Abstract
Objective
To determine the benefits of preoperative breathing exercises on hospital length of
stay (LOS), pneumonia, postoperative pulmonary complications (PPC), 6-minute walk
distance (6MWD), forced expiratory volume in 1 second (FEV1), and health-related quality of life (HRQOL) in patients undergoing surgical lung
cancer resection.
Data Sources
PubMed, EMBASE, Web of Science Core Collection, and Cochrane Central Register of Controlled
Trials were comprehensively searched from inception to March 2021.
Study Selection
Only studies including preoperative inspiratory muscle training (IMT) and/or breathing
exercises compared with a nontraining control group were included. The meta-analysis
was done using Cochrane software for multiple variables including LOS, pneumonia,
PPC, 6MWD, FEV1, mortality, and HRQOL.
Data Extraction
Two authors extracted the data of the selected studies. The primary outcomes were
LOS and PPC.
Data Synthesis
A total of 10 studies were included in this meta-analysis, 8 of which had both IMT
and aerobic exercise. Pooled data for patients who performed preoperative breathing
exercises, compared with controls, demonstrated a decrease in LOS with a pooled mean
difference of –3.44 days (95% confidence interval [CI], –4.14 to –2.75; P<.01). Subgroup analysis also demonstrated that LOS was further reduced when breathing
exercises were combined with aerobic exercise (χ2, 4.85; P=.03). Preoperative breathing exercises reduce pneumonia and PPCs with an odds ratio
of 0.37 (95% CI, 0.18-0.75; P<.01) and 0.37 (95% CI, 0.21-0.65; P<.01), respectively. An increase in 6MWD of 20.2 meters was noted in those performing
breathing exercises (95% CI, 9.12-31.21; P<.01). No significant differences were noted in FEV1, mortality, or HRQOL.
Conclusions
Preoperative breathing exercises reduced LOS, PPC, and pneumonia and potentially improved
6MWD in patients undergoing surgical lung cancer resection. Breathing exercises in
combination with aerobic exercise yielded greater reductions in LOS. Randomized controlled
trials are needed to test the feasibility of introducing a preoperative breathing
exercise program in this patient population.
Keywords
List of abbreviations:
CI (confidence interval), COPD (chronic obstructive lung disease), DLCO (diffusing capacity for carbon monoxide), FEV1 (forced expiratory volume in 1 second), FVC (forced vital capacity), HRQOL (health-related quality of life), IMT (inspiratory muscle training), LOS (length of stay), MCID (minimal clinically important difference), OR (odds ratio), PMD (pooled mean difference), PPC (postoperative pulmonary complication), RCT (randomized controlled trial), 6MWD (6-minute walk distance)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: April 26, 2021
Accepted:
March 23,
2021
Received:
March 23,
2021
Footnotes
Disclosures: none.
Identification
Copyright
© 2021 The American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
