Preoperative Structured Exercise Programme on Patients With Non-Small Cell Lung Cancer

The Effect of Preoperative Structured Exercise Programme on Postoperative Pain Severity, Recovery Level, Discharge Time and Quality of Life in Patients With Non-Small Cell Lung Cancer: Randomised Controlled Study

INTRODUCTION: Lung cancer is among the leading cancers, and surgery has a major role in treatment. Patients diagnosed with Non-Small Cell Lung Cancer (NSCLC) who are eligible for surgical treatment have a high risk of experiencing postoperative complications. Therefore, in recent years, the concept of prehabilitation has begun to gain importance. Within the scope of prehabilitation practices, patients are provided with programmes that include aerobic exercises and breathing exercises in the preoperative period.

AIM: This study aims to evaluate the effects of a structured exercise programme, including aerobic exercises and breathing exercises in the preoperative period, on postoperative pain severity, surgical recovery level, length of hospital stays (LOS), and quality of life (QoL) in patients diagnosed with NSCLC and planned for surgical treatment.

METHODS: The research is an experimental, parallel group-randomised controlled trial to be conducted with 62 participants followed in the Thoracic Surgery Outpatient Clinic of Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital and scheduled for surgery due to NSCLC. Patients will be equally assigned to the intervention and control groups using the block randomization method. In the intervention group, in the preoperative period, for two weeks and five days per week, at least 30 minutes of walking per day will be performed; in addition, for two weeks before surgery, throughout the entire week, during waking hours, 10 repetitions with incentive spirometer every hour, and daily four sessions of deep breathing & coughing exercises will be performed as breathing exercises. In the control group, routine preoperative clinical procedures will be applied. In the postoperative period, pain severity, surgical recovery level, LOS, and QoL will be compared between the two groups. Data will be collected face-to-face by the researcher using the "Descriptive Characteristics Form", "EQ-5D-5L Quality of Life Scale", "Numeric Rating Scale (NRS)", and "Surgical Recovery Scale". Data on the length of hospital stay will be obtained from patient files. The data will be analysed using parametric and/or nonparametric tests through the SPSS.

CONCLUSION: The findings of the study are expected to contribute to strengthening holistic care approaches for the preoperative period in surgical nursing practices and to improving patient outcomes.

Inclusion Criteria

1. Age ≥ 18 years.
2. Ownership of a smartphone capable of tracking daily walking time.
3. Diagnosis of primary non-small cell lung cancer.
4. ASA (American Society of Anesthesiologists) classification I, II, or III.
5. Follow-up and treatment provided by the same surgical team.
6. No physical or cognitive impairment that would hinder participation in the study.

Exclusion Criteria

1. Diagnosis of recurrent lung cancer.
2. Previous radiotherapy treatment prior to surgery.
3. Any condition preventing walking or exercise (orthopedic, neurological, cardiovascular, metastatic, etc.).
4. Diagnosis of additional respiratory system disease such as COPD, asthma, or emphysema preventing breathing exercises.
5. Inability to complete the two-week structured exercise programme due to surgery being scheduled earlier or later than planned.
6. Complications resulting in prolonged (>24 hours) intensive care unit stay after surgery.
7. Inability to discontinue or continue the structured exercise programme at any stage.
8. Refusal to participate in the study.