PulmoSalud: Multimodal Program for Prehabilitation and Early Home Rehabilitation in Patients With Lung Cancer

PulmoSalud: Multimodal Program for Prehabilitation and Early Home Rehabilitation in Patients With Lung Cancer

Lung cancer remains a leading cause of morbidity and mortality, and resective surgery is the treatment of choice in operable stages. However, a significant proportion of patients present with functional impairment prior to surgery and develop postoperative complications, especially respiratory ones. Prehabilitation has become established as a strategy capable of optimizing physical condition before surgery, while early rehabilitation contributes to accelerating recovery after discharge. Nevertheless, its routine implementation is limited by logistical barriers, short waiting times, and difficulties in accessing in-person care.

The PulmoSalud project proposes a multimodal program, consisting of 8 weeks of prehabilitation (strength and endurance exercises, and respiratory physiotherapy) and 4 weeks of early home-based rehabilitation, supported by a specific digital application, in order to facilitate continuity of care without the need for additional travel. The content includes progressive strength training, structured breathing exercises (including inspiratory muscle training), educational guidelines, and digital recording of activity and symptoms. Patients will receive initial in-person training to ensure the correct execution of the exercises, and will subsequently continue independently with remote supervision.

A controlled study will be conducted comparing this program with the center's standard care. Functional variables (aerobic capacity, muscle strength), respiratory parameters, postoperative complications, quality of life, self-efficacy, and healthcare resource utilization will be evaluated. Measurements will be taken at three time points: baseline (T0), immediate pre-surgical (T1), and one month post-surgery (T2).

PulmoSalud aims to improve preoperative preparation, accelerate post-surgical recovery, and reduce the burden on healthcare services by safely integrating a home-based intervention supported by digital technology.

Inclusion Criteria:

1. Age ≥ 18 years.
2. Histological or cytological diagnosis of lung cancer (resectable stage according to the multidisciplinary team).
3. Patients scheduled for lung surgery with curative intent (lobectomy, segmentectomy, pneumonectomy, etc.).
4. Ability to understand and sign informed consent.
5. Clinical condition that allows participation in a supervised exercise program, according to medical evaluation, with an ECOG performance status of 0-2 (Eastern Cooperative Oncology Group Performance Status).
6. Availability to perform the scheduled measurements and follow-ups (preoperative and postoperative).
7. Ability to use the mobile application or have family support to do so. Exclusion Criteria:

1. Absolute medical contraindications to supervised physical exercise, such as unstable angina, recent decompensated heart failure, uncontrolled arrhythmias, or acute cardiovascular events within the last 3 months.

2. Very advanced chronic lung disease that prevents participation in the program (e.g., severe COPD with FEV1 < 30% predicted, as determined by the clinical team).

3. Distant metastases or metastatic cancer that contraindicate surgery with curative intent.

4. Planned palliative surgery or life expectancy < 3 months.

5. Home oxygen therapy with severe, uncorrectable hypoxemia, as determined by clinical judgment.

6. Moderate-to-severe cognitive, neurological, or psychiatric impairment that prevents understanding of the study or proper use of the mobile application. 7. An insurmountable language barrier that prevents understanding the study information or using the mobile application.

8. Pregnancy.

9. Participation in another interventional clinical trial that may interfere with the study objectives or its primary outcome.

10. Any other condition that, in the opinion of the research team, compromises the participant's safety or adherence to the protocol.

Withdrawal Criteria

1. Withdrawal of consent.
2. Adverse events that contraindicate continued exercise (clinical decision).
3. Failure to complete more than 30% of planned sessions (for per-protocol analysis; continue in ITT).