Effect of preoperative respiratory prehabilitation on cardiopulmonary function in patients undergoing lung resection...

Preoperative respiratory prehabilitation has attracted increasing attention as a perioperative strategy in thoracic surgery, but evidence regarding its short-term effects on early postoperative functional recovery remains limited. This randomized controlled trial investigated the effect of a 7-day preoperative respiratory prehabilitation program on postoperative pulmonary function, cardiopulmonary exercise capacity, and postoperative complications in patients undergoing curative-intent lung resection for non-small cell lung cancer (NSCLC).

This single-center exploratory randomized controlled trial enrolled 120 patients with suspected NSCLC who were scheduled to undergo curative-intent anatomical lobectomy or wedge resection between January 2025 and November 2025. Patients were randomly assigned in a 1:1 ratio to routine perioperative care alone (control group, n = 60) or routine perioperative care plus a 7-day preoperative respiratory prehabilitation program (intervention group, n = 60). The primary endpoint was pulmonary function on postoperative day 7, assessed by forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and peak expiratory flow (PEF). Secondary endpoints included within-group preoperative pulmonary function change in the intervention group, cardiopulmonary exercise capacity on postoperative day 7, and postoperative complications.

Baseline characteristics were generally comparable between the two groups. In the intervention group, FEV1, FVC, and PEF were all significantly higher 1 day before surgery than before training (all P < 0.001). At admission, no significant between-group differences were observed in pulmonary function. On postoperative day 7, the intervention group had significantly higher FEV1 (1.86 ± 0.64 vs. 1.55 ± 0.48 L, P = 0.003), FVC (2.30 ± 0.58 vs. 1.78 ± 0.42 L, P < 0.001), and PEF (4.50 ± 0.67 vs. 3.85 ± 0.64 L/s, P < 0.001) than the control group. Cardiopulmonary exercise variables were also higher in the intervention group, including VO2max, VO2/kg, anaerobic threshold, and O2 pulse (all P < 0.001). The postoperative complication rate was numerically lower in the intervention group than in the control group (6.67% vs. 18.33%), although this difference should be interpreted cautiously (P = 0.053).

In this single-center exploratory randomized trial, short-term preoperative respiratory prehabilitation was associated with better pulmonary function and cardiopulmonary exercise capacity on postoperative day 7 in patients undergoing curative-intent lung resection for NSCLC. These findings suggest that short-term respiratory prehabilitation may be a feasible perioperative strategy to support early postoperative functional recovery.

Medical Research Registration and Record Information System of the National Healthcare Security Information Platform, MR-33-25-019022.