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The effect of early activity on postoperative patients with lung cancer: a systematic review and meta-analysis
Zengxu Wang1, Yanli Xiu2, Xiaoxuan Qi2
1Department of Nursing, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Background:
Early activity is recognized as a safe and effective therapeutic approach that offers benefits in accelerating the recovery of patients with lung cancer after surgery.
Objectives:
Data from studies that met the inclusion criteria were pooled to assess the impact of early activity on the prognosis of postoperative lung cancer patients, including duration of chest tube retention, length of hospital stay (LOS), incidence of complications, lung function, and 6-minute walking distance (6MWD).
Methods:
Electronic databases, including Web of Science, CINAHL, the Cochrane Library, EMBASE, PubMed, the Chinese BioMedical Literature Service System (SinoMed), WANFANG, CNKI, VIP databases, and Clinical Trial Register Platform were systematically searched from inception to March 11, 2026. Two researchers independently assessed study eligibility. Titles and abstracts were initially screened, followed by a full-text review of potentially eligible articles. Data extraction and risk of bias (RoB) assessment were performed for all studies meeting the eligibility criteria. Pooled outcomes were presented as mean differences (MDs) or risk ratios (RRs) with corresponding 95% confidence intervals (CIs).
Results:
Twenty-three studies involving 2,234 participants were included in the meta-analysis. The results demonstrated that early activity significantly improved postoperative outcomes in patients with lung cancer. It notably reduced the incidence of pulmonary complications, LOS, and duration of chest tube retention. Subgroup analysis of lung function outcomes showed that early activity significantly improved forced expiratory volume in the first second (FEV1), whereas no significant effect was observed for FEV1%. Regarding exercise capacity, early in-hospital activity alone significantly improved 6MWD; however, combining it with post-discharge programs yielded no significant benefit and showed substantial heterogeneity.
Conclusions:
This study's findings underscore the significant role of early activity in the recovery of postoperative patients with lung cancer. While early in-hospital activity effectively reduced complications, chest tube duration, and LOS and improved FEV1, its effects on FEV1% and long-term exercise capacity remain uncertain due to inconsistent results and high heterogeneity in existing studies. Further large-scale, multicenter, randomized controlled trials (RCTs) are needed to strengthen these findings.
Systematic Review Registration:
https://www.crd.york.ac.uk/prospero/, identifier CRD42022333696.
