Title : How well does prehabilitation preserve pre-surgery cardiorespiratory fitness for lung cancer patients? Systematic review and meta-analysis
Abstract:
Background: Exercise prehabilitation (Prehab) for cancer patients awaiting surgery has shown to be effective for both surgery tolerance and recovery but its effect in lung cancer is limited. This systematic review and meta-analysis have therefore aimed to assess the effect of Prehab on Cardio Respiratory Fitness (CRF) and Quality of Life (QoL) in people with lung cancer.
Method: MEDLINE, AMED, CINAHL Plus, PEDro, and Cochrane data-bases were searched for eligible studies published up to 16 April 2026. Studies evaluating exercise-based prehabilitation with cardiorespiratory fitness outcomes were included.
Results: Twenty-nine studies totalling 1616 participants (44-79 years, 54.3% male) met the inclusion criteria, of which 17 were randomised controlled trials (RCTs) included in the meta-analysis. CRF was measured either by 6-minute walk test (18 studies), incremental shuttle walk test (two studies) or Cardio Pulmonary Exercise Tests (CPET nine studies).
From baseline to pre- surgery, baseline to post-surgery and pre- to post-surgery in intervention vs control), 6MWT distances achieved were: +44.44m vs +30.19m; -96.43m vs -135.81m; and −117.69m vs −169.32m, respectively. For CPET, baseline to pre-surgery were reported, respectively for intervention vs control: +2.08 mL·kg?¹·min?¹ vs −0.17 mL·kg?¹·min?¹). Those studies which combined aerobic and resistance/strength training reported the greatest improvements in CRF. Random-effects meta-analysis showed a significant pooled effect for the overall CRF (SMD = 0.48, 95% CI 0.15 to 0.80, p = 0.007) and the 6MWT (SMD = 0.39, 95% CI 0.03 to 0.76, p = 0.038), whereas the pooled CPET effect was not significant (SMD= 0.74, 95%CI - 0.42 to 1.90, p = 0.134). QoL were inconsistent across studies because of mixed outcomes measures used, although several studies reported improvements in specific QoL domains.
Conclusions: Exercise-based prehabilitation improves cardiorespiratory fitness in lung cancer patients awaiting for surgery, with improvements or preservation across the preoperative period. While these results are encouraging, the evidence remains limited by differnt CRF assessment and the lack of studies reporting at baseline, pre-surgery, and post-surgery, highlighting the need for more trials assessing fitness across the full treatment pathway.
