The effect of a post-operative mobility and strengthening programme on quality of life, exercise tolerance and muscle strength after thoracotomy for non-small lung cancer

Arbane, Gill (2011) The effect of a post-operative mobility and strengthening programme on quality of life, exercise tolerance and muscle strength after thoracotomy for non-small lung cancer. (MSc(R) thesis), Kingston University, .


Background: Deterioration in exercise tolerance, muscle strength and impairment in quality of life (Qol) are common consequences of lung resection. This study uses these measures to evaluate the efficacy of administering an additional exercise and strength training programme after lung resection. Methods: 53 (28 male) patients attending thoracotomy were recruited into the study: mean age (range) 64 (32 to 82) years; mean pack years (M±SD) 31.9 ± 26.8; BMI 25.6 ±4.2; FEV1 2.0 ± 0.7 litres (I). Patients were randomised to control (usual care) or intervention (twice daily training plus usual care). Physícal training was provided twice daily (for 30 minutes maximum) for 5 days post-operatively and involved marching on the spot, walking, and cycling on a recumbent bike and seated quadriceps raises; Pre-and 5 day post-operative assessments consisted of quadriceps strength using magnetic stimulation superimposed twitch and exercise tolerance using 6 minute walking distance (6MWD). Qol was assessed pre-operatively only using European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QlQ) C30 with lC13. At 12 weeks post-operatively both groups were reassessed for quadriceps strength, exercise tolerance and QoL. The intervention group received additional monthly home visits and weekly telephone calls for the 12 weeks; the control group only received the monthly telephone calls. length of stay (lOS) and post-operative complications (PaC's) were recorded, Unpaired t-tests were used to evaluate difference between groups, p<0.05 taken as significant.• Paired t-tests were used to evaluate change over time and repeated measure analysis of variance (ANOVA) was used where subjects performed all assessments. Results: There were no significant changes for any measures of Qol either within subject or between groups over 12 weeks. Exercise Tolerance There was a significant deterioration in both the active and control groups for 6MWD at 5 days post-operatively compared with pre-operatively, (M±SD) -131.6 ± 101.8 metres and -128.0 ± 90.7 metres in active and control groups respectively (p=0.89 between groups). This returned to pre-operative levels by 12 weeks in both groups. Muscle Strength There was no effect on muscle strength over time within subjects (p=0.70), nor any effect on muscle strength over time within groups on subjects (p=0.38). There was a significant group effect between subjects on the overall mean (p=O.04). With the control group there showed a significant decrease of (M±SD) -8.3 ± 11.3 kilograms in muscle strength compared to a non-significant increase of (M±SD) 4.0 ± 21.2 kiløgrams ini the intervention group from pre-operative to 5 days post-operative. The difference between groups for muscle strength was significant (psO.05). Conclusion: The study shows a significant effect on muscle strength at 5 days post-operatively from pre-operatively in the active group. It shows a significant decrease in exercise tolerance at 5 days post¬operatively in both groups compared to baseline. It also supports the use of recumbent cycles in the aid of post-operative recovery following lung resection. Although the results at 12 weeks do not support a strength and mobility programme provided in addition to usual care early after lung resection, it suggests that further research is needed to ascertain if the active group returned to their pre-operative levels earlier .than the control group. The results do not preclude the possible benefit of additional support for selected patients and it is unknown whether larger sample sizes would alter the results.

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