Journal of Rehabilitation Medicine 51-9 | Page 88

J Rehabil Med 2019; 51: 712–718 ORIGINAL REPORT PREOPERATIVE HIGH-INTENSITY INTERVAL TRAINING IS EFFECTIVE AND SAFE IN DECONDITIONED PATIENTS WITH LUNG CANCER: A RANDOMIZED CLINICAL TRIAL Chetna BHATIA, MSc 1 and Bengt KAYSER, MD, PhD 2 From the 1 Respiratory Care Service, University Hospitals of Geneva, Geneva and 2 Institute of Sport Sciences of the University of Lausanne, Lausanne, Switzerland Background: The outcome of surgery in deconditio- ned patients can be improved through prehabilita- tion. This study examined the effect of prehabilita- tion in patients diagnosed with lung cancer. Methods: Candidates for lung cancer resection were assigned to high-intensity interval training (n  = 74) or usual care (n  =  77). Cardiopulmonary exercise testing and 6-min walk test were performed before and after training. High-intensity interval training consisted of 2–3-weekly, 2 × 10-min series of cyc- ling at peak power, measured with cardiopulmonary exercise testing prior to training, with a 15-s on-off duty cycle, preceded by a 5-min warm-up and fol- lowed by a 5-min cool-down. Work-rate, heart-rate, saturation, dyspnoea and leg effort were monitored. Results: Waiting time (median 25 days) allowed a median of 8 high-intensity interval training sessions to be performed. Adherence to mean high-intensity interval training was 87% (18% standard devia- tion; SD). High-intensity interval training power in- creased (23 watt, 95% confidence interval (95% CI): 20–26 watt), as did heart rate (14 bpm, 95% CI 11–16 bpm). Resting heart rate (–6 bpm, 95% CI –4 to –7 bpm) and heart rate 1 min post-cool-down decreased (–5 bpm, 95% CI –4 to –7 bpm). Aero- bic capacity increased after high-intensity interval training (14%, 95% CI 3–26%), as did peak power output (median 7%, 95% CI 2–13%), but not after usual care. Six-min walk test score increased after high-intensity interval training (median 20%, 95% CI 14–26%), but not after usual care. Conclusion: Short-term high-intensity interval train- ing is feasible in deconditioned patients and in- creases cardio-respiratory fitness and walking capa- city. Key words: exercise; neoplasm; thoracic surgery; lung; pre- habilitation; high-intensity interval training; HIIT. Accepted Aug 13, 2019; Epub ahead of print Aug 29, 2019 J Rehabil Med 2019; 51: 712–718 Correspondence address: Bengt Kayser, Institute of Sport Sciences of the University of Lausanne, Synathlon, Uni-Centre, 1015 Lausanne, Switzerland. E-mail: [email protected] A potential curative option for early-stage non- small cell lung cancer (NSCLC) is primary lung LAY ABSTRACT High-intensity interval training is used increasingly in patient care. Various training patterns are used. For patients diagnosed with lung cancer, the first choice intervention is surgery. There is a wait of approxima- tely a mean of 3 weeks between the clinical decision to operate and the intervention. A high-intensity interval training protocol was designed, to be performed during this time-window, to improve the physical condition of these patients before surgery. Patients cycled 3 times per week under supervision, performing 2 × 10-min se- ries of 15-s sprints at peak power, interspersed with 15-s pauses. Compared to usual care, just before sur- gery, after 8 sessions of high-intensity interval training, the patients’ physical fitness was significantly improved while after surgery the outcome was improved. resection (1). However, physical deconditioning is a major risk factor for patients undergoing surgery, and low peak oxygen uptake (VO 2peak ) is a predictor of perioperative mortality and cardiopulmonary mor- bidity (2, 3). A VO 2peak cut-off of 16 ml/kg/min and an anaerobic threshold VO 2 cut-off of 10–12 ml/kg/ min can distinguish between low- and high-risk for major postoperative complications (4). Pre-operative improvement in fitness (i.e. prehabilitation) is therefore clinically relevant. Prehabilitation reduces imminent risk prior to surgery and improves operative recovery and outcome (5). It also improves VO 2peak , muscle strength and quality of life (6). Different prehabilita- tion programmes for patients with NSCLC have been evaluated, in home-based, out- and in-patient settings, using strength exercise, continuous and interval train- ing on a cycle ergometer or treadmill, breathing and coughing exercises, and specific inspiratory muscle training (7–13). Inspired by the use of interval training by athletes, short high-intensity intervals of activity, interspersed by recovery periods, so-called high-intensity interval training (HIIT), are used increasingly in patient care (14, 15). HIIT refers to series of repeated sessions of efforts close to, or even over that corresponding to, peak aerobic power (W peak ), interspersed by active or passive recovery periods. The duration of these repea- This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm doi: 10.2340/16501977-2592 Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977