Preoperative Exercise to Improve Fitness in Patients Undergoing Complex Surgery for Cancer of the Lung or Esophagus (PRE-HIIT): A Randomised Controlled Trial

Objective: This randomised controlled trial (RCT) compared the impact of high-intensity interval training (HIIT) versus standard care (SC) on preoperative cardiopulmonary fitness in patients prior to esophageal or lung cancer surgery. Summary of Background Data: Exercise prehabilitation aims to optimise preoperative condition and attenuate postoperative risks. Although intuitive, defining the optimal training parameters to impact physiologically prior to surgery with attendant clinical benefit remains challenging. Methods: Utilising a parallel, two-armed RCT design, n=79 participants ((mean age (SD) 64 (9.3), 67% males) scheduled for curative resection for lung (50.6%) or esophageal (49.6%) cancer with ≥2-weeks preoperative lead-in, were recruited and randomised to HIIT (n=41) or SC (n=38). HIIT was completed on an electronically braked cycle ergometer consisting of 30-minutes of 15-seconds intervals at 100% peak power output alternating with 15-second active recovery for five days/week. The SC arm was offered moderate-intensity exercises 2-3 days/week. The primary outcome was peak oxygen consumption (VO2peak), measured by cardiopulmonary exercise testing. Secondary outcomes included lower limb strength and physical functioning. Results: Baseline cardiopulmonary fitness was predominantly very poor (n=75 (95%)). Adjusting for baseline in a linear model, VO2peak increased significantly (P=0.05) in the HIIT group vs SC (6.6% between-group difference). HIIT increased VO2peak from 18.7 (5.0) to 21.7 (5.7) ml/kg/min while with SC it remained unchanged at 19.6 (5.4) to 20.1 (5.7) ml/kg/min) from pre- to post-intervention. Sit-to-stand scores were significantly (P=0.02) improved with HIIT. Conclusion: HIIT is effective for eliciting meaningful gains in preoperative fitness in a deconditioned cohort within short timeframes.