Respiratory Muscle Training in Patients Undergoing Lung Cancer Surgery

Saglik Bilimleri Universitesi

Status: Begins enrollment in 6 months

Conditions: Lung Cancer

Treatments: Other: Inspiratory Muscle Training; Other: Expiratory Muscle Training; Other: Conventional Physiotherapy

Study type: Interventional

Funder types: Other

Identifiers

NCT07499986

RMT_Preop 1

Details and patient eligibility

About

This randomized, controlled, double-blind clinical trial aims to investigate the effectiveness of preoperative inspiratory muscle training (IMT) and expiratory muscle training (EMT) in patients scheduled for lung cancer surgery. Respiratory muscle dysfunction contributes to postoperative pulmonary complications (PPCs), prolonged hospitalization, and reduced functional recovery. Although IMT has been evaluated in several studies, the evidence is limited and heterogeneous, and the effectiveness of EMT in this population has never been studied.

This study will compare conventional preoperative physiotherapy alone with physiotherapy combined with IMT or EMT to determine their impact on postoperative clinical outcomes, respiratory muscle function, and exercise capacity.

Full description

Lung cancer surgery is frequently associated with postoperative pulmonary complications, which negatively impact recovery, hospital length of stay, and postoperative quality of life. Preoperative physiotherapy has been shown to improve clinical outcomes; however, the optimal content of such programs remains unclear.

Inspiratory muscle training has been associated with improvements in maximum inspiratory pressure (MIP), exercise capacity, and potentially reduced PPC rates, though findings are inconsistent. In contrast, no study has evaluated expiratory muscle training-despite its potential benefits in enhancing cough effectiveness, secretion clearance, and thoracic stability after surgery.

This trial is designed to fill this knowledge gap by systematically comparing IMT and EMT within a structured preoperative physiotherapy program. All groups will receive standard preoperative education, breathing exercises, and walking training. Participants randomized to the IMT or EMT groups will additionally undergo daily training using threshold-based devices at 40% of MIP or MEP, respectively, with intensity progression based on the Borg scale.

Enrollment: 70 estimated patients

Sex: All

Ages: 18 to 70 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Diagnosis of lung cancer staged IA to IIIB based on clinical staging
• Planned to undergo surgery via thoracotomy or videothoracoscopy (VATS)
• Having a smartphone and being capable of performing video call

Exclusion criteria

• Presence of a cardiac disease that affects quality of life (ASA II or better is required)
• Presence of severe cognitive problems or psychiatric disorders
• Presence of physical limitations (e.g., visual or hearing impairment, orthopedic problems)
• If the lung cancer diagnosis is not confirmed after frozen section or wedge resection, the patient will be removed from the study

Trial design

Primary purpose: Prevention

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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70 participants in 3 patient groups

Inspiratory Muscle Training + Conventional Physiotherapy

Experimental group

Description:

Participants receive the full conventional physiotherapy program plus Inspiratory Muscle Training (IMT) using a threshold device set initially at 40% of the individual's maximum inspiratory pressure (MIP). Training consists of 2 minutes of loading followed by 1 minute of rest, repeated 7 times (total 21 minutes), performed twice daily, 5 days per week, until surgery.

Treatment:

Other: Conventional Physiotherapy

Other: Inspiratory Muscle Training

Expiratory Muscle Training + Conventional Physiotherapy

Experimental group

Description:

Participants receive the full conventional physiotherapy program plus Expiratory Muscle Training (EMT) using a threshold-based expiratory device set at 40% of maximum expiratory pressure (MEP). Training follows the same schedule as the IMT protocol (2 min loading / 1 min rest × 7 cycles), twice daily, 5 days per week, until surgery.

Treatment:

Other: Conventional Physiotherapy

Other: Expiratory Muscle Training

Conventional Preoperative Physiotherapy (Control Group)

Experimental group

Description:

Participants receive the standard preoperative physiotherapy program including diaphragmatic and thoracic breathing exercises, basal breathing techniques, and individualized walking training based on 80% of the 6-minute walk test distance. Three supervised sessions (one in-person, two via videoconference) are followed by daily home exercises until the surgery date. No respiratory muscle training device is used.

Treatment:

Other: Conventional Physiotherapy