Preoperative exercise intervention for individuals with early stage non-small cell lung cancer undergoing lung surgery

INTERVENTION: Intervention (Prehabilitation group): Participants allocated to the intervention group will receive a prehabilitation program prior to surgery. This includes resistance (free weights/ resistance band exercises for upper limb and lower limb) and aerobic training (walking, bike or treadmill) of moderate intensity designed and supervised by an experienced thoracic physiotherapist using exercise training principles. For between 1‐4 weeks preoperatively, intervention participants will receive; ‐ hospital based supervised gym sessions (3x week, each 45 min duration), one‐on‐one ‐ individualised home exercise program on days not attending hospital‐based gym sessions and education regarding a home exercise program (exercise booklet + resistance exercise band designed specifically for this study) ‐ 1‐2 home visits ‐ weekly phone calls to encourage home adherence ‐ education: including lay information about lung cancer, the importance of staying active, diet and symptom control (e.g. breathlessness) given verbally in the initial consultation by the trial physiotherapist. This education will be provided once on the initial consultation, duration of the session will be approximately 15 minutes. ‐ an exercise diary to record weekly exercise sessions The intervention will be individualised such that participants who opt not to attend the hospital gym sessions will be prescribed an exercise program (minimum 3x/week, 45min duration each session) to complete in their home with telephone and home visit follow‐up. Participants will be given a stationary bike to use whilst exercising at home (if they do not already have one). Exercise intensity will be tailored to the individual and will utilise the BORG scale to monitor/progress as appropriate. The last exercise session for the intervention group will occur in the days preceding the surgery and may differ for each participant (dependant on the day of surgery). Exercise sessions are flexible in tha CONDITION: Cancer ‐ Lung ‐ Non small cell Physical Medicine / Rehabilitation ‐ Physiotherapy Suspected stage I‐IIIA non‐small cell lung cancer (NSCLC); ; Suspected stage I‐IIIA non‐small cell lung cancer (NSCLC) SECONDARY OUTCOME: Functional exercise capacity: measured via Incremental Shuttle Walk Test (ISWT), an externally paced walking test measuring exercise tolerance[Baseline ; Preoperative (after prehabilitation) ; Hospital Discharge ; 30‐days post surgery] Health‐related Quality of Life ‐ measured via questionnaire ‐ European Organisation for the Research and Treatment of Cancer Questionnaire lung cancer specific measurement tool (EORTC QLQ‐C30‐LC13)[Baseline ; 30‐days post surgery] Mood ‐ measured via questionnaire ‐ Hospital Anxiety and Depression Questionnaire (HADS)[Baseline ; Preoperatively (after prehabilitation) ; Hospital discharge ; 30‐days post surgery] Muscle strength: measured via a hand‐held dynamometer ‐ a simple, quick measurement of muscle strength. Areas tested include; hand grip, rotation cuff strength (arm abduction) and quadriceps strength (knee extension) ; Composite secondary outcome[Baseline ; Preoperative (after prehabilitation) ; Hospital discharge ; 30 days post surgery ; 30‐days post surgery] INCLUSION CRITERIA: INCLUSION CRITERIA: ‐ suspected stage I‐IIIA NSCLC presenting for surgical consult ‐ age > 18 years ‐ functional exercise capacity < 70% predicted (6MWT) (recruiting those who are most likely to benefit ‐ primary treating surgeon approval PRIMARY OUTCOME: ‐ Safety: study specific questionnaire documenting number of minor and major adverse events (fall/collapse, participant becomes acutely unwell, significant haemodynamic changes, new onset of chest pain, SpO2 < 85% or 10% drop below resting SpO2, respiratory rate > 35 breaths/min, participant temperature > 38 degrees) as reported by the trial researchers , length of time between surgical consult to recruitment and length of prehabilitation (days) ; [At conclusion of the prehabilitation program] Composite primary outcome: Feasibility; assessed as the number screened, number consenting (number of refusals), patient reported satisfaction with exercise program using semi‐structured qualitative interviews (structured telephone interview of varying duration), adherence to program (number of gym/home exercise and home walking sessions completed out of the total available)[At conclusion of the prehabilitation program] ; ] Number and type of postoperative pulmonary complications (PPC) measured via the Melbourne Group Scale (MGS) version 2[Hospital discharge] Postoperative Length of Stay (LOS) ‐ measured via data linkage to medical records[Hospital discharge] Self reported Physical Activity Levels ‐ measured via questionnaire ‐ International Physical Activity Questionnaire (IPAQ)[Baseline