Hybrid Prehabilitation Before Thoracic Surgery

Background and study aims: Lung cancer is a leading cause of cancer-related deaths worldwide. Patients with non-small cell lung cancer often undergo lung surgery to remove the tumor. Before surgery, patients may participate in prehabilitation programs to improve their physical fitness and overall health, which can lead to better surgical outcomes. Traditionally, these programs are conducted entirely in specialized centers, but places are scarce, limiting access. This study aims to compare the relative effectiveness of a hybrid prehabilitation program, combining home-based and center-based sessions, with the standard center-based program. The primary goal is to assess changes in aerobic capacity, measured by peak oxygen uptake, before and after participation in the prehabilitation program. Who can participate? Adults over 18 years old who are scheduled for lung resection surgery to treat diagnosed or suspected non-small cell lung cancer can participate. Participants should be referred for respiratory prehabilitation in a preoperative context and live at home with another adult, present during exercise sessions. The surgery date should be either not yet established at the time of inclusion or scheduled for at least four weeks later. Participants should have a peak oxygen uptake of less than 20 ml/kg/min, be beneficiaries of a social security system, and have read and understood the information letter and signed the consent form. What does the study involve? This is a single-center, randomized controlled trial with two groups: Center-based prehabilitation group: Participants will attend 15 sessions over three weeks (five sessions per week) at the center. The program includes an initial session of therapeutic education and exercise training, followed by 13 prehabilitation sessions, and a final session with educational reinforcement. Hybrid prehabilitation group: Participants will have three sessions at the center and 13 sessions at home over the same period. They will be provided with equipment such as a cycle ergometer, pulse oximeter, physical activity sensor, and a tablet application (TELEREHAPP) to guide and monitor their home-based exercises. Regular phone contact with healthcare professionals will be maintained for support. All participants will undergo assessments before and after the program, including an incremental exercise test on a cycle ergometer to measure peak oxygen uptake. What are the possible benefits and risks of participating? Participants may experience improved physical fitness, which could lead to better surgical outcomes and reduced postoperative complications. The study will also provide insights into the relative effectiveness of hybrid prehabilitation, potentially offering more flexible options and facilitating access to care for future patients. Risks may include muscle soreness, fatigue, or injury related to exercise, independently of group allocation. All exercise sessions will be supervised or monitored to minimize these risks. Participants will receive instructions on how to perform exercises safely and will be encouraged to report any adverse effects promptly.

Sex

All

Minimum age

18 Years

Inclusion Criteria:

* Age \> 18 years
* Patient scheduled to undergo lung resection for the treatment of diagnosed or suspected bronchial cancer
* Referred for prehabilitation before lung resection surgery
* Patient living at home with another adult present during exercise sessions
* Surgery date not established at the time of inclusion in the program, or at least 4 weeks away
* Peak oxygen uptake below 20 ml/kg/min
* Affiliated with a health insurance system
* Able to read and understand the information letter and sign the consent form

Non-Inclusion Criteria\*:

* Oxygen therapy during exercise
* Cardiological contraindication to exercise training
* Refusal to participate in a center-based prehabilitation training program
* Orthopedic, neurological, vascular, or neuromuscular conditions limiting exercise training on a cycle ergometer
* Patient under guardianship or curatorship
* Pregnant or breastfeeding women

Exclusion Criteria:

-Withdrawal of consent

\*The eligibility criteria were revised in May 2026 following approval of a protocol amendment by the French Ethics Committee (CPP Île-de-France IV). The former non-inclusion criterion of patients receiving concomitant neoadjuvant chemoradiotherapy was removed to better reflect the study population to current clinical practice, as neoadjuvant treatments are increasingly integrated into the care pathway of patients undergoing thoracic surgery for non-small cell lung cancer and referred for pulmonary prehabilitation. The previous restriction had been too limiting and had slowed recruitment. This amendment was proposed to improve the feasibility of recruitment and to increase the representativeness of the study population, while ensuring the safety of the participants as no additional safety concerns were identified and all other exclusion criteria related to safety were unchanged.

• RESULTGravier FE, Smondack P, Boujibar F, Prieur G, Medrinal C, Combret Y, Muir JF, Baste JM, Cuvelier A, Debeaumont D, Bonnevie T. Prehabilitation sessions can be provided more frequently in a shortened regimen with similar or better efficacy in people with non-small cell lung cancer: a randomised trial. J Physiother. 2022 Jan;68(1):43-50. doi: 10.1016/j.jphys.2021.12.010. Epub 2021 Dec 21. PMID 34952813