Effect of Pursed-lips Breathing Combined With Aerobic Walking Exercise on Oxygenation and Activity Endurance in Lung Cancer Patients After Lobectomy

NCT06118164 | Completed

• 1 other identifier: TaichungTCH
• Study Type: interventional
• Target: 60
• Locations: 1 country
• Sites: 1

Brief Summary

The effects of pursed-lip breathing or aerobic walking exercise in increasing muscle strength and motility and relieving dyspnea have been proved. However, patients with lung cancer often have decreased lung function and exercise capacity after lobectomy. The aim of this study was to explore the effects of pursed-lip breathing combined with aerobic walking exercise on postoperative oxygenation and exercise tolerance of lung cancer patients underwent lobectomy.

Conditions

Complications During Rehabilitation Stay

Keywords

lung cancer; lobectomy; pursed-lip breathing; aerobic walking; oxygenation; exercise tolerance

Outcome Measures

Primary Outcomes (8)

• Effect on Postoperative Oxygenation in Lung Cancer Patients

  Measurements were taken on the 1st day after surgery, prior to the intervention. The pulse oximeter was placed on the patient's fingertip, and after a 5-second wait, the SpO2 value appeared on the monitor interface, which was then recorded on the data sheet.

  pretests(before the start of the three interventions on the post-op day 1)

• Effect on Postoperative Oxygenation in Lung Cancer Patients

  Measurements were taken on the 5th day after surgery, after three activities. The pulse oximeter was placed on the patient's fingertip, and after a 5-second wait, the SpO2 value appeared on the monitor interface, which was then recorded on the data sheet.

  posttests(after the completion of the three interventions on the post-op day 5)

• Effect on Postoperative Oxygenation in Lung Cancer Patients

  Dyspnea Visual Analogue Scale (DVAS):Draw a vertical 10 cm line on an A4 white paper. Label the top end of the line as "Not Breathless" and the bottom end as "Very Breathless." The longer the distance marked on the line, the more severe the breathlessness. Measurement Method: Measurements were taken on the 1st day after surgery, prior to the intervention. After the patient completes a six-minute walk test, they mark their level of breathlessness on the vertical line to assess the degree of breathlessness.

  pretests(before the start of the three interventions on the post-op day 1)

• Effect on Postoperative Oxygenation in Lung Cancer Patients

  Dyspnea Visual Analogue Scale (DVAS): Draw a vertical 10 cm line on an A4 white paper. Label the top end of the line as "Not Breathless" and the bottom end as "Very Breathless." The longer the distance marked on the line, the more severe the breathlessness. Measurement Method: Measurements were taken on the 5th day after surgery, after three activities. After the patient completes a six-minute walk test, they mark their level of breathlessness on the vertical line to assess the degree of breathlessness.

  posttests(after the completion of the three interventions on the post-op day 5)

• Effect on Postoperative activity endurance in Lung Cancer Patients

  Six-minute walking test (6MWT) : A long, flat, unobstructed hospital corridor is selected as the testing location. The floor is marked every 1 meter, covering a total distance of 30 meters. Patients are instructed to walk back and forth within the marked distance. Before the test, patients are informed to walk at the fastest pace they can tolerate and that they can slow down or pause if they experience any physical discomfort during the test. The test lasts for six minutes, and when the time is up, patients stop walking. The location where patients stop is recorded, corresponding to a marked point on the floor. The distances covered are summed up to determine the test result.

  pretests(before the start of the three interventions on the post-op day 1)

• Effect on Postoperative activity endurance in Lung Cancer Patients

  Six-minute walking test (6MWT) : A long, flat, unobstructed hospital corridor is selected as the testing location. The floor is marked every 1 meter, covering a total distance of 30 meters. Patients are instructed to walk back and forth within the marked distance. Before the test, patients are informed to walk at the fastest pace they can tolerate and that they can slow down or pause if they experience any physical discomfort during the test. The test lasts for six minutes, and when the time is up, patients stop walking. The location where patients stop is recorded, corresponding to a marked point on the floor. The distances covered are summed up to determine the test result. Measurements were taken on the 1st day after surgery before the intervention.

  posttests(after the completion of the three interventions on the post-op day 5)

• Effect on Postoperative activity endurance in Lung Cancer Patients

  Rating scale of perceived exertion (RPE / Borg 6-20):This scale ranges from 6 points (indicating no perceived exertion) to 20 points (indicating maximal exertion). Higher scores indicate a higher level of perceived exertion.Measurements were taken on the 1st day after surgery before the intervention. After the six-minute walking test, patients were asked to circle the score on the scale that corresponds to their perceived level of exertion to assess the level of exertion felt by patients after activity.

  pretests(before the start of the three interventions on the post-op day 1)

• Effect on Postoperative activity endurance in Lung Cancer Patients

  Rating scale of perceived exertion (RPE / Borg 6-20):This scale ranges from 6 points (indicating no perceived exertion) to 20 points (indicating maximal exertion). Higher scores indicate a higher level of perceived exertion.Measurements were taken on the 5th day after surgery after three separate activities. Following the six-minute walking test, patients were asked to circle the score on the scale that corresponds to their perceived level of exertion to assess the level of exertion felt by patients after activity.

  posttests(after the completion of the three interventions on the post-op day 5)

Study Arms (3)

experimental group -pursing- lip breathing combined with aerobic walking exercise

EXPERIMENTAL

For the pursed-lip breathing combined with aerobic walking exercise group (experimental group), subjects were taught to coordinate their breathing with their walking. They were instructed to inhale for two steps and exhale with pursed lips for four to five steps. Initially, they were allowed to walk at a pace that felt comfortable to them, and then gradually increase their walking speed until they reached the target aerobic heart rate, calculated using the formula: (220 - age) × 55-65% of maximum heart rate. During the walking exercise, a pulse oximeter was used to monitor their heart rate and blood oxygen saturation. Training sessions were conducted daily from the first day after surgery until the fifth day, with three sessions each day, and each session lasting for 15 minutes.

Behavioral: pursing- lip breathing combined with aerobic walking exercise

Control group 1-pursed-lip breathing

ACTIVE COMPARATOR

For the group receiving single pursing- lip breathing training (control group 1), subjects were taught to perform deep inhalation through the nose (counting mentally from 1 to 2) while in a seated or standing position. They were then instructed to purse their lips and exhale slowly and steadily (counting mentally from 1 to 4). During the walking exercise, a pulse oximeter was used to monitor their heart rate and blood oxygen saturation. Training sessions were conducted daily from the first day after surgery until the fifth day, with three sessions each day, and each session lasting for 15 minutes.

Behavioral: pursing- lip breathing

Control group 2 -aerobic walking exercise

ACTIVE COMPARATOR

For the single aerobic walking exercise group (control group 2), subjects were taught to start with their own acceptable stride and pace and then gradually increase their walking speed until they reached the target aerobic heart rate. Pulse oximeters were used to monitor their heart rate and blood oxygen saturation levels during the process. During the walking exercise, a pulse oximeter was used to monitor their heart rate and blood oxygen saturation. Training sessions were conducted daily from the first day after surgery until the fifth day, with three sessions each day, and each session lasting for 15 minutes.

Behavioral: aerobic walking exercise

Interventions

pursing- lip breathing combined with aerobic walking exercise BEHAVIORAL

pursing- lip breathing combined with aerobic walking exercise

experimental group -pursing- lip breathing combined with aerobic walking exercise

pursing- lip breathing BEHAVIORAL

pursing- lip breathing

Control group 1-pursed-lip breathing

aerobic walking exercise BEHAVIORAL

aerobic walking exercise

Control group 2 -aerobic walking exercise

Eligibility Criteria

• Age: 20 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Participants aged over 20 who have been informed of the research process and are willing to participate and sign consent.
• Participants with clear consciousness, the ability to communicate in Mandarin or Taiwanese, and the ability to walk independently.
• Participants diagnosed with lung cancer who have undergone lung lobe resection surgery.

You may not qualify if:

• Changes in the surgical plan, not undergoing at least a single lung lobe resection.
• Deterioration of postoperative condition, making it impossible to correctly perform pursed lip breathing or aerobic walking exercises.

Sponsors & Collaborators

• Taichung Tzu Chi Hospital: lead

Study Sites (1)

Asia University

Taichung, Wufeng, 41354, Taiwan

Location

Related Publications (12)

• Amin MB, Greene FL, Edge SB, Compton CC, Gershenwald JE, Brookland RK, Meyer L, Gress DM, Byrd DR, Winchester DP. The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more "personalized" approach to cancer staging. CA Cancer J Clin. 2017 Mar;67(2):93-99. doi: 10.3322/caac.21388. Epub 2017 Jan 17.

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• Abbas AE. Surgical Management of Lung Cancer: History, Evolution, and Modern Advances. Curr Oncol Rep. 2018 Nov 13;20(12):98. doi: 10.1007/s11912-018-0741-7.

  PMID: 30421260 RESULT

• Ettinger DS, Wood DE, Aggarwal C, Aisner DL, Akerley W, Bauman JR, Bharat A, Bruno DS, Chang JY, Chirieac LR, D'Amico TA, Dilling TJ, Dobelbower M, Gettinger S, Govindan R, Gubens MA, Hennon M, Horn L, Lackner RP, Lanuti M, Leal TA, Lin J, Loo BW Jr, Martins RG, Otterson GA, Patel SP, Reckamp KL, Riely GJ, Schild SE, Shapiro TA, Stevenson J, Swanson SJ, Tauer KW, Yang SC, Gregory K; OCN; Hughes M. NCCN Guidelines Insights: Non-Small Cell Lung Cancer, Version 1.2020. J Natl Compr Canc Netw. 2019 Dec;17(12):1464-1472. doi: 10.6004/jnccn.2019.0059.

  PMID: 31805526 RESULT

• Granger CL, Edbrooke L, Denehy L. The nexus of functional exercise capacity with health-related quality of life in lung cancer: how closely are they related? Ann Transl Med. 2018 Dec;6(Suppl 2):S131. doi: 10.21037/atm.2018.12.35. No abstract available.

  PMID: 30740452 RESULT

• Kobayashi N, Kobayashi K, Kikuchi S, Goto Y, Ichimura H, Endo K, Sato Y. Long-term pulmonary function after surgery for lung cancer. Interact Cardiovasc Thorac Surg. 2017 May 1;24(5):727-732. doi: 10.1093/icvts/ivw414.

  PMID: 28453808 RESULT

• Lugg ST, Agostini PJ, Tikka T, Kerr A, Adams K, Bishay E, Kalkat MS, Steyn RS, Rajesh PB, Thickett DR, Naidu B. Long-term impact of developing a postoperative pulmonary complication after lung surgery. Thorax. 2016 Feb;71(2):171-6. doi: 10.1136/thoraxjnl-2015-207697.

  PMID: 26769017 RESULT

• Li J, Guo NN, Jin HR, Yu H, Wang P, Xu GG. Effects of exercise training on patients with lung cancer who underwent lung resection: a meta-analysis. World J Surg Oncol. 2017 Aug 23;15(1):158. doi: 10.1186/s12957-017-1233-1.

  PMID: 28835249 RESULT

• Mayer AF, Karloh M, Dos Santos K, de Araujo CLP, Gulart AA. Effects of acute use of pursed-lips breathing during exercise in patients with COPD: a systematic review and meta-analysis. Physiotherapy. 2018 Mar;104(1):9-17. doi: 10.1016/j.physio.2017.08.007. Epub 2017 Aug 31.

  PMID: 28969859 RESULT

• Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021 May;71(3):209-249. doi: 10.3322/caac.21660. Epub 2021 Feb 4.

  PMID: 33538338 RESULT

• Travis WD, Brambilla E, Burke AP, Marx A, Nicholson AG. Introduction to The 2015 World Health Organization Classification of Tumors of the Lung, Pleura, Thymus, and Heart. J Thorac Oncol. 2015 Sep;10(9):1240-1242. doi: 10.1097/JTO.0000000000000663. No abstract available.

  PMID: 26291007 RESULT

• Villeneuve PJ. Interventions to avoid pulmonary complications after lung cancer resection. J Thorac Dis. 2018 Nov;10(Suppl 32):S3781-S3788. doi: 10.21037/jtd.2018.09.26.

  PMID: 30505565 RESULT

• Ziarnik E, Grogan EL. Postlobectomy Early Complications. Thorac Surg Clin. 2015 Aug;25(3):355-64. doi: 10.1016/j.thorsurg.2015.04.003. Epub 2015 Jun 12.

  PMID: 26210931 RESULT

MeSH Terms

Conditions

Lung Neoplasms

Condition Hierarchy (Ancestors)

Respiratory Tract Neoplasms; Thoracic Neoplasms; Neoplasms by Site; Neoplasms; Lung Diseases; Respiratory Tract Diseases

Study Officials

• Hua-Shan Wu, PhD

  Asia University

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: TRIPLE
• Who Masked: PARTICIPANT, CARE PROVIDER, OUTCOMES ASSESSOR
• Masking Details: Patients who agreed to participate were randomly assigned to the experimental group or one of the two control groups (Control I and Control II) by outpatient nurses drawing lots from a lottery box. Once the group assignment was determined, on the day of admission, the researchers provided instructions on the respective intervention measures for that group (Pursed-lip breathing combined with aerobic walking exercise group, Pursed-lip breathing only group, Aerobic walking exercise only group). Data collection was carried out by registered nurses with at least two years of clinical experience in non-enrollment wards.
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Director of Thoracic Surgery

Model Details: The experimental group was given pursed-mouth breathing training combined with aerobic walking exercise. Control group I was given pursed-mouth breathing training. Control group II was given aerobic walking exercise.

Study Record Dates

• First Submitted: October 31, 2023
• First Posted: November 7, 2023
• Study Start: April 22, 2020
• Primary Completion: June 30, 2022
• Study Completion: June 30, 2022
• Last Updated: November 9, 2023

Record last verified: 2023-11

Data Sharing

• IPD Sharing: Will not share

Locations

TW (1)