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Preoperative exercise-based prehabilitation for reducing postoperative pulmonary complications after lung cancer surgery: a systematic review and meta-analysis
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DOI：10.3389/fmed.2026.1899789.png)
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Abstract
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BackgroundPostoperative pulmonary complications (PPCs) are common and clinically important adverse outcomes after lung cancer surgery. Preoperative exercise-based prehabilitation may enhance functional reserve before surgery; but its effects on PPCs and related perioperative outcomes remain uncertain.MethodsThis systematic review and meta-analysis followed the PRISMA 2020 guidelines and was registered with PROSPERO (CRD420251273259). PubMed; Web of Science; Embase; the Cochrane Library; CINAHL; CNKI; Wanfang Data; and the VIP Database were searched from inception to 25 December 2025. Randomized controlled trials evaluating preoperative exercise-based prehabilitation in adults undergoing lung cancer surgery were included. Risk of bias was assessed using the Cochrane RoB 2 tool; and certainty of evidence was assessed using the GRADE approach. Random-effects meta-analyses were performed using RevMan 5.4.1.ResultsA total of 28 reports comprising 29 randomized controlled trials and 2; 900 eligible surgical participants were included. Compared with usual perioperative care; preoperative exercise-based prehabilitation significantly reduced the risk of overall PPCs (RR = 0.42; 95% CI 0.33–0.53; I2 = 0%); pneumonia or pulmonary infection (RR = 0.52; 95% CI 0.36–0.75; I2 = 0%); atelectasis (RR = 0.36; 95% CI 0.25–0.51; I2 = 0%); and respiratory failure (RR = 0.37; 95% CI 0.17–0.78; I2 = 0%). Prehabilitation also reduced postoperative length of hospital stay (MD = −2.22 days; 95% CI −2.52 to −1.92; I2 = 52%). Results for preoperative 6-minute walk distance were inconsistent and were summarized narratively because of substantial heterogeneity.ConclusionPreoperative exercise-based prehabilitation may reduce PPCs and shorten postoperative hospital stay after lung cancer surgery; but the certainty of evidence ranged from moderate to very low across outcomes. Evidence for functional improvement remains uncertain. Future multicenter trials should standardize prehabilitation protocols; outcome definitions; safety monitoring; and adherence reporting.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/; identifier CRD420251273259.
Keywords:
systematic review
meta-analysis
lung cancer
pulmonary rehabilitation
prehabilitation
lung resection
postoperative pulmonary complications
exercise training
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