STRUCTURED AND TAILORED EXERCISE PREHABILITATION IN COMPLEX PATIENTS SCHEDULED FOR LUNG RESECTION A RETROSPECTIVE–PROSPECTIVE OBSERVATIONAL STUDY

Lung resection represents the standard curative treatment for early-stage lung cancer and selected pulmonary metastases; however, postoperative morbidity remains frequent, particularly in elderly, frail, and comorbid patients with reduced cardiopulmonary reserve. Functional impairment, physical deconditioning, and multiple comorbidities significantly increase surgical risk and negatively influence postoperative recovery. Exercise-based prehabilitation has recently gained a role as a strategy aimed at improving physiological reserve before surgery, but clinical implementation in thoracic surgery remains limited and poorly standardized, especially in complex patients. Since 2018, a structured collaboration between the Thoracic Surgery Unit and the Sports Medicine Unit of the Policlinico Riuniti of Foggia has progressively developed a multidisciplinary prehabilitation pathway integrated within an Enhanced Recovery After Surgery (ERAS) program, culminating in the implementation of a formally approved prospective protocol. Methods This retrospective–prospective single-centre observational study evaluated the effects of a structured and individualized exercise-based prehabilitation program in patients scheduled for lung resection. Patients underwent comprehensive functional assessment before (T0) and after prehabilitation (T1), including spirometry, body composition analysis, handgrip strength, and performance evaluation through the six-minute walk test (6MWT). The training program consisted of supervised aerobic, mobility, and resistance exercises prescribed according to ACSM principles and the FITT-VP model. Postoperative outcomes were analysed in patients undergoing major lung resection and compared with a contemporaneous non-prehabilitated control group with comparable baseline characteristics. Outcomes included postoperative complications, prolonged air leak (PAL), chest drain duration, and length of hospital stay (LOS). Multivariable regression analyses were performed to adjust for relevant clinical confounders. Results Between December 2022 and November 2025, 76 patients were referred for prehabilitation; 48 completed the program and were evaluated at T0 and T1, and 30 subsequently underwent major lung resection. Prehabilitation resulted in significant improvements in functional performance, with marked increases in 6MWT distance and walking speed, together wit favourable trends in respiratory and muscular parameters. Multivariable analysis demonstrated that functional improvement was primarily associated with exercise intensity 5 rather than the number of training sessions performed. Compared with matched controls, prehabilitated patients experienced a significantly lower incidence of postoperative complications and prolonged air leak, together with shorter air leak duration and trends toward reduced chest drain duration and hospital stay. Conclusions Exercise-based prehabilitation represents a feasible and effective strategy for perioperative optimization in complex thoracic surgical patients. The integration of a multidisciplinary, hospital- based prehabilitation pathway within ERAS programs may improve functional status before surgery and contribute to reducing postoperative morbidity, supporting its broader implementation in thoracic surgical practice.