{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T06:30:28Z","timestamp":1786516228943,"version":"build-2736575974"},"reference-count":50,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Postoperative 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A 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\u20130.53; I\n                      <jats:sup>2<\/jats:sup>\n                      = 0%), pneumonia or pulmonary infection (RR = 0.52, 95% CI 0.36\u20130.75; I\n                      <jats:sup>2<\/jats:sup>\n                      = 0%), atelectasis (RR = 0.36, 95% CI 0.25\u20130.51; I\n                      <jats:sup>2<\/jats:sup>\n                      = 0%), and respiratory failure (RR = 0.37, 95% CI 0.17\u20130.78; I\n                      <jats:sup>2<\/jats:sup>\n                      = 0%). Prehabilitation also reduced postoperative length of hospital stay (MD = \u22122.22 days, 95% CI \u22122.52 to \u22121.92; I\n                      <jats:sup>2<\/jats:sup>\n                      = 52%). Results for preoperative 6-minute walk distance were inconsistent and were summarized narratively because of substantial heterogeneity.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Preoperative 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic review registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/prospero\/<\/jats:ext-link>\n                      , identifier CRD420251273259.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1899789","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T05:54:43Z","timestamp":1786514083000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Preoperative exercise-based prehabilitation for reducing postoperative pulmonary complications after lung cancer surgery: a systematic review and meta-analysis"],"prefix":"10.3389","volume":"13","author":[{"given":"Qi-Qi","family":"Chen","sequence":"first","affiliation":[{"name":"Sir Run Run Shaw Hospital (SRRSH), Zhejiang University School of Medicine","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yin","family":"Liang","sequence":"additional","affiliation":[{"name":"Sir Run Run Shaw Hospital (SRRSH), Zhejiang University School of Medicine","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"YiHong","family":"Xu","sequence":"additional","affiliation":[{"name":"Sir Run Run Shaw Hospital (SRRSH), Zhejiang University School of Medicine","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lin-Fang","family":"Zhao","sequence":"additional","affiliation":[{"name":"Sir Run Run Shaw Hospital (SRRSH), Zhejiang University School of Medicine","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,12]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"229","DOI":"10.3322\/caac.21834","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J Clin."},{"key":"B2","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1093\/ejcts\/ezy301","article-title":"Guidelines for enhanced recovery after lung surgery: recommendations of the Enhanced Recovery After Surgery (ERAS\u00ae) Society and the European Society of Thoracic Surgeons (ESTS).","volume":"55","author":"Batchelor","year":"2019","journal-title":"Eur J Cardiothorac Surg"},{"key":"B3","doi-asserted-by":"publisher","first-page":"317","DOI":"10.1093\/bja\/aex002","article-title":"Postoperative pulmonary complications.","volume":"118","author":"Miskovic","year":"2017","journal-title":"Br J Anaesth"},{"key":"B4","doi-asserted-by":"publisher","first-page":"223","DOI":"10.2147\/TCRM.S195010","article-title":"Risk factors of postoperative pulmonary complications after minimally invasive anatomic resection for lung cancer.","volume":"15","author":"Yang","year":"2019","journal-title":"Ther Clin Risk Manag"},{"key":"B5","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1136\/thoraxjnl-2015-207697","article-title":"Long-term impact of developing a postoperative pulmonary complication after lung surgery.","volume":"71","author":"Lugg","year":"2016","journal-title":"Thorax"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1317","DOI":"10.2147\/COPD.S105206","article-title":"Prevalence of and risk factors for postoperative pulmonary complications after lung cancer surgery in patients with early-stage COPD.","volume":"11","author":"Kim","year":"2016","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"key":"B7","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1016\/j.anclin.2014.11.002","article-title":"Prehabilitation to enhance perioperative care.","volume":"33","author":"Carli","year":"2015","journal-title":"Anesthesiol Clin"},{"key":"B8","doi-asserted-by":"publisher","first-page":"434","DOI":"10.1016\/j.bja.2021.12.007","article-title":"Prehabilitation, enhanced recovery after surgery, or both?","volume":"128","author":"Gillis","year":"2022","journal-title":"A narrative review. 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