human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: STUDY OBJECTIVES Surgical resection remains the treatment of choice for anatomically resectable non-small cell lung cancer . However , the presence of associated comorbid conditions increases the risk of death and surgical complications . Several studies have evaluated the usefulness of preoperative exercise testing for predicting postoperative morbidity and mortality . The aim of this study was to establish whether exercise testing could predict poor surgical outcome in lung cancer surgery and whether the absolute value or percentage of predicted value is the better predictor of the surgical outcome . DESIGN The study was design ed as a prospect i ve study . PATIENTS AND SETTING One hundred thirty patients with potentially operable lung cancer at Papworth Hospital over 2 years were recruited ; of these , 101 underwent curative surgery .  INTERVENTIONS Spirometry and cardiopulmonary exercise tests were performed for every patient ( n = 99 ) , except for two patients with back problems . We also recorded the outcome of surgery , in particular , complications and mortality . MEASUREMENTS AND RESULTS Mean maximum oxygen transport at peak exercise ( Vo(2)peak ) was 18.3 mL/kg/min ( SD , 4.7 mL/kg/min ) , and mean percentage of predicted Vo(2)peak value was 84.4 % ( SD , 30 % ) . Poor surgical outcome was significantly related to Vo(2)peak percentage of predicted ( p < 0.01 ) but not to the actual oxygen uptake value . CONCLUSIONS The use of the percentage of predicted Vo(2)peak value would be a better indicator of surgical outcome , since it predicts the surgical outcome better , and corrects for normal physiologic ranges . The threshold of Vo(2)peak for surgical intervention could be set between 50 % and 60 % of predicted without excess surgical mortality BACKGROUND The impact of short-term preoperative pulmonary rehabilitation on exercise capacity of patients with chronic obstructive pulmonary disease undergoing lobectomy for non-small cell lung cancer is evaluated . METHODS A prospect i ve observational study was design ed . Inclusion criteria consisted of an indication to lung resection because of a clinical stage I or II non-small cell lung cancer and a chronic obstructive disease on preoperative pulmonary function test . In such conditions , maximal oxygen consumption by a cardio-pulmonary exercise test was evaluated ; when this result ed as being < or = 15 ml/kg/min a pulmonary rehabilitation programme lasting 4 weeks was considered . Twelve patients fulfilled inclusion criteria , completed the preoperative rehabilitation programme and underwent a new functional evaluation prior to surgery . The postoperative record of these patients was collected . RESULTS On completion of pulmonary rehabilitation , the resting pulmonary function test and diffuse lung capacity of patients was unchanged , whereas the exercise performance was found to have significantly improved ; the mean increase in maximal oxygen consumption proved to be at 2.8 ml/kg/min ( p<0.01 ) . Eleven patients underwent lobectomy ; no postoperative mortality was noted and mean hospital stay was 17 days . Postoperative pulmonary complication was recorded in 8 patients . CONCLUSIONS Short-term preoperative pulmonary rehabilitation could improve the exercise capacity of patients with chronic obstructive pulmonary disease who are c and i date s for lung resection for non-small cell lung cancer Purpose It has not previously been shown whether there is any benefit to multi-morbid patients with lung cancer who participate in complex interdisciplinary rehabilitation programmes after primary therapy . The purpose of this prospect i ve study was to assess changes in exercise capacity and quality of life before and after an in-patient training programme . Patients and methods Forty-five patients with lung cancer ( WHO I-III after surgery and /or radiotherapy and /or chemotherapy )  were enrolled in a 28-day in-patient rehabilitation programme that included st and ardised aerobic training . Functional status and health-related quality of life ( QLQ-C30 , QLQ-LC13 , SF-36 , and MFI-20 ) were examined at the beginning of the study and at day 28 . Results A substantial increase in work performance ( bicycle ergometry from 68 ± 3 to 86 ± 4 W , p < 0.001 , and 6-minute walk test from 322 ± 11 to 385 ± 13 m , p < 0.001 ) was registered . In addition , heart rate at rest was reduced ( from 84 ± 2 to 80 ± 1 beats per minute , p < 0.05 ) and heart rate variability ( indicator of the efficacy of endurance training ) was significantly increased ( from 9.7 ± 1 to 12.9 ± 1 root mean square of successive differences , p < 0.001 ) . Moreover , there was also a significant improvement in quality of life ( 48 ± 3 to 62 ± 2 , p < 0.001 ) while fatigue was reduced from 66 ± 3 to 41 ± 4 , p < 0.001 . Conclusion A st and ardised , aerobic endurance training programme as part of the in-patient oncological rehabilitation of patients with lung cancer results in improvements in both physiological and psychological parameters after therapy . A follow-on study in order to determine to what extent this benefit persists over the long-term , particularly , in comparison with patients who have not participated in a rehabilitation programme , is currently being conducted OBJECTIVE The purpose of this study was to investigate the impact of pulmonary rehabilitation on surgical morbidity and lung function in lung cancer patients with chronic obstructive pulmonary disease ( COPD ) . METHODS Prospect ively , 22 lung cancer patients with COPD who underwent lobectomy between 2000 and 2003 were enrolled for this study as a rehabilitation group (  Rehab . Group ) . The criteria of COPD were preoperative forced expiratory volume in 1 second (FEV1)/forced vital capacity ( FVC ) < or = 70 % and more than 50 % of low attenuation area in a computed tomography . Preoperatively patients performed aggressive pulmonary exercise for two weeks and received chest physiotherapy postoperatively .  As a historical control , 60 patients with lung cancer who fulfilled the same criteria but did not receive rehabilitation between 1995 and 1999 ( control group ) were entered in this study . RESULTS Patient background s were all equivalent between the two groups . However , FEV1 and FEV1/FVC were significantly lower in the Rehab . Group ( p < 0.05 ) . Prolonged oxygen supplement and tracheostomy tended to be more frequent in the control group . The ratio of actual postoperative to predicted postoperative FEV1 was significantly better in the Rehab . Group ( p = 0.047 ) . Furthermore , postoperative hospital stay was significantly longer in the control group ( p = 0.0003 ) . CONCLUSION Despite lower FEV1 and FEV1/FVC in the Rehab . Group , postoperative pulmonary complications and long hospital stay could be effectively prevented and FEV1 was well preserved by rehabilitation and physiotherapy The effects of endurance training on exercise capacity and health-related quality of life ( HRQL ) in chronic obstructive pulmonary disease ( COPD ) patients have been studied thoroughly , while resistance training has been rarely evaluated . This study investigated the effects of resistance training in comparison with endurance training in patients with moderate to severe COPD and peripheral muscle weakness ( isometric knee extension peak torque < 75 % predicted ) . Forty-eight patients ( age 64±8 yrs , forced expiratory volume in one second 38±17 % pred ) were r and omly assigned to resistance training ( RT , n=24 ) or endurance training ( ET , n=24 ) . The former consisted of dynamic strengthening exercises . The latter consisted of walking , cycling and arm cranking .  Respiratory and peripheral muscle force , exercise capacity , and HRQL were re-evaluated in all patients who completed the 12-week rehabilitation ( RT n=14 , ET n=16 ) . Statistically significant increases in knee extension peak torque ( RT 20±21 % , ET 42±21 % ) , maximal knee flexion force ( RT 31±39 % , ET 28±37 % ) , elbow flexion force ( RT 24±19 % , ET 33±25 % ) , 6-min walking distance ( 6MWD ) ( RT 79±74 m , ET 95±57 m ) , maximum workload ( RT 15±16 Watt , ET 14±13 Watt ) and HRQL ( RT 16±25 points , ET 16±15 points ) were observed . No significant differences in changes in HRQL and 6MWD were seen between the two treatments . Resistance training and endurance training have similar effects on peripheral muscle force , exercise capacity and health-related quality of life in chronic obstructive pulmonary disease patients with peripheral muscle weakness Our aim was to determine the minimal important difference ( MID ) for 6-min walk distance ( 6MWD ) and maximal cycle exercise capacity ( MCEC ) in patients with severe chronic obstructive pulmonary disease ( COPD ) . 1,218 patients enrolled in the National Emphysema Treatment Trial completed exercise tests before and after 4–6 weeks of pre-trial rehabilitation  , and 6 months after r and omisation to surgery or medical care .  The St George 's Respiratory Question naire ( domain and total scores ) and University of California San Diego Shortness  of Breath Question naire ( total score ) served as anchors for anchor-based MID estimates . In order to calculate distribution-based estimates , we used the st and ard error of measurement , Cohen 's effect size and the empirical rule effect size . Anchor-based estimates for the 6MWD were 18.9 m ( 95 % CI 18.1–20.1 m ) , 24.2 m ( 95 % CI 23.4–25.4 m ) , 24.6 m ( 95 % CI 23.4–25.7 m ) and 26.4 m ( 95 % CI 25.4–27.4 m ) , which were similar to distribution-based MID estimates of 25.7 , 26.8 and 30.6 m. For MCEC , anchor-based estimates for the MID were 2.2 W ( 95 % CI 2.0–2.4 W ) , 3.2 W ( 95 % CI 3.0–3.4 W ) , 3.2 W ( 95 % CI 3.0–3.4 W ) and 3.3 W ( 95 % CI 3.0–3.5 W ) , while distribution-based estimates were 5.3 and 5.5 W. We suggest a MID of 26±2 m for 6MWD and 4±1 W for MCEC for patients with severe COPD STUDY OBJECTIVES Although the benefit of pulmonary rehabilitation ( PR ) has been demonstrated for patients with COPD , the benefit for patients with non- COPD lung disorders is still unclear . In the present study , we compared the effect of PR on patients with post-tuberculosis ( TBC ) lung disorders and patients with COPD . DESIGN We performed a prospect i ve nonr and omized open trial over a 9-week period . PATIENTS AND METHODS Thirty-two patients with post-TBC lung disorders ( thoracoplasty , 25 patients ; mean [ + /- SD ] age , 71 + /- 5 years ; FEV(1 ) , 0.84 + /- 0.29 L ) and 32 age-matched and FEV(1)-matched COPD patients were enrolled in the study . First , we compared the exercise tolerance between groups using a 6-min walking test . Next , we trained the patients using a 9-week outpatient PR program . We assessed improvement using clinical dyspnea ratings , a daily activity score , and the results of a 6-min walking test . RESULTS When age and FEV(1 ) were matched , the distance covered during the 6-min walking test did not differ between the groups . After rehabilitation , significant improvement was observed in both the post-TBC group and the COPD group in terms of Medical Research Council dyspnea grade , transition dyspnea index , activity score , and 6-min walking distance ( 42 m [ p < 0.01 ] vs 47 m [ p < 0.01 ] , respectively ) . The magnitudes of the improvement in these parameters were comparable between the groups . CONCLUSIONS PR is as beneficial in post-TBC lung disorder patients as in COPD patients if the severity of the disability is similar Deterioration in exercise tolerance and impairment in quality of life ( QoL ) are common consequences of lobectomy . This study evaluates additional exercise and strength training after lung resection on QoL , exercise tolerance and muscle strength .  Fifty-three ( 28 male ) patients attending thoracotomy for lung cancer , mean age , range 64 ( 32 - 82 ) years ; mean pack years ( SD ) 31.9 ( 26.8 ) ; BMI 25.6 ( 4.2 ) ; FEV1 2.0 ( 0.7 ) l were r and omised to control ( usual care ) or intervention ( twice daily training plus usual care ) . After discharge the intervention group received monthly home visits and weekly telephone calls , the control group received monthly telephone calls up to 12 weeks . Assessment pre-operatively , 5 day and 12 weeks post-operatively consisted of quadriceps strength using magnetic stimulation , 6 Minute Walking Distance ( 6MWD ) and QoL-EORTC-QLQ-LC13 . QoL was unchanged over 12 weeks ; 6 
    Output:
    
agent
Preliminary work from this review suggests that exercise intervention compared with usual care both pre and post-surgery is associated with improved cardiopulmonary exercise capacity , increased muscle strength and reduced fatigue , post-operative complications and hospital length of stay .
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: STUDY OBJECTIVES Surgical resection remains the treatment of choice for anatomically resectable non-small cell lung cancer . However , the presence of associated comorbid conditions increases the risk of death and surgical complications . Several studies have evaluated the usefulness of preoperative exercise testing for predicting postoperative morbidity and mortality . The aim of this study was to establish whether exercise testing could predict poor surgical outcome in lung cancer surgery and whether the absolute value or percentage of predicted value is the better predictor of the surgical outcome . DESIGN The study was design ed as a prospect i ve study . PATIENTS AND SETTING One hundred thirty patients with potentially operable lung cancer at Papworth Hospital over 2 years were recruited ; of these , 101 underwent curative surgery .  INTERVENTIONS Spirometry and cardiopulmonary exercise tests were performed for every patient ( n = 99 ) , except for two patients with back problems . We also recorded the outcome of surgery , in particular , complications and mortality . MEASUREMENTS AND RESULTS Mean maximum oxygen transport at peak exercise ( Vo(2)peak ) was 18.3 mL/kg/min ( SD , 4.7 mL/kg/min ) , and mean percentage of predicted Vo(2)peak value was 84.4 % ( SD , 30 % ) . Poor surgical outcome was significantly related to Vo(2)peak percentage of predicted ( p < 0.01 ) but not to the actual oxygen uptake value . CONCLUSIONS The use of the percentage of predicted Vo(2)peak value would be a better indicator of surgical outcome , since it predicts the surgical outcome better , and corrects for normal physiologic ranges . The threshold of Vo(2)peak for surgical intervention could be set between 50 % and 60 % of predicted without excess surgical mortality BACKGROUND The impact of short-term preoperative pulmonary rehabilitation on exercise capacity of patients with chronic obstructive pulmonary disease undergoing lobectomy for non-small cell lung cancer is evaluated . METHODS A prospect i ve observational study was design ed . Inclusion criteria consisted of an indication to lung resection because of a clinical stage I or II non-small cell lung cancer and a chronic obstructive disease on preoperative pulmonary function test . In such conditions , maximal oxygen consumption by a cardio-pulmonary exercise test was evaluated ; when this result ed as being < or = 15 ml/kg/min a pulmonary rehabilitation programme lasting 4 weeks was considered . Twelve patients fulfilled inclusion criteria , completed the preoperative rehabilitation programme and underwent a new functional evaluation prior to surgery . The postoperative record of these patients was collected . RESULTS On completion of pulmonary rehabilitation , the resting pulmonary function test and diffuse lung capacity of patients was unchanged , whereas the exercise performance was found to have significantly improved ; the mean increase in maximal oxygen consumption proved to be at 2.8 ml/kg/min ( p<0.01 ) . Eleven patients underwent lobectomy ; no postoperative mortality was noted and mean hospital stay was 17 days . Postoperative pulmonary complication was recorded in 8 patients . CONCLUSIONS Short-term preoperative pulmonary rehabilitation could improve the exercise capacity of patients with chronic obstructive pulmonary disease who are c and i date s for lung resection for non-small cell lung cancer Purpose It has not previously been shown whether there is any benefit to multi-morbid patients with lung cancer who participate in complex interdisciplinary rehabilitation programmes after primary therapy . The purpose of this prospect i ve study was to assess changes in exercise capacity and quality of life before and after an in-patient training programme . Patients and methods Forty-five patients with lung cancer ( WHO I-III after surgery and /or radiotherapy and /or chemotherapy )  were enrolled in a 28-day in-patient rehabilitation programme that included st and ardised aerobic training . Functional status and health-related quality of life ( QLQ-C30 , QLQ-LC13 , SF-36 , and MFI-20 ) were examined at the beginning of the study and at day 28 . Results A substantial increase in work performance ( bicycle ergometry from 68 ± 3 to 86 ± 4 W , p < 0.001 , and 6-minute walk test from 322 ± 11 to 385 ± 13 m , p < 0.001 ) was registered . In addition , heart rate at rest was reduced ( from 84 ± 2 to 80 ± 1 beats per minute , p < 0.05 ) and heart rate variability ( indicator of the efficacy of endurance training ) was significantly increased ( from 9.7 ± 1 to 12.9 ± 1 root mean square of successive differences , p < 0.001 ) . Moreover , there was also a significant improvement in quality of life ( 48 ± 3 to 62 ± 2 , p < 0.001 ) while fatigue was reduced from 66 ± 3 to 41 ± 4 , p < 0.001 . Conclusion A st and ardised , aerobic endurance training programme as part of the in-patient oncological rehabilitation of patients with lung cancer results in improvements in both physiological and psychological parameters after therapy . A follow-on study in order to determine to what extent this benefit persists over the long-term , particularly , in comparison with patients who have not participated in a rehabilitation programme , is currently being conducted OBJECTIVE The purpose of this study was to investigate the impact of pulmonary rehabilitation on surgical morbidity and lung function in lung cancer patients with chronic obstructive pulmonary disease ( COPD ) . METHODS Prospect ively , 22 lung cancer patients with COPD who underwent lobectomy between 2000 and 2003 were enrolled for this study as a rehabilitation group (  Rehab . Group ) . The criteria of COPD were preoperative forced expiratory volume in 1 second (FEV1)/forced vital capacity ( FVC ) < or = 70 % and more than 50 % of low attenuation area in a computed tomography . Preoperatively patients performed aggressive pulmonary exercise for two weeks and received chest physiotherapy postoperatively .  As a historical control , 60 patients with lung cancer who fulfilled the same criteria but did not receive rehabilitation between 1995 and 1999 ( control group ) were entered in this study . RESULTS Patient background s were all equivalent between the two groups . However , FEV1 and FEV1/FVC were significantly lower in the Rehab . Group ( p < 0.05 ) . Prolonged oxygen supplement and tracheostomy tended to be more frequent in the control group . The ratio of actual postoperative to predicted postoperative FEV1 was significantly better in the Rehab . Group ( p = 0.047 ) . Furthermore , postoperative hospital stay was significantly longer in the control group ( p = 0.0003 ) . CONCLUSION Despite lower FEV1 and FEV1/FVC in the Rehab . Group , postoperative pulmonary complications and long hospital stay could be effectively prevented and FEV1 was well preserved by rehabilitation and physiotherapy The effects of endurance training on exercise capacity and health-related quality of life ( HRQL ) in chronic obstructive pulmonary disease ( COPD ) patients have been studied thoroughly , while resistance training has been rarely evaluated . This study investigated the effects of resistance training in comparison with endurance training in patients with moderate to severe COPD and peripheral muscle weakness ( isometric knee extension peak torque < 75 % predicted ) . Forty-eight patients ( age 64±8 yrs , forced expiratory volume in one second 38±17 % pred ) were r and omly assigned to resistance training ( RT , n=24 ) or endurance training ( ET , n=24 ) . The former consisted of dynamic strengthening exercises . The latter consisted of walking , cycling and arm cranking .  Respiratory and peripheral muscle force , exercise capacity , and HRQL were re-evaluated in all patients who completed the 12-week rehabilitation ( RT n=14 , ET n=16 ) . Statistically significant increases in knee extension peak torque ( RT 20±21 % , ET 42±21 % ) , maximal knee flexion force ( RT 31±39 % , ET 28±37 % ) , elbow flexion force ( RT 24±19 % , ET 33±25 % ) , 6-min walking distance ( 6MWD ) ( RT 79±74 m , ET 95±57 m ) , maximum workload ( RT 15±16 Watt , ET 14±13 Watt ) and HRQL ( RT 16±25 points , ET 16±15 points ) were observed . No significant differences in changes in HRQL and 6MWD were seen between the two treatments . Resistance training and endurance training have similar effects on peripheral muscle force , exercise capacity and health-related quality of life in chronic obstructive pulmonary disease patients with peripheral muscle weakness Our aim was to determine the minimal important difference ( MID ) for 6-min walk distance ( 6MWD ) and maximal cycle exercise capacity ( MCEC ) in patients with severe chronic obstructive pulmonary disease ( COPD ) . 1,218 patients enrolled in the National Emphysema Treatment Trial completed exercise tests before and after 4–6 weeks of pre-trial rehabilitation  , and 6 months after r and omisation to surgery or medical care .  The St George 's Respiratory Question naire ( domain and total scores ) and University of California San Diego Shortness  of Breath Question naire ( total score ) served as anchors for anchor-based MID estimates . In order to calculate distribution-based estimates , we used the st and ard error of measurement , Cohen 's effect size and the empirical rule effect size . Anchor-based estimates for the 6MWD were 18.9 m ( 95 % CI 18.1–20.1 m ) , 24.2 m ( 95 % CI 23.4–25.4 m ) , 24.6 m ( 95 % CI 23.4–25.7 m ) and 26.4 m ( 95 % CI 25.4–27.4 m ) , which were similar to distribution-based MID estimates of 25.7 , 26.8 and 30.6 m. For MCEC , anchor-based estimates for the MID were 2.2 W ( 95 % CI 2.0–2.4 W ) , 3.2 W ( 95 % CI 3.0–3.4 W ) , 3.2 W ( 95 % CI 3.0–3.4 W ) and 3.3 W ( 95 % CI 3.0–3.5 W ) , while distribution-based estimates were 5.3 and 5.5 W. We suggest a MID of 26±2 m for 6MWD and 4±1 W for MCEC for patients with severe COPD STUDY OBJECTIVES Although the benefit of pulmonary rehabilitation ( PR ) has been demonstrated for patients with COPD , the benefit for patients with non- COPD lung disorders is still unclear . In the present study , we compared the effect of PR on patients with post-tuberculosis ( TBC ) lung disorders and patients with COPD . DESIGN We performed a prospect i ve nonr and omized open trial over a 9-week period . PATIENTS AND METHODS Thirty-two patients with post-TBC lung disorders ( thoracoplasty , 25 patients ; mean [ + /- SD ] age , 71 + /- 5 years ; FEV(1 ) , 0.84 + /- 0.29 L ) and 32 age-matched and FEV(1)-matched COPD patients were enrolled in the study . First , we compared the exercise tolerance between groups using a 6-min walking test . Next , we trained the patients using a 9-week outpatient PR program . We assessed improvement using clinical dyspnea ratings , a daily activity score , and the results of a 6-min walking test . RESULTS When age and FEV(1 ) were matched , the distance covered during the 6-min walking test did not differ between the groups . After rehabilitation , significant improvement was observed in both the post-TBC group and the COPD group in terms of Medical Research Council dyspnea grade , transition dyspnea index , activity score , and 6-min walking distance ( 42 m [ p < 0.01 ] vs 47 m [ p < 0.01 ] , respectively ) . The magnitudes of the improvement in these parameters were comparable between the groups . CONCLUSIONS PR is as beneficial in post-TBC lung disorder patients as in COPD patients if the severity of the disability is similar Deterioration in exercise tolerance and impairment in quality of life ( QoL ) are common consequences of lobectomy . This study evaluates additional exercise and strength training after lung resection on QoL , exercise tolerance and muscle strength .  Fifty-three ( 28 male ) patients attending thoracotomy for lung cancer , mean age , range 64 ( 32 - 82 ) years ; mean pack years ( SD ) 31.9 ( 26.8 ) ; BMI 25.6 ( 4.2 ) ; FEV1 2.0 ( 0.7 ) l were r and omised to control ( usual care ) or intervention ( twice daily training plus usual care ) . After discharge the intervention group received monthly home visits and weekly telephone calls , the control group received monthly telephone calls up to 12 weeks . Assessment pre-operatively , 5 day and 12 weeks post-operatively consisted of quadriceps strength using magnetic stimulation , 6 Minute Walking Distance ( 6MWD ) and QoL-EORTC-QLQ-LC13 . QoL was unchanged over 12 weeks ; 6 
    Output:
    