Table 1.

Characteristics of included studies.

Reference, Year	Intervention	Duration/Frequency	N	Setting	Follow-Up Time (Days)	Participants	Outcomes of Interest	Feasibility/AE	Additional Notes	Main Findings
Aerobic exercise training and inspiratory muscle training
Huang et al., 2017 [18]	Three conditions: 1. (a) IMT-ABT: two to three times daily for 15–20 min/s; -TBT (Voldyne 5000): 20 min at least four times daily; (b) CRT (NuStep): twice daily for 20 min/s; (c) psychological educational guidance (EG) 2. Single IMT (SG) 3. Routine preoperative preparation (CG)	1 week 2 times a day	60	In hospital	No follow-up	90 patients were randomized: age, mean (SD); Control group: n = 30, 63.6 (6.5); Exercise group: n = 30, 63.0 (8.7); Single group: n = 30, 64.1 (5.3)	Hospitalization postoperative days a PPCs c 6MWD (meters) ab PEF (L/min) ab FEV1 (L) cd FVC (L) cd Fatigue cd Dyspnoea cd DLCO (mL/min/mmHg) cd HRQoL ab Physical function cd Emotional function cd	The completion rates suggest that compliance with the programs is likely to be high and also supports the feasibility of the EG program	Proportion of subjects who completed the pogram (97%). Adherence to the prescribed training sessions NR. SG did not show significant differences in outcomes compared with CG	This hospital-based short-term pattern of PPR combining high-intensity IMT with CRT could be a feasible strategy for treating NSCLC patients, especially those with risk factors of PPCs awaiting surgery
Lai et al., 2016 [19]	Two conditions: 1. I. Pharmacotherapy (Bricanyl, Pulmicort, Mucosolvan): 2 times/day; II. Physical rehabilitation: (a) IMT-ABT: (20–30 rep in 15–30 min), -TBT (Voldyne 5000): 2–3 s, 12–20 rep/2 h; (b) -EET-LE (NuStep): 15–20 min/day, -Climbing ladder training (EG): 15–30 min/day 2. Underwent standard preoperative (CG)	1 week Daily	48	In hospital	No follow-up	48 patients were randomized: age, mean (SD); Exercise group: n = 24, 63.13 (6.26); Control group: n = 24, 64.04 (8.94)	Hospitalization postoperative days a PEF (L/min) b 6MWD (meters) b HRQoL d Physical function d Emotional function d Dyspnoea d Fatigue d PPCs c	No AE related to the intervention	Proportion of subjects who completed the pogram (100%). Adherence to the prescribed training sessions NR	Pre-operative short-term comprehensive pulmonary rehabilitation training can improve pulmonary resistance of patients with mild to moderate COPD, accelerate rapid recovery of patients after surgery, can be used as an important part of the PPR fast
Lai, Huang, et al., 2017 [20]	Two conditions: 1. (a) IMT-ABT: twice per day 15–20 min/s; -TBT (Voldyne 5000): 3 s/day 20 min/s. (b) EET (NuStep): 30 min/day 2. Usual care (CG)	1 week Daily	127	In hospital	No follow-up	60 patients were randomized: age, mean (SD); Exercise group: n = 30, 72.5 ± (3.4); Control group: n = 30, 71.6 ± (1.9)	Hospitalization postoperative days a PEF (L/min) ab FVC (L) c FEV1 (L) c DLCO (ml/min/mmHg) c 6MWD (meters) ab HRQoL c Physical function c Emotional function c Dyspnoea c PPCs a	4 patients in the EG suspended the training because they could not endure the highly intensive regimen, 1 perceived a lack of benefit, and 1 suffered from knee pain	Proportion of subjects who completed the pogram (47%). Adherence to the prescribed training sessions NR	PPR played a positive physical role in improving the PEF and 6MWD in elderly surgical patients with LC while significantly reducing the postoperative length of stay. We, thus, consider the 7-day intensive pattern of PPR to be a feasible rehabilitation strategy for elderly NSCLC patients in China
Lai, Su, et al., 2017 [21]	Two conditions: 1. (a) IMT-TBT (HUDSON RCI 2500): 3 s/day, 20 rep/s; -ABT: twice per day 15–30 min/s. (b) EET (NuStep): 30 min/day 2. Usual care (CG)	1 week Daily	101	In hospital	No follow-up	101 patients were randomized: age, mean (SD); Exercise group: n = 51, 63.8 ± (8.2); Control group: n = 50, 64.6 ± (6.6) Range: (50–80 years)	Hospitalization postoperative days a PEF (L/min) ab 6MWD (meters) ab HRQoL cd Physical function cd Emotional function cd Dyspnoea cd Fatigue cd PPCs a	No AE related to the intervention	Proportion of subjects who completed the pogram (94%). Adherence to the prescribed training sessions NR	Fewer PPCs and better postoperative recovery in the EG, which led to shorter postoperative hospital stays, reduced use of medications and medical care, consequently, lower in-hospital expenses
Stefanelli et al., 2013 [26]	Two conditions: 1. (a) IMT: Respiratory exercises on the bench, mattress pad and wall bar. (b) EET: High intensity training of UE (rowing ergometer) and LE (treadmill and the ergometric bicycle), 70% PWC (c) Pharmacotherapy (bronchodilators, inhaled corticosteroids) 2. Usual care (CG)	3 weeks 5 times a week	40	In hospital	60	40 patients were randomized: age, mean (SD); Exercise group: 65.5 (± 7.4) Control group: 64.8 (± 7.3)	FEV1 (L) ab VO2peak (mL/kg/min) ab DLCO (ml/min/mmHg) cd Dyspnoea ab	NR	Proportion of subjects who completed the pogram NR. Adherence to the prescribed training sessions NR	It is possible to state that preoperative high-intensity PRP improves the degree of physical performance of patients with COPD and NSCLC undergoing surgical resection compared with similar surgical patients who did not undergo preoperative PRP
Aerobic exercise training, strength training, and IMT
Benzo et al., 2011 [22]	Two studies: I. NR II. Two conditions: 1. (a) EET (LE/UE) (NuStep): 20 min (b) Strength alternating UE/LE every other day (Thera-band): 2s × 10–12 rep (c) (IMT) (Threshold IMT or the P-Flex valve) (EG): 15–20 min of daily use. 2. Usual care (CG)	I. 4 weeks II. 1 week 2 times a day	I. 9; II. 19	I. In hospital II. In hospital	No follow-up	I. 9 patients were randomized: EG n = 5; CG n = 4 II. 17 patients were randomized: age, mean (SD); Exercise group: n = 9, 70.2 (8.61); Control group: n = 8, 72.0 (6.69)	II. Hospitalization postoperative days c PPCs a	I. Non-feasibility of 4 weeks of PPR. No AE related to the intervention	II. Proportion of subjects who completed the pogram (89%). Adherence to the prescribed training sessions NR	I. PPR is appropriate and recommended by experts. II. The development of a short and feasible PPR protocol was the natural consequence of the failure of the longer one. The 10-session protocol showed a high likelihood of decreasing hospital length of stay, a very meaningful outcome that is a crude estimation of postoperative morbidity and costs
Sebio García et al., 2017 [27]	Two conditions: 1. (a) EET moderate (cycle ergometer-Monark): -30 min interval training -5 min warm-up (30% PWC) -1 min (80% PWC) -4 min (active rest 50% PWC). -4 min cool down (30% PWC) (b) CRT: - elastic bands (Thera-Band®) body-weight exercises: six different exercises: 15 rep × 3 s, 45 s micropause (increased to 4 s if tolerated) (c) IMT (Coach 2 Incentive Spirometer®). -TBT: 2 s/day 30 sustained inspirations (80% MVC) end inspiratory hold (2–3 s). 6 cycles × 5 rep, 1 min pause/ cycle. 2. Usual care (CG)	Median of 16 sessions 3–5 times a week	40	In hospital	55	22 patients were randomized: age, mean (SD); Exercise group: n = 10, 70.9 ± (6.1); Control group: n = 12, 69.4 ± (9.4)	Hospitalization postoperative days c PPCsc 6MWD (meters) cd Physical Component ad Physical functioning d Emotional function d	No AE related to the intervention.	Proportion of subjects who completed the pogram (55%). Adherence to the prescribed training sessions NR	Although no significant differences between groups were observed at three weeks in any of the variables analyzed, three months postoperatively, there were statistically significant differences in the mean change for the exercise capacity, the physical component summary, and the upper and lower muscle strength assessment leading to two opposite trends in patients’ recovery
Aerobic exercise training and strength training
Licker et al., 2017 [24]	Two conditions: 1. (a) Warm-up: 5 min (50% PWC); 2 s × 10 min [(interv 15 s (80–100% PWC), micropause 15 s, macropause 4 min/s; Cooled down: 5 min (30% PWC) (b) EET (cycle ergometer) (c) strengthening UE/LE: leg press, leg extension, back extension, seat row, biceps curls or chest and shoulder press 2. Usual care (CG)	3–4 weeks 2–3 times a week	164	In hospital	No follow-up	151 patients were randomized: age, mean (SD); Exercise group: n = 74, 64 (13); Control group: n = 77, 64 (10)	VO2peak (mL/kg/min) ab 6MWD (meters) ab PPCs a Hospitalization postoperative (days) c	No AE related to the intervention	Proportion of subjects who completed the pogram (92%). Adherence to the prescribed training sessions. EG: 87 ± 18%	Demonstrated the safety and effectiveness of a short-term exercise training program in improving aerobic performances in patients LC. However, this HIIT rehabilitation modality failed to produce significant difference in composite morbidity-mortality index, compared with usual care
Multicomponent training and IMT
Morano et al., 2014 [25]	Two conditions: 1. (a) Stretching LE/UE; (b) warm-up exercises; (c) strengthening UE (50% PWC), PNF (barbells); (d) EET (treadmill) 80% PWC; (e) IMT; (f) educational sessions 2. (a) CPT (routine protocol of the hospital comprising lung expansion techniques) -sustained maximum inspiration; -fractional inspiration; -breathing patterns; -pursed lip breathing; -use of a flow-based incentive spirometer (Respiron) (b) Educational sessions (CG)	4 weeks 5 times a week	31	In hospital	30	24 patients were randomized: age, mean (SD); Exercise group: n = 12, 65 ± (8); Control group: n = 12, 69 ± (7)	6MWD (meters) cd HRQoL cd	No AE related to the intervention	Proportion of subjects who completed the pogram (100%). Adherence to the prescribed training sessions NR	The study showed improvements in PEF and 6MWD and reductions in the total / postoperative length of stay, hospital costs and occurrence of PPCs
Only aerobic exercise training
Karenovics et al., 2017 [23]	Two conditions: 1. (a) Warm-up: 5 min (50% PWC); 2 s × 10 min (interv 15 s sprint and 15 s pause, macropause 4 min/s); Cooled down: 5 min (30% PWC) (b) EET (cycle ergometer) 2. Usual care (CG)	2–4 weeks 3 times a week	164	In hospital	30	151 patients were randomized: age, mean (SD); Exercise group: n = 74, 64 (13); Control group: n = 77, 64 (10)	VO2peak (mL/kg/min) a PPCs a	No AE related to the intervention	Proportion of subjects who completed the pogram (92%). Adherence to the prescribed training sessions was 87 ± 18% (median 8 sessions, IQ 25–75% [7,8,9,10]) in EG	A HIIT program limited to the preoperative period is not associated with better functional and clinical outcome 1 year after lung cancer surgery

Preoperative pulmonary rehabilitation (PPR); lower extremity (LE); upper extremity (UE); experimental group (EG); control group (CG); single group (SG); exercise endurance training (EET); inspiratory muscle training (IMT); postoperative pulmonary complications (PPCs); adverse events (AE); standard deviation (SD); not reported (NR); abdominal breathing training (ABT); thoracic breathing training (TBT); 6-min walking distance (6MWD); peak expiratory flow (PEF); health-related quality of life (HRQoL); chest physical therapy (CPT); peak work capacity (PWC); unsupported upper limb exercise test (UULEX); whole-body vibration training (WBVT); conventional resistance training (CRT); maximal vital capacity (MVC); video-assisted thoracoscopy (VATS); non-small-cell lung cancer (NSCLC); forced vital capacity (FVC); peak of oxygen consumption (VO₂peak); forced expiratory volume in one second (FEV₁); diffusion capacity of the lung to carbon monoxide (DLCO); chronic obstructive pulmonary disease (COPD); high intensity interval training (HIIT); proprioceptive neuromuscular facilitation (PNF). ^a Significantly greater improvement the intervention compared with control; ^b significant program effects for exercise group from baseline to post intervention; no significant effect for controls; ^c no significant intervention difference between exercise and control groups; ^d without significant effects for the exercise group from the beginning to the post intervention.