The purpose of this K23 proposal is to prepare the candidate to become an independent investigator, able to design, conduct, and acquire funding for, high-quality clinical trials that focus on measuring and improving outcomes and quality of care for patients with Chronic Obstructive Pulmonary Disease (COPD) and Lung Cancer. During the proposed study period, career development activities will include (1) one-on-one mentoring, (2) development and conduct of a research project, (3) presentation and publication of research findings, and (4) course work leading to a Masters degree in epidemiology. The candidate proposes a research project that will focus on demonstrating a novel approach for decreasing pulmonary complications and hospital stay after lung cancer resection, a major cause of morbidity and mortality. Decreasing the incidence of postoperative pulmonary complications (PPC) will allow more patients to safely undergo and recover from surgery, currently the most effective treatment for lung cancer. Currently, the only intervention shown to decrease the incidence of post-operative pulmonary complications is smoking cessation. Independent predictors of pulmonary complications after lung resection are all consequences of COPD. Eighty percent of patients with lung cancer have COPD. Pulmonary rehabilitation (PR) has been shown to effectively reduce symptoms, exacerbations and duration of hospitalization in COPD. The research proposal and specific aim of this K award includes a randomized controlled trial (exercise versus usual care) that will examine the effects of four weeks of preoperative upper and lower extremity endurance training on postoperative pulmonary complications and hospital stay after lung cancer resection in patients with COPD and moderate to high operative risk. It will evaluate functional capacity three month after discharge. It is hypothesized that four weeks of preoperative exercise training, when compared to usual care, will (1) decrease the number of hospital days, (2) result in significantly fewer intensive care and ventilator days, (3) decrease the incidence of major postoperative pulmonary complications, including pneumonia, respiratory failure, prolonged mechanical ventilation, atelectasis, and (4) improve recovery to active life.
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