Inah Kim; Haejung Lee

doi:10.4040/jkan.2014.44.4.381

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Original Article
Effects of a Progressive Walking Program on Physical Activity, Exercise Tolerance, Recovery, and Post-Operative Complications in Patients with a Lung Resection: Inah Kim, Haejung Lee; Journal of Korean Academy of Nursing 2014;44(4):381-390.
DOI: https://doi.org/10.4040/jkan.2014.44.4.381
Published online: August 15, 2014

College of Nursing, Pusan National University, Yangsan, Korea

Address reprint requests to : Lee, Haejung College of Nursing, Pusan National University, Beomeo-ri, Mulgeum-eup, Yangsan 626-870, Korea Tel: +82-51-510-8344 Fax: +82-51-510-8308 E-mail: haejung@pusan.ac.kr

• Received: January 10, 2014 • Revised: February 7, 2014 • Accepted: June 26, 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

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Abstract
REFERENCES

Abstract

Purpose
The purpose of this study was to identify the effects of a Progressive Walking program (PW) on physical activity, exercise tolerance, recovery, and post-operative complications for patients with a lung resection.
Methods
A nonequivalent control group non-synchronized design was utilized and 37 participants with a lung resection (22 for control group, 15 for experimental group) were recruited at A university hospital from December 2012 to August 2013. The PW consisted of preoperative education, goal setting, and feedback, provided to the experimental group, and usual care to the control group. Data were analyzed using the SPSS WIN 18.0.
Results
A higher proportion of patients in the experimental group showed adequate levels of physical activity (p= .001), shorter period of chest tube retention (≤ 7 days; p= .011), and shorter stay in the hospital (≤ 10 days; p= .036) than patients in the control group. Patients in the experimental group reported longer 6-minute walking distance (p= .032) and lower levels of dyspnea (p= .049) than patients in the control group. The PW did not influence the occurrence of pulmonary complications.
Conclusion
The findings of this study suggest that the PW could be a useful strategy for improving patients’ post-operative health and reducing cost after lung resection.
Keywords: Pneumonectomy; Lung neoplasms; Walking; Exercise tolerance

Figure 1.

Effects of progressive walking program on patterns of physical activity and 6 minute walking distance.

Table 1.

Contents of Progressive Walking Program

Categories	Contents
Pre operation education	1) Preview=Exercise, manual for Pedometer.
	2) Video=Anatomy of lung, kind of operation, importance of exercise & nutrition.
	→ Provided to patients and their family caregivers
Goal setting	1) Walking=Using the pedometer.
	Start from 1000 steps and increase 8 % everyday. (POD 10=1999 steps/POD 20=4315 steps/POD 30=10062 steps)
	2) Shoulder=Elevation through flexion & abduction, external & internal rotation (OP day=1 set).
	Once 1 set achieved, ↑the numbers of sets (Max 8 sets). 3) Respiration=Deep breathing & coughing (OP day=1 set).
	Once 1 set achieved, ↑the numbers of sets (Max 8 sets).
Feedback	1) Identify the amount of exercise & difficulties during exercise.
	2) Encouraging message=Address barriers to exercise for increasing amounts of exercise. POD 1-5=Provided daily feedback.
	POD 6-30=Provided feedback once every 3 days (Feedback by telephone call after discharge).

POD=Post operative day; OP=Operation.

Table 2.

Homogeneity Test for Characteristics between Experimental and Control Group Participants (N=37)

Characteristics	Categories	Total	Exp. (n=15)	Cont. (n=22)	χ²	p
Characteristics	Categories	n (%) or M±SD	n (%) or M±SD	n (%) or M±SD	χ²	p
Age (year)	<65	25 (67.6)	12 (80.0)	13 (59.1)		.286*
	≥65	12 (32.4)	3 (20.0)	9 (40.9)
		59.51±11.06	59.46±8.89	59.50±12.54
Gender	Male	28 (75.7)	11 (73.3)	17 (77.3)		1.000*
	Female	9 (24.3)	4 (26.7)	5 (22.7)
Spouse	Yes No	34 (91.9) 3 (8.1)	14 (93.3) 1 (6.7)	20 (90.9) 2 (9.1)		1.000*
Education	≤Middle school	19 (51.4)	8 (53.3)	11 (50.0)	0.04	1.000
	≥High school	18 (48.6)	7 (46.7)	11 (50.0)
Regular exercise	Yes No	14 (37.8) 23 (62.2)	7 (46.7) 8 (53.3)	7 (31.8) 15 (68.2)	0.84	.361
Operation history	Yes	20 (54.1)	8 (53.3)	13 (59.1)	0.55	.457
	No	17 (45.9)	7 (46.7)	9 (40.9)
BMI	<18.5	1 (2.7)	0 (0.0)	1 (4.6)		.891*
	18.5 to<25.0	30 (81.1)	12 (80.0)	18 (81.8)
	≥25.0	6 (16.2)	3 (20.0)	3 (13.6)
		23.01±2.73	23.08±2.96	22.96±2.63
Comorbidity	Yes	25 (67.6)	9 (60.0)^†	16 (27.3)^‡	0.66	.202
	No	12 (32.4)	6 (40.0)	6 (72.7)
Smoking state	Never smoked	22 (59.5)	8 (53.3)	14 (63.6)		.177*
	Quit smoking Current smoker	9 (24.3) 6 (16.2)	1 (6.7) 6 (40.0)	3 (13.7) 5 (22.7)
FEV1 % predicted	<80	27 (73.0)	10 (66.7)	17 (77.3)	0.51	.708
	≥80	10 (27.0)	5 (33.3)	5 (22.7)
		72.70±9.97	73.00±9.97	72.50±10.19

Exp.=Experimental group; Cont.=Control group; FEV1=Forced Expiratory Volume in 1 second; BMI=Body Mass Index. *Fisher’s exact test;

^†Hypertension, diabetes;

^‡Hypertension, diabetes, arthritis, osteoporosis, gastritis.

Table 3.

Homogeneity Test for Levels of Physical Activity, 6 Minute Walk Distance, and Dyspnea at Pre-test between Experimental and Control Groups (N=37)

Characteristics	Total	Exp. (n=15)	Cont. (n=22)	χ² or t or U	p
Characteristics	n (%) or M±SD	n (%) or M±SD	n (%) or M±SD	χ² or t or U	p
Physical activity				0.54	.207
Adequate	22 (59.5)	10 (66.7)	12 (54.5)
Inadequate	15 (40.5)	5 (33.3)	10 (45.5)
6 minute walk distance (m)	472.35±83.91	457.35±78.45	482.85±87.95	−0.89	.382
Dyspnea	12.01±13.45	10.37±9.82	13.13±15.58	160	.870

Exp.=Experimental group; Cont.=Control group; Adequate=Meet physical activity guidelines (≥900 MET-min/wk); Inadequate=Do not meet physical activity guidelines (<900 MET-min/wk).

Table 4.

Effects of Progressive-walking Program on Daily Steps, Pulmonary Complications, and Recovery (N=37)

Outcome variables	Exp. (n=15)	Cont. (n=22)	t	p
Outcome variables	n (%) or M±SD	n (%) or M±SD	t	p
Total steps at POD 30 days	9,933.33±6,485.85	−
<10,000	8 (53.3)	−
≥10,000	7 (46.7)	−
Recovery
Number of days with chest tube retention (days)	5.93±2.93	8.45±6.20		.016*
≤7	13 (86.7)	10 (45.5)
>7^†	2 (13.3)	12 (54.5)
Hospital stay (days)	8.80±3.73	11.68±6.46		.047*
≤10	12 (80.0)	10 (45.5)
>10^‡	3 (20.0)	12 (54.5)
Dyspnea	12.59±11.00	21.71±16.25	2.03	.049
Occurrence of pulmonary complication (OP day-POD 30)	0 (0.0)	3 (13.6)		.233*

Exp.=Experimental group; Cont.=Control group; OP=Operation; POD=Post operative Day; *Fisher’s exact test;

^†Reasons=Persistent air leakage (43.0%), chest tube drainage>100 ml for last 24 hours (28.5%), both persistent air leak and chest tube drainage>100 ml for last 24 hours (28.5%);

^‡Reasons=Further evaluation (40.0%), delayed removal of chest tube (33.3%), refuse to be discharged (20.0%), pneumonia (6.7%).

REFERENCES

1. Statistics Korea. 2010 life tables for Korea [Internet]. Daejeon: Author; 2011.[cited 2012 December 10]. Available from:. http://kostat.go.kr/portal/korea/kor_nw/3/index.board?bmode=read&aSeq=252533
2. Win T, Groves AM, Ritchie AJ, Wells FC, Cafferty F, Laroche CM. The effect of lung resection on pulmonary function and exercise capacity in lung cancer patients. Respiratory Care. 2007;52(6):720–726.PubMed
3. Johar RS, Hayn MH, Stegemann AP, Ahmed K, Agarwal P, Balbay MD, et al. Complications after robot-assisted radical cystectomy: Results from the International Robotic Cystectomy Consortium. European Urology. 2013;64(1):52–57. http://dx.doi.org/10.1016/j.eururo.2013.01.010Article PubMed
4. Scholes RL, Browning L, Sztendur EM, Denehy L. Duration of anaesthesia, type of surgery, respiratory co-morbidity, predicted VO2max and smoking predict postoperative pulmonary complications after upper abdominal surgery: An observational study. Australian Journal of Physiotherapy. 2009;55(3):191–198.Article PubMed
5. Agostini P, Cieslik H, Rathinam S, Bishay E, Kalkat MS, Rajesh PB, et al. Postoperative pulmonary complications following thoracic surgery: Are there any modifiable risk factors? Thorax. 2010;65(9):815–818. http://dx.doi.org/10.1136/thx.2009.123083Article PubMed
6. Varela G, Ballesteros E, Jiménez MF, Novoa N, Aranda JL. Cost-effectiveness analysis of prophylactic respiratory physiotherapy in pulmonary lobectomy. European Journal of Cardio-Thoracic Surgery. 2006;29(2):216–220. http://dx.doi.org/10.1016/j.ejcts.2005.11.002Article PubMed
7. Novoa N, Ballesteros E, Jimenez MF, Aranda JL, Varela G. Chest physiotherapy revisited: Evaluation of its influence on the pulmonary morbidity after pulmonary resection. European Journal of Cardio-Thoracic Surgery. 2011;40(1):130–134. http://dx.doi.org/10.1016/j.ejcts.2010.11.028Article PubMed
8. Cesario A, Ferri L, Galetta D, Pasqua F, Bonassi S, Clini E, et al. Post-operative respiratory rehabilitation after lung resection for non-small cell lung cancer. Lung Cancer. 2007;57(2):175–180. http://dx.doi.org/10.1016/j.lungcan.2007.02.017Article PubMed
9. Hirschhorn AD, Richards D, Mungovan SF, Morris NR, Adams L. Supervised moderate intensity exercise improves distance walked at hospital discharge following coronary artery bypass graft surgery: A ran- domised controlled trial. Heart, Lung & Circulation. 2008;17(2):129–138. http://dx.doi.org/10.1016/j.hlc.2007.09.004Article
10. Souza Possa S, Braga Amador C, Meira Costa A, Takahama Sakamoto E, Seiko Kondo C, Maida Vasconcellos AL, et al. Implementation of a guideline for physical therapy in the postoperative period of upper abdominal surgery reduces the incidence of atelectasis and length of hospital stay. Revista Portuguesa de Pneumologia. 2014;20(2):69–77. http://dx.doi.org/10.1016/j.rppneu.2013.07.005Article PubMed
11. Reeve JC, Nicol K, Stiller K, McPherson KM, Denehy L. Does physiotherapy reduce the incidence of postoperative complications in patients following pulmonary resection via thoracotomy? A protocol for a randomised controlled trial. Journal of Cardiothoracic Surgery. 2008;3:48http://dx.doi.org/10.1186/1749-8090-3-48Article PubMed PMC PDF
12. Arbane G, Tropman D, Jackson D, Garrod R. Evaluation of an early exercise intervention after thoracotomy for non-small cell lung cancer (NSCLC), effects on quality of life, muscle strength and exercise tolerance: Randomised controlled trial. Lung Cancer. 2011;71(2):229–234. http://dx.doi.org/10.1016/j.lungcan.2010.04.025Article PubMed
13. Seo YH, Kang HS. The effects of the respiration strengthening exercise program on pulmonary function, anxiety, and sleep of patients underwent lung surgery. Clinical Nursing Research. 2007;13(3):157–167.
14. Jung KJ, Lee YS. The effect of a breathing exercise intervention on pulmonary function after lung lobectomy. Journal of Korean Oncology Nursing. 2010;10(1):95–102.
15. Hong YL. Effect of preoperative educational DVD on postoperative self care knowledge and performance in lung cancer patient [master’s thesis]. Seoul: Hanyang University; 2007.
16. Bourke L, Homer KE, Thaha MA, Steed L, Rosario DJ, Robb KA, et al. Interventions for promoting habitual exercise in people living with and beyond cancer. Cochrane Database of Systematic Reviews. 2013;9:CD010192http://dx.doi.org/10.1002/14651858.CD010192.pub2Article
17. Lyons EJ, Hatkevich C. Prevalence of behavior changing strategies in fitness video games: Theory-based content analysis. Journal of Medical Internet Research. 2013;15(5):e81http://dx.doi.org/10.2196/jmir.2403Article PubMed PMC
18. Richardson CR, Newton TL, Abraham JJ, Sen A, Jimbo M, Swartz AM. A meta-analysis of pedometer-based walking interventions and weight loss. Annals of Family Medicine. 2008;6(1):69–77.Article PubMed PMC
19. Oh JY, Yang YJ, Kim BS, Kang JH. Validity and reliability of Korean version of international physical activity questionnaire (IPAQ) short form. Journal of the Korean Academy of Family Medicine. 2007;28(7):532–541.
20. Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN, Franklin BA, et al. Physical activity and public health: Updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Circulation. 2007;116(9):1081–1093. http://dx.doi.org/10.1161/circulationaha.107.185649Article PubMed
21. Rikli RE, Jones J. The reliability and validity of a 6-minute walk test as a measure of physical endurance in older adults. Journal of Aging and Physical Activity. 1988;6(4):363–375.Article
22. ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: Guidelines for the six-minute walk test. American Journal of Respiratory and Critical Care Medicine. 2002;166(1):111–117. http://dx.doi.org/10.1164/ajrccm.166.1.at1102PubMed
23. Roh JS. Development of critical pathway for patients with lobectomy and pneumonectomy [master’s thesis]. Seoul: Yonsei University; 2003.
24. Chie WC, Yang CH, Hsu C, Yang PC. Quality of life of lung cancer patients: Validation of the Taiwan Chinese version of the EORTC QLQ-C30 and QLQ-LC13. Quality of Life Research. 2004;13(1):257–262.Article PubMed
25. Novoa N, Varela G, Jiménez MF, Aranda JL. Influence of major pulmonary resection on postoperative daily ambulatory activity of the patients. Interactive Cardiovascular and Thoracic Surgery. 2009;9(6):934–938. http://dx.doi.org/10.1510/icvts.2009.212332Article PubMed
26. Coups EJ, Park BJ, Feinstein MB, Steingart RM, Egleston BL, Wilson DJ, et al. Correlates of physical activity among lung cancer survivors. Psycho-Oncology.. 2009;18(4):395–404. http://dx.doi.org/10.1002/pon.1520Article PubMed PMC
27. Kervio G, Carre F, Ville NS. Reliability and intensity of the six-minute walk test in healthy elderly subjects. Medicine and Science in Sports and Exercise. 2003;35(1):169–174. http://dx.doi.org/10.1249/01.mss.0000043545.02712.a7Article PubMed
28. Nimmo MA, Leggate M, Viana JL, King JA. The effect of physical activity on mediators of inflammation. Diabetes, Obesity & Metabolism. 2013;15(Suppl 3):51–60. http://dx.doi.org/10.1111/dom.12156Article
29. Brunelli A, Refai M, Xiume F, Salati M, Sciarra V, Socci L, et al. Performance at symptom-limited stair-climbing test is associated with increased cardiopulmonary complications, mortality, and costs after major lung resection. The Annals of Thoracic Surgery. 2008;86(1):240–247. http://dx.doi.org/10.1016/j.athoracsur.2008.03.025Article PubMed
30. Courneya KS, Friedenreich CM. Physical activity and cancer control. Seminars in Oncology Nursing. 2007;23(4):242–252. http://dx.doi.org/10.1016/j.soncn.2007.08.002Article PubMed
31. Chung CW, Lee S, Hwang SW, Park EH. Systematic review of exercise effects on health outcomes in women with breast cancer. Asian Nursing Research. 2013;7(3):149–159. http://dx.doi.org/10.1016/j.anr.2013.07.005Article PubMed

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Effects of a Progressive Walking Program on Physical Activity, Exercise Tolerance, Recovery, and Post-Operative Complications in Patients with a Lung Resection

J Korean Acad Nurs. 2014;44(4):381-390. Published online August 15, 2014

DOI: https://doi.org/10.4040/jkan.2014.44.4.381

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Effects of a Progressive Walking Program on Physical Activity, Exercise Tolerance, Recovery, and Post-Operative Complications in Patients with a Lung Resection

Figure 1. Effects of progressive walking program on patterns of physical activity and 6 minute walking distance.

Figure 1.

Effects of a Progressive Walking Program on Physical Activity, Exercise Tolerance, Recovery, and Post-Operative Complications in Patients with a Lung Resection

Table 1.

Contents of Progressive Walking Program

Categories	Contents
Pre operation education	1) Preview=Exercise, manual for Pedometer.
	2) Video=Anatomy of lung, kind of operation, importance of exercise & nutrition.
	→ Provided to patients and their family caregivers
Goal setting	1) Walking=Using the pedometer.
	Start from 1000 steps and increase 8 % everyday. (POD 10=1999 steps/POD 20=4315 steps/POD 30=10062 steps)
	2) Shoulder=Elevation through flexion & abduction, external & internal rotation (OP day=1 set).
	Once 1 set achieved, ↑the numbers of sets (Max 8 sets). 3) Respiration=Deep breathing & coughing (OP day=1 set).
	Once 1 set achieved, ↑the numbers of sets (Max 8 sets).
Feedback	1) Identify the amount of exercise & difficulties during exercise.
	2) Encouraging message=Address barriers to exercise for increasing amounts of exercise. POD 1-5=Provided daily feedback.
	POD 6-30=Provided feedback once every 3 days (Feedback by telephone call after discharge).

POD=Post operative day; OP=Operation.

Table 2.

Homogeneity Test for Characteristics between Experimental and Control Group Participants (N=37)

Characteristics	Categories	Total	Exp. (n=15)	Cont. (n=22)	χ²	p
Characteristics	Categories	n (%) or M±SD	n (%) or M±SD	n (%) or M±SD	χ²	p
Age (year)	<65	25 (67.6)	12 (80.0)	13 (59.1)		.286*
	≥65	12 (32.4)	3 (20.0)	9 (40.9)
		59.51±11.06	59.46±8.89	59.50±12.54
Gender	Male	28 (75.7)	11 (73.3)	17 (77.3)		1.000*
	Female	9 (24.3)	4 (26.7)	5 (22.7)
Spouse	Yes No	34 (91.9) 3 (8.1)	14 (93.3) 1 (6.7)	20 (90.9) 2 (9.1)		1.000*
Education	≤Middle school	19 (51.4)	8 (53.3)	11 (50.0)	0.04	1.000
	≥High school	18 (48.6)	7 (46.7)	11 (50.0)
Regular exercise	Yes No	14 (37.8) 23 (62.2)	7 (46.7) 8 (53.3)	7 (31.8) 15 (68.2)	0.84	.361
Operation history	Yes	20 (54.1)	8 (53.3)	13 (59.1)	0.55	.457
	No	17 (45.9)	7 (46.7)	9 (40.9)
BMI	<18.5	1 (2.7)	0 (0.0)	1 (4.6)		.891*
	18.5 to<25.0	30 (81.1)	12 (80.0)	18 (81.8)
	≥25.0	6 (16.2)	3 (20.0)	3 (13.6)
		23.01±2.73	23.08±2.96	22.96±2.63
Comorbidity	Yes	25 (67.6)	9 (60.0)^†	16 (27.3)^‡	0.66	.202
	No	12 (32.4)	6 (40.0)	6 (72.7)
Smoking state	Never smoked	22 (59.5)	8 (53.3)	14 (63.6)		.177*
	Quit smoking Current smoker	9 (24.3) 6 (16.2)	1 (6.7) 6 (40.0)	3 (13.7) 5 (22.7)
FEV1 % predicted	<80	27 (73.0)	10 (66.7)	17 (77.3)	0.51	.708
	≥80	10 (27.0)	5 (33.3)	5 (22.7)
		72.70±9.97	73.00±9.97	72.50±10.19

Exp.=Experimental group; Cont.=Control group; FEV1=Forced Expiratory Volume in 1 second; BMI=Body Mass Index. *Fisher’s exact test;

^†Hypertension, diabetes;

^‡Hypertension, diabetes, arthritis, osteoporosis, gastritis.

Table 3.

Homogeneity Test for Levels of Physical Activity, 6 Minute Walk Distance, and Dyspnea at Pre-test between Experimental and Control Groups (N=37)

Characteristics	Total	Exp. (n=15)	Cont. (n=22)	χ² or t or U	p
Characteristics	n (%) or M±SD	n (%) or M±SD	n (%) or M±SD	χ² or t or U	p
Physical activity				0.54	.207
Adequate	22 (59.5)	10 (66.7)	12 (54.5)
Inadequate	15 (40.5)	5 (33.3)	10 (45.5)
6 minute walk distance (m)	472.35±83.91	457.35±78.45	482.85±87.95	−0.89	.382
Dyspnea	12.01±13.45	10.37±9.82	13.13±15.58	160	.870

Exp.=Experimental group; Cont.=Control group; Adequate=Meet physical activity guidelines (≥900 MET-min/wk); Inadequate=Do not meet physical activity guidelines (<900 MET-min/wk).

Table 4.

Effects of Progressive-walking Program on Daily Steps, Pulmonary Complications, and Recovery (N=37)

Outcome variables	Exp. (n=15)	Cont. (n=22)	t	p
Outcome variables	n (%) or M±SD	n (%) or M±SD	t	p
Total steps at POD 30 days	9,933.33±6,485.85	−
<10,000	8 (53.3)	−
≥10,000	7 (46.7)	−
Recovery
Number of days with chest tube retention (days)	5.93±2.93	8.45±6.20		.016*
≤7	13 (86.7)	10 (45.5)
>7^†	2 (13.3)	12 (54.5)
Hospital stay (days)	8.80±3.73	11.68±6.46		.047*
≤10	12 (80.0)	10 (45.5)
>10^‡	3 (20.0)	12 (54.5)
Dyspnea	12.59±11.00	21.71±16.25	2.03	.049
Occurrence of pulmonary complication (OP day-POD 30)	0 (0.0)	3 (13.6)		.233*

Exp.=Experimental group; Cont.=Control group; OP=Operation; POD=Post operative Day; *Fisher’s exact test;

^†Reasons=Persistent air leakage (43.0%), chest tube drainage>100 ml for last 24 hours (28.5%), both persistent air leak and chest tube drainage>100 ml for last 24 hours (28.5%);

^‡Reasons=Further evaluation (40.0%), delayed removal of chest tube (33.3%), refuse to be discharged (20.0%), pneumonia (6.7%).

Table 1. Contents of Progressive Walking Program

POD=Post operative day; OP=Operation.

Table 2. Homogeneity Test for Characteristics between Experimental and Control Group Participants (N=37)

Exp.=Experimental group; Cont.=Control group; FEV1=Forced Expiratory Volume in 1 second; BMI=Body Mass Index. *Fisher’s exact test;

†

Hypertension, diabetes;

‡

Hypertension, diabetes, arthritis, osteoporosis, gastritis.

Table 3. Homogeneity Test for Levels of Physical Activity, 6 Minute Walk Distance, and Dyspnea at Pre-test between Experimental and Control Groups (N=37)

Exp.=Experimental group; Cont.=Control group; Adequate=Meet physical activity guidelines (≥900 MET-min/wk); Inadequate=Do not meet physical activity guidelines (<900 MET-min/wk).

Table 4. Effects of Progressive-walking Program on Daily Steps, Pulmonary Complications, and Recovery (N=37)

Exp.=Experimental group; Cont.=Control group; OP=Operation; POD=Post operative Day; *Fisher’s exact test;

†

Reasons=Persistent air leakage (43.0%), chest tube drainage>100 ml for last 24 hours (28.5%), both persistent air leak and chest tube drainage>100 ml for last 24 hours (28.5%);

‡

Reasons=Further evaluation (40.0%), delayed removal of chest tube (33.3%), refuse to be discharged (20.0%), pneumonia (6.7%).