Effect of Technology-Assisted Preoperative Home Exercise on Postoperative Handgrip Strength, Muscle Endurance, and Psychological Distress in Patients With Pulmonary Nodules Undergoing Video-Assisted Thoracoscopic Surgery

Effect of Technology-Assisted Intervention Program on Postoperative Handgrip Strength, Muscle Endurance, and Psychological Distress in Patients With Pulmonary Nodules

This study aims to evaluate the effects of a technology-assisted preoperative home-based exercise program, delivered through a LINE Official Account and LINE BOT, on postoperative hand-grip strength, muscle endurance, and psychological distress in patients undergoing thoracoscopic pulmonary nodule resection. The study adopts a single-group pretest post-test design and plans to recruit 60 eligible patients.

The intervention consists of at least one week of home exercise training before surgery, incorporating aerobic, resistance, and breathing exercises. Education, guidance, and interactive feedback are provided through the LINE platform to support adherence and exercise performance. Outcomes will be assessed at three time points: baseline (T0), immediately before surgery (T1), and two weeks after surgery (T2).

Study Overview

• Status: Not yet recruiting
• Conditions: Pulmonary Nodules
• Intervention / Treatment: Behavioral: Technology-Assisted Preoperative Home-Based Exercise Program

Detailed Description

Lung cancer remains the leading cause of cancer-related mortality in Taiwan, and pulmonary nodule resection is a common surgical intervention. Patients often experience postoperative declines in physical function, including hand-grip strength, muscle endurance, and aerobic capacity, along with increased psychological distress such as anxiety and depression. Preoperative rehabilitation has been shown to improve peri-operative outcomes; however, traditional in-person programs are often limited by time constraints, travel burden, and access barriers. Technology-assisted remote health interventions have emerged as a feasible approach to enhancing patient engagement and extending preoperative support.

This study aims to evaluate the effectiveness of a technology-assisted preoperative home-based exercise program delivered through a LINE Official Account and LINE BOT platform. The program is designed to improve postoperative hand-grip strength, muscle endurance, body composition, and psychological distress among patients undergoing thoracoscopic pulmonary nodule resection. The study adopts a quasi-experimental single-group pretest-posttest design and plans to enroll approximately 60 eligible participants.

The intervention includes at least one week of home-based exercise training before surgery and consists of aerobic exercises (such as walking or marching), resistance training movements (including high-knee marching, sit-to-stand, and other functional muscle-strengthening exercises), and breathing exercises (including pursed-lip breathing and diaphragmatic breathing). Educational materials, reminders, guidance, and interactive feedback will be delivered through the LINE platform to enhance adherence, reinforce correct techniques, and support patient engagement.

Outcome assessments will be conducted at three time points: baseline (T0) during the outpatient visit when surgery is scheduled; immediately before surgery at hospital admission (T1); and two weeks after surgery (T2). Primary outcomes include hand-grip strength and muscle endurance, while secondary outcomes include body composition and psychological distress (anxiety and depression).

This study is expected to establish a feasible, sustainable, and flexible model for technology-assisted preoperative health promotion. Findings may provide evidence for integrating digital health tools into peri-operative care pathways to support enhanced recovery following thoracic surgery.

• Study Type: Interventional
• Enrollment (Estimated): 60
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Li-Ping Chen, RN, NP; Phone Number: 886-2--23123456#238070; Email: A00727@ntucc.gov.tw

Study Locations

• Taiwan
  • Taipei, Taiwan
    • National Taiwan University Cancer Center
    • Contact: Li-Ping Chen; Phone Number: 886-2-23220322#238070; Email: A00727@ntucc.gov.tw

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Patients with pulmonary nodules who are scheduled to undergo video-assisted thoracoscopic surgery for nodule resection (including wedge resection, segmentectomy, or lobectomy).
2. Aged 20 years or older and assessed by a healthcare provider as medically suitable to participate in exercise training.
3. At least one week between the date of enrollment and the scheduled surgery.
4. Willing to provide written informed consent and complete all study procedures, including joining the LINE Official Account, participating in the exercise training, completing questionnaires, and undergoing outcome assessments.

Exclusion Criteria:

1. Metastatic tumors or contraindications to exercise participation.
2. Engagement in regular aerobic or resistance exercise within the past month (defined as ≥2 sessions per week, ≥30 minutes per session).
3. Inability to communicate in Mandarin or Taiwanese.
4. Inability to use technology-assisted applications (e.g., LINE APP).

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Technology-Assisted Preoperative Home-Based Exercise Program; Participants in this arm will receive a technology-assisted preoperative home-based exercise program delivered through a LINE APP. The program includes aerobic, resistance, and breathing exercises performed for at least one week before surgery. Educational messages, reminders, and interactive feedback are provided through the LINE platform to support exercise adherence.

Behavioral: Technology-Assisted Preoperative Home-Based Exercise Program; This behavioral intervention uses a technology-assisted approach to deliver preoperative home-based exercise training for patients scheduled to undergo video-assisted lung nodule resection. The intervention integrates a LINE Official Account with an automated LINE Bot that provides exercise instructions, educational materials, reminders, and self-report mechanisms. The exercise program is based on published preoperative home-exercise protocols for lung cancer surgery patients. It includes: Aerobic exercise - walking or marching in place for 30 minutes, three times per week;; Resistance training - six exercises (high-knee marching, bridging, sit-to-stand, shoulder press, biceps curl, heel raise), performed twice weekly (non-consecutive), 30 repetitions each;; Breathing exercises - pursed-lip and diaphragmatic breathing, 10 repetitions each, three times per week;; Warm-up and cool-down for 5 minutes before and after exercise. The LINE Bot system provides video demonstration

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Hand-grip Strength	Hand-grip strength will be measured using a calibrated handheld dynamometer. Measurements will be collected at three time points: Baseline at outpatient visit when surgery is scheduled (T0), Preoperative assessment on the day of admission (T1), Two weeks after surgery (T2). The primary outcome is the change in dominant-hand grip strength from T0 to T2. Higher values indicate greater muscle strength. The measure reflects postoperative functional recovery and the effectiveness of the technology-assisted preoperative exercise program.	Before surgery (T0) to 2 weeks post-surgery (T2)

Collaborators and Investigators

• Sponsor: National Taiwan University Hospital

Study record dates

Study Major Dates

• Study Start (Estimated): December 17, 2025
• Primary Completion (Estimated): December 31, 2026
• Study Completion (Estimated): December 31, 2026

Study Registration Dates

• First Submitted: December 11, 2025
• First Submitted That Met QC Criteria: December 11, 2025
• First Posted (Actual): December 24, 2025

Study Record Updates

• Last Update Posted (Actual): December 24, 2025
• Last Update Submitted That Met QC Criteria: December 11, 2025
• Last Verified: December 1, 2025

More Information

Terms related to this study

• Keywords: exercise; Lung nodule; APP LINE
• Additional Relevant MeSH Terms: Neoplasms by Site; Neoplasms; Respiratory Tract Diseases; Lung Diseases; Respiratory Tract Neoplasms; Thoracic Neoplasms; Lung Neoplasms; Behavior; Multiple Pulmonary Nodules; Motor Activity
• Other Study ID Numbers: 202509080RINB

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED
• IPD Plan Description: The plan for sharing individual participant data (IPD) has not yet been determined. Decisions regarding data sharing will depend on institutional policies, ethical considerations, and data privacy regulations. IPD will only be shared if appropriate safeguards and approvals are in place.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No