Acute Effects of Visual Feedback-Assisted Inspiratory Muscle Training After Lobectomy

Evaluation of the Acute Effects of Respiratory Muscle Strength Training With Visual Feedback in Lung Cancer Patients Undergoing Lobectomy

This study aims to evaluate the acute effects of inspiratory muscle training performed with and without a mobile application providing visual feedback on exercise motivation, patient adherence, dyspnea perception, usability, and patient satisfaction in lung cancer patients undergoing lobectomy via video-assisted thoracic surgery. Participants will perform conventional inspiratory muscle training without visual feedback in the morning on postoperative day 1 after transfer to the ward. After at least two hours of rest, the same exercise protocol will be repeated with a smart adaptor connected to a mobile application to provide visual feedback. Inspiratory muscle training will be performed using a threshold-loading device at 40% of maximal inspiratory pressure, with three sets of ten breaths. Outcomes will be assessed before and/or after each session as appropriate.

Study Overview

• Status: Recruiting
• Conditions: Exercise Training; Lobectomy; VATS; Respiratory Muscles; Lung Cancer (NSCLC)
• Intervention / Treatment: Other: Conventional Inspiratory Muscle Training; Other: Visual Feedback-Assisted Inspiratory Muscle Training

Detailed Description

Lung cancer is one of the leading causes of cancer-related mortality worldwide. In patients with early-stage non-small cell lung cancer, surgical resection remains the main curative treatment option. Lobectomy, particularly through video-assisted thoracic surgery, is commonly performed as an anatomical resection method. However, despite the advantages of minimally invasive thoracic surgery, patients may experience postoperative pulmonary complications, impaired respiratory muscle function, pain-related breathing limitations, and reduced exercise capacity after lobectomy.

Inspiratory muscle training is commonly used as part of postoperative physiotherapy and pulmonary rehabilitation after thoracic surgery. Because inspiratory muscle training requires active patient participation and effort, exercise motivation and adherence are important determinants of effective implementation. Recent technological developments have enabled the use of mobile application-supported systems and smart adaptors that provide visual feedback during inspiratory muscle training. Visual feedback may improve patient motivation, participation, and usability of the training. However, the acute effects of mobile application-supported inspiratory muscle training with visual feedback have not been adequately investigated in patients undergoing lobectomy after lung cancer surgery.

This study is designed to evaluate the acute effects of conventional inspiratory muscle training and visual feedback-assisted inspiratory muscle training on exercise motivation, dyspnea perception, usability, and patient satisfaction in lung cancer patients undergoing lobectomy via video-assisted thoracic surgery. The study will include clinically stable volunteers aged 18-75 years who are scheduled for lobectomy due to lung cancer and who are able to cooperate with the planned assessments. A total of 40 participants is planned.

Preoperative assessments will be performed on the day before surgery. Demographic and clinical characteristics, including age, height, body weight, smoking history, previous surgeries, and pulmonary function test results, will be recorded. Respiratory muscle strength will be assessed by measuring maximal inspiratory pressure and maximal expiratory pressure using a mouth pressure device.

The intervention will be performed on postoperative day 1 after the patient has been transferred to the ward. First, participants will perform conventional inspiratory muscle training without mobile application support or visual feedback in the morning. After at least two hours of rest, the same inspiratory muscle training protocol will be repeated with a smart adaptor connected to a mobile application, providing visual feedback during the exercise. Inspiratory muscle training will be performed using a threshold-loading device at 40% of maximal inspiratory pressure, with three sets of ten breaths during each session.

After each training session, exercise motivation, dyspnea perception, and patient satisfaction will be evaluated. Exercise motivation will be assessed using the Exercise Motivation Attitude Scale. Dyspnea perception will be assessed using the Modified Borg Scale before and after each intervention. Patient satisfaction, perceived difficulty of training, willingness to continue training, and perceived benefit will be evaluated using 0-10 rating scales. For the mobile application-assisted session, usability will also be assessed using the System Usability Scale. In addition, mobile application-derived data, including the number of successful breaths, total training duration, and total number of breaths, will be recorded.

The primary aim of the study is to determine whether visual feedback-assisted inspiratory muscle training provides more favorable acute effects on exercise motivation and patient adherence compared with conventional inspiratory muscle training. Secondary aims include evaluating dyspnea perception, usability of the mobile application-supported system, patient satisfaction, and objective training data obtained from the smart adaptor. The findings may contribute to the development of technology-supported pulmonary rehabilitation strategies after lobectomy and may guide the integration of visual feedback systems into routine postoperative respiratory physiotherapy.

• Study Type: Interventional
• Enrollment (Estimated): 40
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Funda Alma, MsC; Phone Number: +905079394348; Email: funda.sirakaya@hacettepe.edu.tr

Study Locations

• Turkey (Türkiye)
  • Altındağ
    • Ankara, Altındağ, Turkey (Türkiye), 06230
      • Recruiting
      • Hacettepe University

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Volunteering to participate in the study,
• Being clinically stable,
• Being a lung cancer patient scheduled for lobectomy,
• Being between 18 and 75 years of age,
• Being able to cooperate with the tests to be performed.

Exclusion Criteria:

• Presence of any orthopedic or neurological problem that prevents walking,
• History of any surgery involving the thoracic wall,
• Having diseases that may affect respiratory parameters, such as severe heart failure or severe chronic obstructive pulmonary disease (COPD).

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Conventional IMT Followed by Visual Feedback-Assisted IMT; Participants randomized to this arm will first receive conventional inspiratory muscle training without visual feedback. After a rest period of at least two hours, they will receive visual feedback-assisted inspiratory muscle training using a smart adaptor connected to a mobile application. Both training sessions will be performed using a threshold-loading inspiratory muscle training device at 40% of maximal inspiratory pressure, with three sets of ten breaths.	Other: Conventional Inspiratory Muscle Training; Conventional inspiratory muscle training will be performed without visual feedback or mobile application support. Training will be delivered using a threshold-loading inspiratory muscle training device at 40% of maximal inspiratory pressure, with three sets of ten breaths.; Other: Visual Feedback-Assisted Inspiratory Muscle Training; Visual feedback-assisted inspiratory muscle training will be performed using a threshold-loading inspiratory muscle training device connected to a smart adaptor and mobile application. The mobile application will provide visual feedback during training. Training will be performed at 40% of maximal inspiratory pressure, with three sets of ten breaths. Application-derived data, including the number of successful breaths, total training duration, and total number of breaths, will be recorded.
Experimental: Visual Feedback-Assisted IMT Followed by Conventional IMT; Participants randomized to this arm will first receive visual feedback-assisted inspiratory muscle training using a smart adaptor connected to a mobile application. After a rest period of at least two hours, they will receive conventional inspiratory muscle training without visual feedback. Both training sessions will be performed using a threshold-loading inspiratory muscle training device at 40% of maximal inspiratory pressure, with three sets of ten breaths.	Other: Conventional Inspiratory Muscle Training; Conventional inspiratory muscle training will be performed without visual feedback or mobile application support. Training will be delivered using a threshold-loading inspiratory muscle training device at 40% of maximal inspiratory pressure, with three sets of ten breaths.; Other: Visual Feedback-Assisted Inspiratory Muscle Training; Visual feedback-assisted inspiratory muscle training will be performed using a threshold-loading inspiratory muscle training device connected to a smart adaptor and mobile application. The mobile application will provide visual feedback during training. Training will be performed at 40% of maximal inspiratory pressure, with three sets of ten breaths. Application-derived data, including the number of successful breaths, total training duration, and total number of breaths, will be recorded.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Exercise Motivation	Exercise motivation will be assessed using the Exercise Motivation Scale after each inspiratory muscle training condition. The scale includes subdomains related to negative attitudes and thoughts, positive perspective and health, and physical appearance and health. Higher scores indicate higher exercise motivation. Scores obtained after conventional inspiratory muscle training and visual feedback-assisted inspiratory muscle training will be compared.	Immediately after each intervention on postoperative day 1-2.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Dyspnea Perception	Dyspnea perception will be assessed using the Modified Borg Scale before and after each inspiratory muscle training condition. The scale is used to evaluate perceived breathlessness, with higher scores indicating greater dyspnea severity. Changes in dyspnea perception will be compared between conventional inspiratory muscle training and visual feedback-assisted inspiratory muscle training.	Before and immediately after each intervention on postoperative day 1-2.
System Usability	The usability of the conventional inspiratory muscle training and visual feedback-assisted inspiratory muscle training system will be assessed using the System Usability Scale after the inspiratory muscle training session. Higher scores indicate better perceived usability.	Immediately after each intervention on postoperative day 1-2.
Respiratory Muscle Strength	Respiratory muscle strength will be assessed preoperatively by measuring maximal inspiratory pressure and maximal expiratory pressure using a mouth pressure device. These measurements will be used to determine the training intensity and to characterize baseline respiratory muscle function.	Preoperative day, one day before surgery.
Patient Satisfaction	Patient satisfaction with each inspiratory muscle training condition will be evaluated using 0-10 rating scales. Participants will be asked to rate perceived training difficulty, willingness to continue training, and perceived benefit from the training. Scores will be compared between conventional inspiratory muscle training and visual feedback-assisted inspiratory muscle training.	Immediately after each intervention on postoperative day 1-2.
Training Performance Data Recorded by the Mobile Application	For the visual feedback-assisted inspiratory muscle training session, application-derived training data will be recorded, including the number of successful breaths, total training duration, and total number of breaths.	During the visual feedback-assisted intervention on postoperative day 1-2.

Collaborators and Investigators

• Sponsor: Hacettepe University

Study record dates

Study Major Dates

• Study Start (Actual): December 1, 2025
• Primary Completion (Estimated): December 1, 2026
• Study Completion (Estimated): March 1, 2027

Study Registration Dates

• First Submitted: June 9, 2026
• First Submitted That Met QC Criteria: June 9, 2026
• First Posted (Actual): June 12, 2026

Study Record Updates

• Last Update Posted (Actual): June 12, 2026
• Last Update Submitted That Met QC Criteria: June 9, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Neoplasms by Site; Neoplasms; Respiratory Tract Diseases; Lung Diseases; Respiratory Tract Neoplasms; Thoracic Neoplasms; Carcinoma, Bronchogenic; Bronchial Neoplasms; Lung Neoplasms; Carcinoma, Non-Small-Cell Lung
• Other Study ID Numbers: E-81471704-050-00004500476; THD-2025-22286 (Other Grant/Funding Number: Hacettepe University Scientific Research Projects Coordination Unit)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

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