Telerehabilitation Exercise Program for Postoperative Recovery in Lung Cancer. (TEPUL)

Lung cancer remains the leading cause of cancer-related mortality worldwide and continues to impose a substantial burden on healthcare systems. Surgical resection is considered the standard treatment for patients with resectable disease and offers the best opportunity for long-term survival. However, despite advances in surgical techniques and perioperative care, recovery following thoracic surgery is frequently characterized by impaired physical function, reduced exercise capacity, dyspnea, decreased physical activity levels, postoperative pulmonary complications, and deterioration in health-related quality of life.

The physical and functional consequences of lung cancer treatment may persist for months or years after surgery and can negatively affect independence, participation in daily activities, and overall well-being. Postoperative rehabilitation and therapeutic exercise have therefore become important components of comprehensive cancer care. Early physiotherapy interventions aim to prevent postoperative pulmonary complications, facilitate recovery of physical function, reduce symptom burden, and promote a safe return to daily activities. Previous studies have shown that exercise-based rehabilitation following lung resection can improve functional capacity and quality of life while reducing postoperative morbidity.

Despite these recognized benefits, access to structured rehabilitation programs remains limited in many healthcare settings due to geographical, logistical, organizational, and resource-related barriers. This challenge is particularly relevant in publicly funded healthcare systems, where rehabilitation services may not be universally available after hospital discharge. As a result, many patients do not receive adequate follow-up rehabilitation during a critical phase of postoperative recovery.

Telerehabilitation has emerged as a promising alternative model of healthcare delivery that enables rehabilitation services to be provided remotely through digital technologies. This approach has the potential to improve accessibility, continuity of care, adherence to prescribed exercise programs, and patient engagement while reducing travel requirements and healthcare costs. Growing evidence supports the safety, feasibility, and effectiveness of telemedicine and telerehabilitation interventions across a variety of chronic and oncological conditions.

In patients with lung cancer, recent studies have reported encouraging results regarding the use of mobile applications and remotely supervised rehabilitation programs. These interventions have been associated with improved adherence to treatment, enhanced functional recovery, better pulmonary function, increased physical activity levels, reduced symptom burden, and improvements in quality of life. Furthermore, digital rehabilitation strategies may facilitate long-term monitoring and support during the postoperative period, helping patients maintain active participation in their recovery process.

Nevertheless, important knowledge gaps remain. The number of high-quality randomized controlled trials specifically evaluating structured postoperative telerehabilitation programs after lung cancer surgery is still limited. Existing studies have often included small sample sizes, heterogeneous interventions, or mixed cancer populations, making it difficult to establish definitive recommendations regarding the optimal design and clinical effectiveness of telerehabilitation in this population. Additional research is needed to determine whether remotely delivered therapeutic exercise programs can produce clinically meaningful improvements in postoperative recovery and patient-centered outcomes.

The present randomized controlled trial has been designed to address this evidence gap by evaluating the effectiveness of an eight-week telerehabilitation program based on therapeutic exercise in patients undergoing thoracic surgery for lung cancer. Participants allocated to the intervention group will receive a structured and progressive exercise program delivered through a dedicated telerehabilitation platform, combined with regular online clinical follow-up sessions. The intervention incorporates aerobic exercise, muscle strengthening exercises, respiratory muscle training, individualized progression, and continuous monitoring of adherence and symptoms. Participants assigned to the control group will receive the usual postoperative physiotherapy care routinely provided after thoracic surgery.

The study will evaluate the impact of the intervention on key dimensions of postoperative recovery, including functional capacity, dyspnea, physical activity levels, postoperative pulmonary complications, and health-related quality of life. Assessments will be performed before surgery, after completion of the intervention period, and following a short-term follow-up period to explore the maintenance of potential benefits.

The findings of this study may contribute to the development of evidence-based rehabilitation pathways for patients recovering from lung cancer surgery. If effective, this telerehabilitation model could represent an accessible, scalable, and cost-efficient strategy for improving postoperative outcomes and expanding access to rehabilitation services within routine clinical practice.