Optimal timing of threshold inspiratory muscle training for functional outcomes in patients undergoing lung cancer surgery: a systematic review and meta-analysis

The aim of this study was to determine the optimal timing of threshold inspiratory muscle training (TIMT) on the premise of ensuring that TIMT is safe and effective for patients with lung cancer after surgery, with a focus on reducing postoperative pulmonary complications (PPCs), length of postoperative hospital stay and improving functional recovery. PubMed, Cochrane Library, Web of Science, Embase, China National Knowledge Infrastructure, Wanfang Database, VIP Database and Chinese Biomedical databases were searched from their inception to May 9, 2025. Two reviewers independently screened the literature, evaluated risk of bias and methodological quality using the Cochrane’s risk of bias tool and the PEDro scale. Thirteen studies involving 761 patients were included in this systematic review. The meta-analysis showed that compared with conventional breathing training, TIMT can reduce PPCs, shorten postoperative hospital stay; improve maximum inspiratory pressure, and 6-minute walk test (6MWT). Subgroup analysis further showed TIMT starting one week before surgery can bring benefits to patients, and it is safe to start training on the first day after surgery. We recommend patients with lung cancer perform TIMT one week before surgery and continue it on the first postoperative day based on current evidence. The pulmonary function of patients with lung cancer decreases sharply after operation Threshold inspiratory muscle training can promote pulmonary rehabilitation Clear training timing can improve patient compliance and promote early rehabilitation of patients