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

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.

Inclusion criteria

• Patients with pulmonary nodules who are scheduled to undergo video-assisted thoracoscopic surgery for nodule resection (including wedge resection, segmentectomy, or lobectomy).
• Aged 20 years or older and assessed by a healthcare provider as medically suitable to participate in exercise training.
• At least one week between the date of enrollment and the scheduled surgery.
• 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

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