Association of wearable device-based perioperative physical activity with recovery outcomes in patients undergoing lung cancer surgery: a systematic review and meta-analysis protocol.

Clinical Snapshot

Key Findings

• P Value: Not yet determined

• Effect Size: Not yet determined

• Primary Outcome: Not applicable — this is a protocol paper; no results are available

• Nnt Or Sensitivity: Not yet determined; planned outcomes include postoperative pulmonary complications (risk ratio/odds ratio anticipated), length of hospital stay (mean difference anticipated), and physical function/exercise capacity (standardised mean difference anticipated)

• Confidence Interval: Not yet determined

Clinical Application

Wearable devices (accelerometers, smartwatches, pedometers, continuous monitoring platforms) are increasingly available and affordable in high-income healthcare settings. Integration into perioperative pathways requires nursing and allied health coordination, patient digital literacy, and data governance frameworks. Feasibility will vary by institution and patient population. In Australia, lung cancer remains the leading cause of cancer-related mortality, with approximately 13,000 new cases annually (Cancer Australia data). Surgical resection via video-assisted thoracoscopic surgery (VATS) is the standard of care at major thoracic centres. Wearable devices are not currently subsidised under the Pharmaceutical Benefits Scheme (PBS) or Medicare Benefits Schedule (MBS) for perioperative monitoring indications. The Therapeutic Goods Administration (TGA) regulates wearable medical devices under the medical device framework; consumer-grade wearables used for activity monitoring may not require TGA approval. RACGP and thoracic surgery guidelines do not currently include specific recommendations on wearable-based perioperative activity monitoring. This systematic review, when completed, could inform future RACGP, ANZCA, or Thoracic Society of Australia and New Zealand (TSANZ) guideline development. Enhanced Recovery After Surgery (ERAS) protocols at Australian thoracic centres may provide a natural implementation pathway for wearable-based activity promotion. Adult patients undergoing elective or semi-elective surgery for primary lung cancer, including lobectomy, segmentectomy, pneumonectomy, and minimally invasive thoracic procedures. Applicable across thoracic surgery, oncology nursing, physiotherapy, and respiratory medicine settings.

Abstract

INTRODUCTION: Lung cancer surgery is a cornerstone of curative treatment for resectable disease, but postoperative recovery is often prolonged and may be complicated by impaired pulmonary function, reduced physical activity, symptom burden and delayed functional restoration. Wearable devices may support perioperative physical activity through objective monitoring and activity promotion; however, existing evidence remains fragmented and has not been synthesised in a focused review. This protocol describes a systematic review and meta-analysis to evaluate the association of wearable device-based perioperative physical activity with recovery outcomes in patients undergoing lung cancer surgery. METHODS AND ANALYSIS: We will include randomised controlled trials, non-randomised interventional studies and prospective or retrospective cohort studies involving adults undergoing surgery for suspected or confirmed primary lung cancer. Eligible studies must examine wearable device-based perioperative physical activity during the preoperative period, postoperative period or both. The primary outcomes will be postoperative pulmonary complications, length of hospital stay and physical function or exercise capacity. Secondary outcomes will include overall postoperative complications, pulmonary function, symptom burden, health-related quality of life, chest tube duration, readmission and postoperative mortality. We will search PubMed, EMBASE, Web of Science, CINAHL and the Cochrane Library from inception to the final search date, supplemented by reference screening, forward citation tracking, grey literature and trial registry searches. Two reviewers will independently perform study selection, data extraction and risk-of-bias assessment. Where appropriate, meta-analysis will be performed using random-effects models; otherwise, findings will be synthesised narratively. ETHICS AND DISSEMINATION: Ethical approval is not required because this review will use data from published studies and publicly accessible sources only and will not involve individual participants or identifiable personal data. The findings will be disseminated through publication in a peer-reviewed journal and presentation at relevant academic or professional conferences. PROSPERO REGISTRATION NUMBER: CRD420261375254.

References

1. 1.Su, J., He, Y., & Shao, F. (2026). Association of wearable device-based perioperative physical activity with recovery outcomes in patients undergoing lung cancer surgery: a systematic review and meta-analysis protocol. BMJ Open. https://doi.org/10.1136/bmjopen-2026-121526