Timed up and go test as a screening tool for exercise capacity after lung cancer resection

Abstract

Background: Pulmonary rehabilitation improves survival and reduces postoperative complications in patients with lung cancer, highlighting the need for precise assessment of exercise capacity. Conventional tools such as the cardiopulmonary exercise test (CPET) and the 6-minute walk test (6MWT) are valuable but often limited by equipment, time, and patient-related factors, including balance problems, musculoskeletal limitations, and postoperative chest wall pain. The timed up and go test (TUGT) is a simple measure reflecting lower extremity strength, balance, and gait speed, yet its clinical utility has not been established in patients after lung cancer resection. This study aimed to investigate the relationship between the TUGT and established exercise assessments (6MWT and CPET) and to evaluate the potential role of the TUGT as a practical screening tool for pulmonary rehabilitation. Methods: This retrospective observational study included 62 patients who underwent lung cancer resection between March 2019 and June 2023. Exercise capacity was evaluated using TUGT, 6MWT, and CPET. Receiver operating characteristic (ROC) curve analysis was performed to determine the diagnostic value of TUGT in identifying reduced exercise capacity, defined as 6MWT <525 meters. A subgroup of 35 patients who completed an 8-week pulmonary rehabilitation was additionally analyzed to assess changes in functional performance. Results: There was a strong negative correlation between TUGT time and 6MWT distance (r=−0.61, P<0.001) and a moderate negative correlation between maximal oxygen consumption (VO2max) and TUGT time (r=−0.46, P<0.001), where shorter TUGT time indicates better performance. In the ROC curve analysis, a TUGT time of 6.4 seconds identified patients with reduced exercise capacity (6MWT <525 meters), considered at higher risk of poor postoperative outcomes, with 66% sensitivity and 93% specificity. In the rehabilitation subgroup, significant improvements were observed across all three assessments, including a decrease in TUGT time, an increase in 6MWT distance, and an improvement in VO2max. Conclusions: TUGT demonstrates significant correlations with both CPET and 6MWT and may serve as a simple, feasible, and clinically valuable screening tool for identifying patients with reduced postoperative exercise capacity. Incorporating TUGT into routine postoperative evaluations may facilitate early detection of reduced functional capacity and guide timely referral for pulmonary rehabilitation.