Secondary outcomes measures
| Outcome | Measure | Details |
| Physical function | SPPB41 | Three-part objective test: 4 m gait speed, standing balance and 5 x sit to stand time. Each test is scored out of 4 points and item scores are summated to give an overall SPPB score out of 12. Individual and overall scores will be recorded. |
| Health-related quality of life and symptoms | EORTC QLQ C3025 and LC1330 | Core questionnaire and supplementary module reported according to domain and single items |
| Functional exercise capacity | 6 min walk test42 | Field walking test performed according to the American Thoracic Society guidelines42 |
| Muscle strength | Quadriceps strength test (bilateral) | Isometric voluntary contraction measured with Lafayette hand-held dynamometer.43 44 Participant positioned in supine on plinth or hospital bed, arms by side relaxed, legs shoulder-width apart, testing knee flexed 35° over foam roll, other leg straight resting on bed. Dynamometer placed on anterior surface of the distal end of the tibia. Test repeated three times after a practice bilaterally. Peak force and time to peak force over 6 s recorded.45 |
| Hand grip strength test (bilateral) | Isometric voluntary contraction measured with SI Instruments Jamar Plus Digital Dynamometer. Participant positioned in sitting, back against a chair, feet flat on the floor, hips and knees at 90° flexion, shoulder adducted and neutrally rotated, elbow flexed to 90°, forearm in neutral position with wrist 0° extension and 0° ulnar deviation, thumb facing upwards, and arm unsupported. Dynamometer placed in hand with grip span set to second narrowest position on handle. Test repeated three times after a practice bilaterally. Highest strength over 6 s recorded. | |
| Quadriceps muscle mass and quality | Neuromuscular ultrasound imaging46 | Imaging performed using a Sonosite Iviz machine with a linear transducer and minimal probe compression approach. Participant positioned in supine on plinth or hospital bed, legs relaxed and straight, hip and knees in neutral rotation. Three images will be taken at two locations. Location 1=anterior surface of the quadriceps, ½ distance from ASIS to superior border of the patella. Location 2=anterior surface of the quadriceps, 2/3 distance from ASIS to superior border of the patella. Muscle cross-sectional area, thickness and echogenicity will be analysed. This outcome will only be measured in a subset of participants due to limited access to the equipment and technical expertise to conduct the test. |
| PA levels | Respironics ActiCal Z Watch accelerometer | Accelerometer worn on the wrist during all waking hours for seven consecutive days of measurement. Set to record in 15 s epochs. Data will be included for participants who wear the device for a minimum of 4 valid days (minimum of 8 hours wear will constitute a valid day).47 48 At the baseline timepoint, this measure will only occur if the participant is at least 7 days out from their scheduled surgery date. |
| International Physical Activity Questionnaire short form49 | Questionnaire | |
| Physical Activity Scale for the Elderly50 51 | Questionnaire | |
| Rating against PA guidelines for people with cancer22 | Self-report | |
| Sedentary time | Self-reported television viewing time and sitting time in average per day over past 7 days | |
| Self-efficacy for PA | Barriers, task and walking self-efficacy scales52 53 | Questionnaires |
| Fatigue | Brief Fatigue Inventory54 | Questionnaire |
| Distress | Distress Thermometer55 | 11-point visual analogous scale |
| Sleep | Sleep Disturbance-Short Form 8b PROMIS Item Bank V.1.056 | Questionnaire |
| Financial toxicity | COmprehensive Score for financial Toxicity, COST V.157 58 | Questionnaire |
| Return to work | Employment questionnaire59 60 adapted for lung cancer | Questionnaire |
| Economic analyses | European Quality of Life Instrument61 | Questionnaire to calculate quality adjusted life years |
| Healthcare resource usage | Hospital length of stay Postoperative ICU admission(s) Hospital readmissions | |
| Cost of delivering intervention | Intervention records | |
| Survival | Survival status | Healthcare records |
ASIS, anterior superior iliac spine; EORTC QLQ C30 and LC13, European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (core) and lung cancer module; ICU, intensive care admission; PA, physical activity; SPPB, Short physical performance battery; v, version.