| Evidential dimension | Content of evidence | Level of evidence | Recommended strength |
| Contents and principles of pre-rehabilitation | 1. The pre-rehabilitation time starts from the joint decision of the surgeon and the patient 1 day before the operation [12] . | 1b | A |
| 2. The pre-rehabilitation time should be 2-4 weeks before surgery. It is not recommended to delay tumor surgery for more than 4 weeks to perform a pre-rehabilitation program. However, if the time from the decision to start surgery is less than 2 weeks, pre-rehabilitation should be carried out as far as possible [12] . | 1a | A | |
| 3. Preoperative patients with high-risk factors should receive at least 1 week of comprehensive pulmonary rehabilitation training before surgery [13] . | 2b | B | |
| 4. Pre-rehabilitation is a multi-mode intervention including assessment, exercise, education, nutrition intervention and psychosocial support, among which exercise is the core [14] . | 1a | A | |
| 5. All patients undergoing elective and limited thoracic surgery can be pre-rehabilitated, especially for the elderly, patients with poor basic functional status, malnutrition, and patients with extensive surgical resection [12] . | 1b | A | |
| 6. The main content of thoracic surgery pre-rehabilitation is to formulate an individualized multi-mode pre-rehabilitation program, which should include smoking cessation, anemia correction, aerobic exercise, resistance strength training, inspiratory muscle training, nutrition optimization and psychological support [12] . | 1b | A | |
| 7. For high-risk patients, airway preparation should be made before surgery, including drug therapy combined with physical rehabilitation [14] [15] . | 2c | B | |
| Pre-rehabilitation assessment
| 8. Comprehensive assessment of patients must be carried out before pre-rehabilitation, including general state assessment, lung function assessment, physical fitness assessment, nutritional assessment, psychological assessment, etc. [12] [15] . | 1a | A |
| 9. A general status assessment is recommended at the time of the outpatient decision to perform surgery, including the patient’s age, body mass index (BMI), comorbiditions and their treatment, the American Society of Anesthesiologists, ASA) grading, etc., and preliminary risk stratification of patients [12] . | 1a | A | |
| 10. Frailty scale, physical function and fall risk assessment should be conducted for elderly or suspected frailty patients [12] . | 1b | A | |
| 11. Exercise tests are recommended to assess cardiorespiratory fitness [12] . | 2c | B | |
| 12. Preoperative nutritional risk screening and assessment should be routinely performed on patients [12] . | 2b | A | |
| 13. Preoperative psychological status and sleep assessment should be performed on patients, and cognitive function assessment should be performed on elderly patients [12] . | 1c | A | |
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| 14. Preoperative activity tolerance assessment is recommended, exercise plans are developed, and functional reserve is improved [16] . | 3a | B |
| 15. It is recommended that the mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA) be used to assess cognitive function before surgery. It can be used as the baseline reference value for postoperative evaluation. Specialist intervention if necessary [16] . | 1b | B | |
| Exercise rehabilitation | 16. Rehabilitation evaluation should be emphasized before pre-rehabilitation exercise training for patients with lung cancer complicated with COPD. Under the premise of ensuring individualization, effectiveness and safety, the training principles are basically the same as those of people without COPD [12] . | 5b | B |
| 17. There are many forms of exercise intervention, and a rehabilitation program combining multiple modes should be designed [17] . | 5a | A | |
| 18. The exercise rehabilitation of patients should not be limited to the hospital, and preoperative physical exercise should be implemented in a multidisciplinary environment [17] . | 5b | B | |
| 19. Aerobic exercise training is recommended for all pre-recovery patients [12] . | 2b | B | |
| 20. Resistance strength training is particularly important for the elderly, the frail, the sedentary, the malnourished, the chronic cardiopulmonary disease and other people [13] . | 2b | B | |
| 21. Elderly patients have various risks, and their physical condition should be comprehensively assessed before starting exercise [17] . | 5a | A | |
| 22.In order to reduce the risk of exercise, patients with cardiovascular and kidney diseases should first evaluate their fitness level [17] . | 5a | A | |
| 23. Patients with poor baseline lung function are at high risk of surgery, and their surgical tolerance should be improved through preoperative exercise management [18] [19] . | 1a | A | |
| Nutrition management | 24. The duration of preoperative exercise should not be too long and should be set at 2 to 4 weeks to avoid affecting the patient's compliance [17] [19] . | 5b | B |
| 25. Preoperative breathing training is recommended for patients with normal lung function or exercise capacity or at risk of postoperative lung complications [20] [22] . | 3a | B | |
| 26. Preoperative respiratory training is recommended for a total intervention time of at least 2 weeks [20] [23] . | 1b | B | |
| 27. Nutritional risk screening 2002 (NRS2002) should be used to assess nutritional risk before surgery [16] . | 1a | A | |
| 28. Preoperative intervention should be given to patients with combined nutritional risk [16] . | 1a | A | |
| 29. It is recommended to conduct routine preoperative anemia-related examination, evaluation and timely intervention [16] . | 2b | B | |
| 30. In pre-rehabilitation management, iron supplementation is preferred for iron deficiency anemia patients [12] . | 1b | A | |
| 31. It is recommended that obese patients optimize their diet structure and lose weight appropriately [12] . | 1c | A | |
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| 32. For patients without chronic kidney disease, appropriate amounts of high-quality protein can be added after pre-rehabilitation exercise training [13] . | 1a | A |
| Psychological guidance | 33. The hospital anxiety and depression scale (HADS) was used to assess the psychological status of patients and conduct effective interventions [16] . | 2b | B |
| 34. Patients are encouraged to adopt various forms of psychological relaxation adjustment before surgery. Patients with anxiety and depression risk should be treated with intervention when necessary [12] . | 1a | A | |
| Health education | 35. Preoperative patient education includes patient self-preparation, introduction of relevant policies, postoperative bed arrangement, postoperative cooperation, postoperative symptom management, individualized guidance, etc [15] . | 1b | B |
| 36. Before operation, cards, manuals, multimedia, display boards and other forms should be used for different patients to focus on the introduction of anesthesia, surgery and perioperative management and other diagnosis and treatment matters, so as to relieve patients’ anxiety and fear [16] . | 1c | B | |
| 37. Quit smoking for at least 4 weeks before surgery [13] . | 1a | A | |
| 38. Abstain from alcohol for 4 weeks before surgery [12] [16] . | 2b | B | |
| 39. Preoperative venous thromboembolism (VTE) risk education, medication and mechanical VTE prophylaxis are recommended for patients who plan to undergo thoracic surgery [13] . | 1b | B | |
| Multidisciplinary cooperation | 40. The development of pre-rehabilitation is based on multi-disciplinary collaboration and is led by the pre-rehabilitation comprehensive clinic. Medical resources should be fully optimized and integrated to gradually form a multi-disciplinary, hierarchical and optimized pre-rehabilitation management model [12] . | 1b | A |
| 41. Establish interdisciplinary teams of professionals including doctors, nurses, respiratory and physical therapists, rehabilitators, exercise specialists, nutritionists, psychologists, occupational therapists and social workers [14] . | 5b | B | |
| Quality control and follow-up | 42. Encourage monitoring and follow-up during multi-mode pre-rehabilitation according to local conditions, including application of wearable devices, community services, telemedicine, etc. [12] . | 2c | A |
| 43. Telephone follow-up every 2 weeks [24] . | 1c | A | |
| 44. Using recovery diaries to promote patient engagement [24] . | 1b | A |