A Structured Exercise Program for Patients with Advanced Non-small Cell Lung Cancer

Abstract

Introduction Exercise improves functional outcome and symptoms for certain cancer populations, but the feasibility, efficacy, and safety of structured exercise in patients with lung cancer is unknown. In this study, we examined the feasibility of a hospital-based exercise program for patients with advanced non-small cell lung cancer. Methods This study included patients with newly diagnosed advanced stage non-small cell lung cancer and Eastern Cooperative Oncology Group performance status 0–1. A physical therapist facilitated twice-weekly sessions of aerobic exercise and weight training over an 8-week period. The primary end point was feasibility of the intervention, defined as adherence to the exercise program. Secondary endpoints included functional capacity, measured by the 6-minute walk test and muscle strength, as well as quality of life, lung cancer symptoms and fatigue, measured by the Functional Assessment of Cancer Therapy-lung and Functional Assessment of Cancer Therapy-fatigue scales. Results Between October 2004 and August 2007, 25 patients enrolled in the study. All participants received anticancer therapy during the study period. Twenty patients (80%) underwent the baseline physical therapy evaluation. Eleven patients (44%) completed all 16 sessions. An additional 6 patients attended at least 6 sessions (range, 6–15), and 2 patients only attended one session. Study completers experienced a significant reduction in lung cancer symptoms and no deterioration in their 6-minute walk test or muscle strength. Conclusions Although the majority of participants attempted the exercise program, less than half were able to complete the intervention. Those who completed the program experienced an improvement in their lung cancer symptoms. Community-based or briefer exercise interventions may be more feasible in this population.

Effect of physical exercise on muscle mass and strength in cancer patients during treatment—A systematic review

“…In this study, patients with advanced incurable cancer were randomized to eight weeks of CAE performed twice weekly in a supervised hospital setting, or to usual care. The increased grip strength in the CAE relative to UC supports previous uncontrolled trials in advanced cancer [47,48] on efficacy of exercise on muscle strength also in this population. In conclusion, the findings from our review support the effect of exercise on muscle strength in cancer patient undergoing curative treatment.…”

“…As only RCT's were included, two uncontrolled trials performed in patients with advanced lung cancer [47,48] were not described in our results. These trials showed improvement in muscle strength after eight weeks of CAE but none of these studies used muscle mass as outcome.…”

Physical Activity and Cancer

“…However, studies have suggested that there is value in those with lung cancer maintaining a certain level of physical activity. Pertinently, cancer symptoms have been shown to significantly decrease in inoperable lung cancer patients after just eight weeks of physical activity, which also prevented a decrease in cardiovascular fitness (Temel et al, 2009). …”

Pulmonary Rehabilitation in lung cancer

“…In light of these considerations, it's clear that there is a growing interest in the identification of strategies to enable patients suffering from NSCLC to improve exercise tolerance, anxiety and depression, which are the main factors involved in the decline in their quality of life; in this scenario, PR with specific muscular exercises may play a decisive role [25][26][27]. This review is intended to analyze the most recent literature: in recent years, in fact, many articles have reported on the potential role of PR in the management of patients with not-operable NSCLC; although the evidence regarding its efficacy on symptoms has not been proven yet, the general impression that emerges is that respiratory exercises represent a valid and useful strategy to adopt in the overall management of these patients.…”