Physical Activity and Exercise in Lung Cancer Care: Will Promises Be Fulfilled?

Abstract

Lung cancer remains the leading cause of cancer‐related death worldwide. Affected patients frequently experience debilitating disease‐related symptoms, including dyspnea, cough, fatigue, anxiety, depression, insomnia, and pain, despite the progresses achieved in term of treatment efficacy. Physical activity and exercise are nonpharmacological interventions that have been shown to improve fatigue, quality of life, cardiorespiratory fitness, pulmonary function, muscle mass and strength, and psychological status in patients with lung cancer. Moreover, physical fitness levels, especially cardiorespiratory endurance and muscular strength, are demonstrated to be independent predictors of survival. Nevertheless, patients with lung cancer frequently present insufficient levels of physical activity and exercise, and these may contribute to quality of life impairment, reduction in functional capacity with skeletal muscle atrophy or weakness, and worsening of symptoms, particularly dyspnea. The molecular bases underlying the potential impact of exercise on the fitness and treatment outcome of patients with lung cancer are still elusive. Counteracting specific cancer cells’ acquired capabilities (hallmarks of cancer), together with preventing treatment‐induced adverse events, represent main candidate mechanisms. To date, the potential impact of physical activity and exercise in lung cancer remains to be fully appreciated, and no specific exercise guidelines for patients with lung cancer are available. In this article, we perform an in‐depth review of the evidence supporting physical activity and exercise in lung cancer and suggest that integrating this kind of intervention within the framework of a global, multidimensional approach, taking into account also nutritional and psychological aspects, might be the most effective strategy. Implications for Practice Although growing evidence supports the safety and efficacy of exercise in lung cancer, both after surgery and during and after medical treatments, most patients are insufficiently active or sedentary. Engaging in exercise programs is particularly arduous for patients with lung cancer, mainly because of a series of physical and psychosocial disease‐related barriers (including the smoking stigma). A continuous collaboration among oncologists and cancer exercise specialists is urgently needed in order to develop tailored programs based on patients’ needs, preferences, and physical and psychological status. In this regard, benefit of exercise appears to be potentially enhanced when administered as a multidimensional, comprehensive approach to patients’ well‐being.

Preoperative paraspinous muscle sarcopenia and physical performance as prognostic indicators in non‐small‐cell lung cancer

“…It is important to accurately assess preoperative sarcopenia and physical performance because both can be targeted for treatment before and after surgery with various interventions, including nutritional recommendations and rehabilitation 43–45 . Exercise is a non‐pharmacological intervention that improves fatigue, quality of life, pulmonary function, muscle mass, physical performance, and psychological status of patients with lung cancer 37,38 . In addition, the performance of resistance training and use of nutritional supplements, including branched‐chain amino acids, vitamin D, whey protein, and hydroxymethylbutyrate‐enriched milk, play important roles in the prevention and improvement of sarcopenia, 15 and these interventions may result in improved post‐operative outcomes for frail NSCLC patients.…”

Patient-Reported Outcomes of Regular Aerobic Exercise in Gastric Cancer

“…The guidelines from the American Cancer Society recommend that cancer survivors engage in regular exercise for at least 150 min/wk [ 4 ]. Recent studies have reported that regular exercise is an effective strategy for improving physical fitness, cardiorespiratory fitness, pulmonary function, muscle mass and strength, health-related quality of life (HRQOL), fatigue, psychological status such as anxiety and depression, and sleep quality in breast, lung, head and neck, ovarian, colorectal, and lymphoma cancer survivors during or after treatment [ 5 , 6 , 7 , 8 , 9 , 10 , 11 ]. Studies of patients with gastric cancer during and after treatment have also shown the beneficial effects of exercise on HRQOL [ 12 , 13 , 14 ] and emotional [ 1 ], social, and role functioning [ 14 ].…”

WITHDRAWN: Correlation between DVH parameters and lung function changes before and after radiotherapy and the occurrence of radiation-induced lung injury (RILI)

“…This makes research simple and easy to predict indicators attract attention, in order to evaluate the risk of lung injury before and early treatment. At the same time, effective interventions can be implemented early to prevent or avoid the occurrence of RILI [20]. The occurrence of RILI is the result of multiple factors.…”