Safety and feasibility of a combined exercise intervention for inoperable lung cancer patients undergoing chemotherapy: A pilot study

Abstract

Aim

To investigate the safety and feasibility of a six-week supervised structured exercise and relaxation training programme on estimated peak oxygen consumption, muscle strength and health related quality of life (HRHRQOL) in patients with inoperable lung cancer, undergoing chemotherapy.

Methods

A prospective, single-arm intervention study of supervised, hospital based muscle and cardiovascular group training and individual home-based training. Peak oxygen consumption (VO_2peak) was assessed using an incremental exercise test. Muscle strength was measured with one repetition maximum test (1RM). HRQOL was assessed using the Functional Assessment of Cancer Therapy-Lung (FACT-L) scale.

Results

Twenty-five patients with non-small cell cancer (NSCLC) stage III–IV and four patients with extensive disease small cell lung cancer (SCLC-ED) were recruited. Six patients (20.7%) dropped out leaving 23 patients for analysis. Exercise adherence in the group training was 73.0% and 8.7% in the home-based training. There were improvements in estimated VO_2peak and six-minute walk distance (6 MWD) as well as increased muscle strength measurements (p < 0.05). There was significant improvement in the “emotional well-being” parameter (FACT-L) while there were no significant changes in HRQOL.

Conclusion

Exercise training produces significant improvements in physiological indices and emotional HRQOL and is safe and feasible in patients with advanced stage lung cancer, undergoing chemotherapy. No analysis on home-based training was done because of low adherence.

Introduction

Physical exercise in selected groups of cancer patients can relieve the burden of disease symptoms and side effects from anticancer treatment, e.g. poor exercise tolerance, fatigue, depression and anxiety [1], [2], [3], [4]. The benefits of physical exercise for cancer patients are described in a series of studies [5], [6], [7], [8], [9], [10], [11], most of which included patients with breast cancer and haematological neoplasias. The studies measured HRQOL and functional capacity and included patients groups with early stage disease. Only two exercise intervention studies have included patients with lung cancer who were undergoing chemotherapy [12], [13] and only one study, Temel et al. [12] investigated the effect of physical training in advanced lung cancer (NSCLC III–IV) and found no significant improvement or decline in HRQOL, anxiety, depression, and physical function (assessed by six minutes walking distance (6 MWD)). However, significant improvement was demonstrated in strength in a single muscle group. Other studies have shown significant improvements following exercise intervention in quality of life and physical function (6 MWD) as well as physical capacity (VO_2peak and 1RM) in patients with lung cancer who were at an earlier stage of disease (NSCLC I–III, SCLC LD) [13], [14], [15], [16], [17].

Moreover, it has been shown that physical activity and relaxation training can relieve side-effects and symptoms in cancer patients with advanced disease who are undergoing chemotherapy [18], [19], [20]. It is not known whether these benefits of physical activity can be achieved in patients with advanced NSCLC and SCLC during chemotherapy. We investigated the impact on aerobic capacity (VO_2peak), muscle strength (1RM), and quality of life (HRQOL) in patients with lung cancer (NSCLC stage III–IV and SCLC-ED) undergoing a six-week hospital based, supervised and structured, muscle-cardiovascular-relaxation training program and home based exercise program while they received chemotherapy. We hypothesized that the intervention could increase physical capacity (fitness and strength) and functional capacity (6 MWD) as well as improve HRQOL.