Exercise training for people following curative intent treatment for non-small cell lung cancer: a randomized controlled trial

Vinicius Cavalheri, Sue Jenkins, Nola Cecins, Kevin Gain, Martin J Phillips, Lucas H Sanders, Kylie Hill, Vinicius Cavalheri, Sue Jenkins, Nola Cecins, Kevin Gain, Martin J Phillips, Lucas H Sanders, Kylie Hill

Abstract

Objective: In people following curative intent treatment for non-small cell lung cancer, to investigate the effects of supervised exercise training on exercise capacity, physical activity and sedentary behavior, peripheral muscle force, health-related quality of life, fatigue, feelings of anxiety and depression, and lung function.

Method: This pilot randomized controlled trial included participants 6-10 weeks after lobectomy for non-small cell lung cancer or, for those who required adjuvant chemotherapy, 4-8 weeks after their last cycle. Participants were randomized to either 8 weeks of supervised exercise training (exercise group) or 8 weeks of usual care (control group). Prior to and following the intervention period, both groups completed measurements of exercise capacity, physical activity and sedentary behavior, quadriceps and handgrip force, HRQoL, fatigue, feelings of anxiety and depression, and lung function. Intention-to-treat analysis was undertaken.

Results: Seventeen participants (mean age 67, SD=9 years; 12 females) were included. Nine and eight participants were randomized to the exercise and control groups, respectively. Four participants (44%) adhered to exercise training. Compared with any change seen in the control group, those in the exercise group demonstrated greater gains in the peak rate of oxygen consumption (mean difference, 95% confidence interval for between-group difference: 0.19 [0.04-0.33]Lmin-1) and 6-minute walk distance (52 [12-93]m). No other between-group differences were demonstrated.

Conclusions: In people following curative intent treatment for non-small cell lung cancer, 8 weeks of supervised exercise training improved exercise capacity, measured by both laboratory- and field-based exercise tests. These results suggest that this clinical population may benefit from attending exercise training programs.

Keywords: Carcinoma; Exercise training; Lung neoplasms; Non-small cell; Rehabilitation.

Copyright © 2017 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier Editora Ltda. All rights reserved.

Figures

Figure 1
Figure 1
Study flow diagram.

References

    1. Ferlay J., Soerjomataram I., Dikshit R. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136(5):E359–E386.
    1. AIHW and Cancer Australia . AIHW; Canberra: 2011. Lung Cancer in Australia: An Overview. Cat. no. CAN 58.
    1. Sher T., Dy G.K., Adjei A.A. Small cell lung cancer. Mayo Clin Proc. 2008;83(3):355–367.
    1. Howington J.A., Blum M.G., Chang A.C., Balekian A.A., Murthy S.C. Treatment of stage I and II non-small cell lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013;143(5 suppl):e278S–e313S.
    1. Jones L.W. Physical activity and lung cancer survivorship. Recent Results Cancer Res. 2011;186:255–274.
    1. Win T., Groves A.M., Ritchie A.J., Wells F.C., Cafferty F., Laroche C.M. The effect of lung resection on pulmonary function and exercise capacity in lung cancer patients. Respir Care. 2007;52(6):720–726.
    1. Cavalheri V., Jenkins S., Cecins N. Impairments after curative intent treatment for non-small cell lung cancer: a comparison with age and gender-matched healthy controls. Respir Med. 2015;109(10):1332–1339.
    1. Poghosyan H., Sheldon L.K., Leveille S.G., Cooley M.E. Health-related quality of life after surgical treatment in patients with non-small cell lung cancer: a systematic review. Lung Cancer. 2013;81(1):11–26.
    1. Balduyck B., Hendriks J., Lauwers P., Sardari Nia P., Van Schil P. Quality of life evolution after lung cancer surgery in septuagenarians: a prospective study. Eur J Cardiothorac Surg. 2009;35(6):1070–1075. discussion 1075.
    1. McCarthy B., Casey D., Devane D., Murphy K., Murphy E., Lacasse Y. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2015;2 CD003793.
    1. Dowman L., Hill C.J., Holland A.E. Pulmonary rehabilitation for interstitial lung disease. Cochrane Database Syst Rev. 2014;10 CD006322.
    1. Schmitz K.H., Holtzman J., Courneya K.S., Masse L.C., Duval S., Kane R. Controlled physical activity trials in cancer survivors: a systematic review and meta-analysis. Cancer Epidemiol Biomark Prev. 2005;14(7):1588–1595.
    1. McNeely M.L., Campbell K.L., Rowe B.H., Klassen T.P., Mackey J.R., Courneya K.S. Effects of exercise on breast cancer patients and survivors: a systematic review and meta-analysis. CMAJ. 2006;175(1):34–41.
    1. Cavalheri V., Tahirah F., Nonoyama M., Jenkins S., Hill K. Exercise training undertaken by people within 12 months of lung resection for non-small cell lung cancer. Cochrane Database Syst Rev. 2013;7 CD009955.
    1. Jenkins S., Cecins N., Camarri B., Williams C., Thompson P., Eastwood P. Regression equations to predict 6-minute walk distance in middle-aged and elderly adults. Physiother Theory Pract. 2009;25(7):516–522.
    1. Holland A.E., Spruit M.A., Troosters T. An official European Respiratory Society/American Thoracic Society technical standard: field walking tests in chronic respiratory disease. Eur Respir J. 2014;44(6):1428–1446.
    1. Ware J.E., Jr., Sherbourne C.D. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30(6):473–483.
    1. Cella D.F., Bonomi A.E., Lloyd S.R., Tulsky D.S., Kaplan E., Bonomi P. Reliability and validity of the Functional Assessment of Cancer Therapy-Lung (FACT-L) quality of life instrument. Lung Cancer. 1995;12(3):199–220.
    1. Aaronson N.K., Ahmedzai S., Bergman B. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993;85(5):365–376.
    1. Snaith R.P. The Hospital Anxiety And Depression Scale. Health Qual Life Outcomes. 2003;1:29.
    1. Yellen S.B., Cella D.F., Webster K., Blendowski C., Kaplan E. Measuring fatigue and other anemia-related symptoms with the Functional Assessment of Cancer Therapy (FACT) measurement system. J Pain Symptom Manag. 1997;13(2):63–74.
    1. Spruit M.A., Sillen M.J., Groenen M.T., Wouters E.F., Franssen F.M. New normative values for handgrip strength: results from the UK Biobank. J Am Med Dir Assoc. 2013;14(10) 775.e775–711.
    1. Hill K., Dolmage T.E., Woon L., Goldstein R., Brooks D. Measurement properties of the SenseWear armband in adults with chronic obstructive pulmonary disease. Thorax. 2010;65(6):486–491.
    1. Cavalheri V., Donaria L., Ferreira T. Energy expenditure during daily activities as measured by two motion sensors in patients with COPD. Respir Med. 2011;105(6):922–929.
    1. Cindy Ng L.W., Jenkins S., Hill K. Accuracy and responsiveness of the stepwatch activity monitor and ActivPAL in patients with COPD when walking with and without a rollator. Disabil Rehabil. 2012;34(15):1317–1322.
    1. Garber C.E., Blissmer B., Deschenes M.R. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011;43(7):1334–1359.
    1. Miller M.R., Hankinson J., Brusasco V. Standardisation of spirometry. Eur Respir J. 2005;26(2):319–338.
    1. Wanger J., Clausen J.L., Coates A. Standardisation of the measurement of lung volumes. Eur Respir J. 2005;26(3):511–522.
    1. Macintyre N., Crapo R.O., Viegi G. Standardisation of the single-breath determination of carbon monoxide uptake in the lung. Eur Respir J. 2005;26(4):720–735.
    1. American Thoracic Society/European Respiratory S ATS/ERS Statement on respiratory muscle testing. Am J Respir Crit Care Med. 2002;166(4):518–624.
    1. ATS/ACCP Statement on cardiopulmonary exercise testing. Am J Respir Crit Care Med. 2003;167(2):211–277.
    1. Blackie S.P., Fairbarn M.S., McElvaney G.N., Morrison N.J., Wilcox P.G., Pardy R.L. Prediction of maximal oxygen uptake and power during cycle ergometry in subjects older than 55 years of age. Am Rev Respir Dis. 1989;139(6):1424–1429.
    1. Decramer M., Gosselink R., Troosters T., Verschueren M., Evers G. Muscle weakness is related to utilization of health care resources in COPD patients. Eur Respir J. 1997;10(2):417–423.
    1. Jenkins S., Hill K., Cecins N.M. State of the art: how to set up a pulmonary rehabilitation program. Respirology. 2010;15(8):1157–1173.
    1. Cavalheri V., Tahirah F., Nonoyama M., Jenkins S., Hill K. Exercise training for people following lung resection for non-small cell lung cancer – a Cochrane systematic review. Cancer Treat Rev. 2014;40(4):585–594.
    1. Edvardsen E., Skjonsberg O.H., Holme I., Nordsletten L., Borchsenius F., Anderssen S.A. High-intensity training following lung cancer surgery: a randomised controlled trial. Thorax. 2015;70(3):244–250.
    1. Jones L.W., Watson D., Herndon J.E., 2nd Peak oxygen consumption and long-term all-cause mortality in nonsmall cell lung cancer. Cancer. 2010;116(20):4825–4832.
    1. Granger C.L., Holland A.E., Gordon I.R., Denehy L. Minimal important difference of the 6-minute walk distance in lung cancer. Chron Respir Dis. 2015;12(2):146–154.
    1. Zarogoulidis P., Kerenidi T., Huang H. Six minute walking test and carbon monoxide diffusing capacity for non-small cell lung cancer: easy performed tests in every day practice. J Thorac Dis. 2012;4(6):569–576.
    1. Griffiths T.L., Burr M.L., Campbell I.A. Results at 1 year of outpatient multidisciplinary pulmonary rehabilitation: a randomised controlled trial. Lancet. 2000;355(9201):362–368.
    1. Arbane G., Douiri A., Hart N. Effect of postoperative physical training on activity after curative surgery for non-small cell lung cancer: a multicentre randomised controlled trial. Physiotherapy. 2014;100(2):100–107.
    1. Novoa N., Varela G., Jimenez M.F., Aranda J.L. Influence of major pulmonary resection on postoperative daily ambulatory activity of the patients. Interact Cardiovasc Thorac Surg. 2009;9(6):934–938.
    1. Cavalheri V., Jenkins S., Cecins N., Phillips M., Sanders L.H., Hill K. Patterns of sedentary behaviour and physical activity in people following curative intent treatment for non-small cell lung cancer. Chron Respir Dis. 2016;13(1):82–85.
    1. Arbane G., Tropman D., Jackson D., Garrod R. Evaluation of an early exercise intervention after thoracotomy for non-small cell lung cancer (NSCLC), effects on quality of life, muscle strength and exercise tolerance: randomised controlled trial. Lung Cancer. 2011;71(2):229–234.
    1. Salhi B., Huysse W., Van Maele G., Surmont V.F., Derom E., van Meerbeeck J.P. The effect of radical treatment and rehabilitation on muscle mass and strength: a randomized trial in stages I–III lung cancer patients. Lung Cancer. 2014;84(1):56–61.
    1. Hawthorne G., Osborne R.H., Taylor A., Sansoni J. The SF36 Version 2: critical analyses of population weights, scoring algorithms and population norms. Qual Life Res. 2007;16(4):661–673.

Source: PubMed

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