Exercise in Patients with NonSmall Cell Lung Cancer

KUEHR, LEA1,2; WISKEMANN, JOACHIM1,3; ABEL, ULRICH4; ULRICH, CORNELIA M.1; HUMMLER, SIMONE2; THOMAS, MICHAEL2

Medicine & Science in Sports & Exercise: April 2014 - Volume 46 - Issue 4 - p 656–663
doi: 10.1249/MSS.0000000000000158
Clinical Sciences

Purpose: This study aimed to evaluate the safety, feasibility, and effects of an 8-wk combined resistance and endurance exercise program in patients with advanced non–small cell lung cancer (NSCLC) during in- and outpatient care.

Methods: In this intervention study, 40 patients with predominantly advanced NSCLC receiving simultaneous or sequential radiochemotherapy or chemotherapy alone were enrolled. For a period of 8 wk, patients were instructed to exercise at least five times per week during the inpatient setting and at least three times per week in the outpatient setting. Physical performance status (endurance capacity: 6-min walk test; strength capacity: handheld dynamometry), quality-of-life (Functional Assessment of Cancer Therapy–Lung), fatigue (Multidimensional Fatigue Inventory), and depression (Patient Health Questionnaire) were assessed at baseline (T0), after the exercise intervention (T1), and at a follow-up time point 8 wk later (T2). The primary end point was adequate adherence (feasibility) defined as completing at least two training sessions per week during a minimum of 6 wk.

Results: Of 40 patients, 31 (77.5%) completed the postexercise assessment (T1) and 22 (55%) completed follow-up (T2). The stages were IIA (5%), IIIA (8%), IIIB (20%), and IV (67%), and the median age was 63 yr (range = 22–75 yr). Overall, adherence was 82% for those patients who completed T1, and 55% of the 40 participating patients fulfilled the adequate adherence criterion. Those who completed the intervention showed a significant improvement in the 6-min walk distance and in knee, elbow, and hip muscle strength after the intervention (T1). Quality of life, fatigue, and depression scores remained stable or declined slightly. Significant improvements in knee-muscle strength were also observed at T2.

Conclusions: Exercise training is feasible in advanced and metastatic NSCLC patients during anticancer treatment. In this pilot study, endurance and strength capacity improved over time, indicating the rehabilitative importance of the applied intervention. To investigate the potential impact of exercise training in this patient group, a larger randomized trial is warranted.

1Division of Preventive Oncology, National Center for Tumor Diseases and German Cancer Research Center, Heidelberg, GERMANY; 2Department of Thoracic Oncology, Thoraxklinik, University of Heidelberg, Heidelberg, GERMANY; 3Division of Medical Oncology, National Center for Tumor Diseases and University Clinic Heidelberg, Heidelberg, GERMANY; and 4National Center for Tumor Diseases and German Cancer Research Center, Heidelberg, GERMANY

Address for correspondence: Joachim Wiskemann, Division of Medical Oncology and Preventive Oncology, National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 460, 69120 Heidelberg, Germany; E-mail: joachim.wiskemann@nct-heidelberg.de.

L.K., J.W., S.H., and M.T. equally contributed to this study.

Submitted for publication May 2013.

Accepted for publication September 2013.

© 2014 American College of Sports Medicine