Short and long-term effects of supervised versus unsupervised exercise training on health-related quality of life and functional outcomes following lung cancer surgery – A randomized controlled trial

Preoperative exercise therapy in lung surgery patients: A systematic review

OBJECTIVES

The impact of postoperative complications after lung surgery for cancer is substantial, with the increasing age of patients and the presence of comorbidities. This systematic review summarises the effects of Preoperative Exercise Therapy (PET) in patients scheduled for lung surgery on aerobic capacity, physical fitness, postoperative complications, length of hospital stay, quality of life and recovery.

METHODS

A systematic search on PET prior to lung surgery was conducted. The methodological quality of the included studies was rated using the Physiotherapy Evidence Database (PEDro) scale. The agreement between the reviewers was assessed with Cohen's kappa.

RESULTS

A total of eleven studies were included with a methodological quality ranging from poor to good. The agreement between the reviewers, assessed with the Cohen's kappa, was 0.79. Due to substantial heterogeneity in the interventions across the included studies, it was impossible to conduct a meta-analysis. The most important finding of this systematic review was that PET based on moderate to intense exercise in patients scheduled for lung surgery has beneficial effects on aerobic capacity, physical fitness and quality of life. Also PET may reduce postoperative complications and length of hospital stay.

CONCLUSION

PET may have beneficial effects on various physical fitness variables and postoperative complications in patients with lung cancer scheduled for surgery. Future research must focus on developing patient tailored exercise programs and investigate the influence of co-existing comorbidities on the outcome measures. Definitions of PET, including timing, (acceptable) duration, intensity and exercise training methods should be determined and compared.

The Impact of a Multidimensional Exercise Intervention on Physical and Functional Capacity, Anxiety, and Depression in Patients With Advanced-Stage Lung Cancer Undergoing Chemotherapy

Introduction. Patients with advanced-stage lung cancer face poor survival and experience co-occurring chronic physical and psychosocial symptoms. Despite several years of research in exercise oncology, few exercise studies have targeted advanced lung cancer patients undergoing chemotherapy. The aim of the present study was to investigate the benefits of a 6-week supervised group exercise intervention and to outline the effect on aerobic capacity, strength, health-related quality of life (HRQoL), anxiety, and depression. Methods. VO2peak was assessed using an incremental exercise test. Muscle strength was measured with one repetition maximum test (1RM). HRQoL, anxiety, and depression were assessed using Functional Assessment of Cancer Therapy–Lung (FACT-L) scale and the Hospital Anxiety and Depression Scale (HADS). Results. One hundred and forthteen patients with advanced stage lung cancer were recruited. Forty-three patients dropped out. No serious adverse events were reported. Exercise adherence in the group training was 68%. Improvements in VO2peak ( P < .001) and 6-minute walk distance ( P < .001) and muscle strength measurements ( P < .05) were seen. There was a reduction in anxiety level ( P = .0007) and improvement in the emotional well-being parameter (FACT-L) but no statistically significant changes in HRQoL were observed. Conclusion. The results of the present study show that during a 6-week hospital-based supervised, structured, and group-based exercise program, patients with advanced-stage lung cancer (NSCLC IIIb-IV, ED-SCLC) improve their physical capacity (VO2peak, 1RM), functional capacity, anxiety level, and emotional well-being, but not their overall HRQoL. A randomized controlled trial testing the intervention including 216 patients is currently being carried out.

Effects of a community-based multimodal exercise program on physical function and quality of life in cancer survivors: a pilot study

The purpose of this single-arm pilot study was to examine the effects of a community-based multimodal exercise program on: physical function (Timed-Up-and-Go [TUG], 6-min walk test [6MWT], leg and chest press strength, and functional reach [FR]); and quality of life, QoL [FACT-G]), in cancer survivors. Fifty-nine cancer survivors (91.5% female; mean age 59 ± 12 years) completed supervised exercise training for 90 min twice weekly for 12 weeks. Exercise training consisted of 30 min of each of the following: (1) aerobic conditioning; (2) resistance training; and (3) balance and flexibility training. Pre-post-outcome measures were compared for statistically significant differences (p < 0.01) and were related to the International Classification of Functioning, Disability and Health Model. Effect sizes (ES), minimal clinically important differences, and minimal detectable change at 90% confidence intervals were calculated. Participants decreased TUG time by 21.1% and walked 15.5% farther during 6-MWT (p < 0.001). Leg and chest press strength increased by 34.5% and 32.7%, respectively (p < 0.001). FR increased by 15.1% (p < 0.001). Significant improvements for physical well-being (13.9%), emotional well-being (6.7%), functional well-being (13.0%), and total well-being (9.6%) were found (p < 0.01). Improvements in physical function and QoL showed "moderate to large" ESs indicating improvements in physical function and QoL are clinically meaningful.