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Kong S, Shin S, Jeon YJ, Lee G, Cho JH, Kim HK, Shim YM, Cho J, Kang D, Park HY. Factors associated with failure of cardiopulmonary function recovery after lung cancer surgery. Respirology 2023; 28:1060-1068. [PMID: 37642118 DOI: 10.1111/resp.14581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 07/10/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND AND OBJECTIVE This study aimed to evaluate the longitudinal changes in cardiopulmonary function (CPF) and identify predictors of cardiopulmonary recovery failure after lung cancer surgery. METHODS Data was obtained from a prospective CATCH-LUNG cohort study, where patients were divided into two groups based on 6-min walk distance (6MWD) at baseline and 6 months after surgery. CPF recovery failure was defined as a participant whose 6MWD dropped over 50 m from baseline to 6 months after surgery. Patients with a baseline 6MWD less than 400 m were excluded. The analysis was investigated using mixed effects models, and the relative estimates for the predictors were expressed relative risk (RR) and 95% CI using a Poisson regression. RESULTS Among 419 patients, 24.1% and 17.7% showed failure of CPF recovery at 6 months and 1 year after surgery, respectively. In the multivariable analysis, baseline step count [RR per 1000 steps lower = 1.05 (95% CI, 1.01-1.09)], baseline dyspnoea [RR per 10 points higher = 1.15(1.07-1.23)], decreased FEV1 % predicted from baseline to 2 weeks after surgery [RR per 10% lower = 1.30(1.10-1.53)] and decreased moderate-to-vigorous physical activity (MVPA) from baseline to 2 weeks [RR = 1.95(1.22, 3.11)] or persistent low MVPA at baseline and 2 weeks after surgery [RR = 1.63(1.04, 2.54)] were significant factors for loss of CPF. CONCLUSION The inability to recover CPF at 6 months after surgery was linked to reduction of lung function and MVPA from baseline to 2 weeks as well as baseline physical activity (PA) and dyspnoea. These results imply that engagement of perioperative PA is necessary to facilitate recovery of CPF after lung cancer surgery.
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Affiliation(s)
- Sunga Kong
- Patient-Centered Outcomes Research Institute, Samsung Medical Center, Seoul, South Korea
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea
| | - Sumin Shin
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, Ewha Womans University, Mokdong Hospital, Seoul, South Korea
| | - Yeong Jeong Jeon
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Genehee Lee
- Patient-Centered Outcomes Research Institute, Samsung Medical Center, Seoul, South Korea
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea
| | - Jong Ho Cho
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Young Mog Shim
- Patient-Centered Outcomes Research Institute, Samsung Medical Center, Seoul, South Korea
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Juhee Cho
- Patient-Centered Outcomes Research Institute, Samsung Medical Center, Seoul, South Korea
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Department of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Danbee Kang
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hye Yun Park
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Chen X, Li C, Zeng L, Rong T, Lin P, Wang Q, Guo Z, Long H, Zhong J. Comparative efficacy of different combinations of acapella, active cycle of breathing technique, and external diaphragmatic pacing in perioperative patients with lung cancer: a randomised controlled trial. BMC Cancer 2023; 23:282. [PMID: 36978035 PMCID: PMC10053339 DOI: 10.1186/s12885-023-10750-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Acapella plus active cycle of breathing technique (ACBT), external diaphragm pacemaker (EDP) plus ACBT have been shown to facilitate the recovery of functional capacity and lung function in patients suffering from airway obstruction but the efficacy in perioperative patients with lung cancer has not been proven. METHODS We conducted a three-arm, prospective, randomized, assessor-blinded, controlled trial in patients with lung cancer who underwent thoracoscopic lobectomy or segmentectomy in the department of thoracic surgery, China. Patients were randomly assigned (1:1:1) to receive Acapella plus ACBT, EDP plus ACBT, or ACBT group (control group) using SAS software. The primary outcome was functional capacity, measured by the 6-minute walk test (6MWT). RESULTS We recruited 363 participants over 17 months: 123 assigned to the Acapella plus ACBT group, 119 to the EDP plus ACBT group, and 121 to the ACBT group. Statistically significant differences were noted for functional capacity between the EDP plus ACBT and control groups at each follow-up time (1-week follow-up: difference = 47.25 m, 95% CI, 31.56-62.93; P < 0.001; and 1-month follow-up: difference = 49.72 m, 95% CI, 34.04-65.41; P < 0.001), between the Acapella plus ACBT and control groups at postoperative week 1 (difference = 35.23 m, 95% CI, 19.30-51.16; P < 0.001) and postoperative month 1 (difference = 34.96 m, 95% CI, 19.03-50.89; P < 0.001), and between the EDP plus ACBT and Acapella plus ACBT groups at 1-month follow-up (difference = 14.76 m, 95% CI, 1.34-28.19; P = 0.0316). CONCLUSION EDP plus ACBT and Acapella plus ACBT significantly improved functional capacity and lung function in perioperative patients with lung cancer, compared with single-model ACBT, and the effects of EDP plus ACBT were clearly superior to those of other programs. TRIAL REGISTRATION The study was registered in the clinical trial database (clinicaltrials.gov) on June 4, 2021 (No. NCT04914624).
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Affiliation(s)
- Xiaoxue Chen
- Department of Thoracic Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, No. 651, Road Dongfengdong, Yuexiu District, Guangzhou, Guangzhou, Guangdong, China
| | - Chuanzhen Li
- Department of Thoracic Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, No. 651, Road Dongfengdong, Yuexiu District, Guangzhou, Guangzhou, Guangdong, China
| | - Linjuan Zeng
- Department of Thoracic Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, No. 651, Road Dongfengdong, Yuexiu District, Guangzhou, Guangzhou, Guangdong, China
| | - Tiehua Rong
- Department of Thoracic Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, No. 651, Road Dongfengdong, Yuexiu District, Guangzhou, Guangzhou, Guangdong, China
| | - Peng Lin
- Department of Thoracic Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, No. 651, Road Dongfengdong, Yuexiu District, Guangzhou, Guangzhou, Guangdong, China
| | - Qinglin Wang
- Department of Thoracic Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, No. 651, Road Dongfengdong, Yuexiu District, Guangzhou, Guangzhou, Guangdong, China
| | - Zhixing Guo
- Department of Thoracic Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, No. 651, Road Dongfengdong, Yuexiu District, Guangzhou, Guangzhou, Guangdong, China.
| | - Hao Long
- Department of Thoracic Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, No. 651, Road Dongfengdong, Yuexiu District, Guangzhou, Guangzhou, Guangdong, China.
| | - Jiudi Zhong
- Department of Thoracic Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, No. 651, Road Dongfengdong, Yuexiu District, Guangzhou, Guangzhou, Guangdong, China.
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Pires IM, Denysyuk HV, Villasana MV, Sá J, Marques DL, Morgado JF, Albuquerque C, Zdravevski E. Development Technologies for the Monitoring of Six-Minute Walk Test: A Systematic Review. SENSORS 2022; 22:s22020581. [PMID: 35062542 PMCID: PMC8782011 DOI: 10.3390/s22020581] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/03/2022] [Accepted: 01/11/2022] [Indexed: 12/12/2022]
Abstract
In the pandemic time, the monitoring of the progression of some diseases is affected and rehabilitation is more complicated. Remote monitoring may help solve this problem using mobile devices that embed low-cost sensors, which can help measure different physical parameters. Many tests can be applied remotely, one of which is the six-minute walk test (6MWT). The 6MWT is a sub-maximal exercise test that assesses aerobic capacity and endurance, allowing early detection of emerging medical conditions with changes. This paper presents a systematic review of the use of sensors to measure the different physical parameters during the performance of 6MWT, focusing on various diseases, sensors, and implemented methodologies. It was performed with the PRISMA methodology, where the search was conducted in different databases, including IEEE Xplore, ACM Digital Library, ScienceDirect, and PubMed Central. After filtering the papers related to 6MWT and sensors, we selected 31 papers that were analyzed in more detail. Our analysis discovered that the measurements of 6MWT are primarily performed with inertial and magnetic sensors. Likewise, most research studies related to this test focus on multiple sclerosis and pulmonary diseases.
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Affiliation(s)
- Ivan Miguel Pires
- Instituto de Telecomunicações, Universidade da Beira Interior, 6200-001 Covilhã, Portugal;
- Escola de Ciências e Tecnologia, University of Trás-os-Montes e Alto Douro, Quinta de Prados, 5001-801 Vila Real, Portugal
- Correspondence: ; Tel.: +351-966-379-785
| | | | - María Vanessa Villasana
- Centro Hospitalar Universitário da Cova da Beira, 6200-251 Covilhã, Portugal;
- Health Sciences Research Unit: Nursing (UICISA: E), School of Health, Polytechnic Institute of Viseu, 3504-510 Viseu, Portugal; (J.S.); (C.A.)
| | - Juliana Sá
- Health Sciences Research Unit: Nursing (UICISA: E), School of Health, Polytechnic Institute of Viseu, 3504-510 Viseu, Portugal; (J.S.); (C.A.)
- Faculty of Health Sciences, Universidade da Beira Interior, 6200-506 Covilhã, Portugal
- Centro Hospitalar Universitário do Porto, 4099-001 Oporto, Portugal
| | - Diogo Luís Marques
- Department of Sport Sciences, University of Beira Interior, 6201-001 Covilhã, Portugal;
| | | | - Carlos Albuquerque
- Health Sciences Research Unit: Nursing (UICISA: E), School of Health, Polytechnic Institute of Viseu, 3504-510 Viseu, Portugal; (J.S.); (C.A.)
| | - Eftim Zdravevski
- Faculty of Computer Science and Engineering, University Ss Cyril and Methodius, 1000 Skopje, North Macedonia;
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Ferreira V, Lawson C, Carli F, Scheede-Bergdahl C, Chevalier S. Feasibility of a novel mixed-nutrient supplement in a multimodal prehabilitation intervention for lung cancer patients awaiting surgery: A randomized controlled pilot trial. Int J Surg 2021; 93:106079. [PMID: 34464752 DOI: 10.1016/j.ijsu.2021.106079] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 07/20/2021] [Accepted: 08/26/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate, in lung cancer patients awaiting elective surgery, the feasibility of delivering a novel four-week multimodal prehabilitation intervention and its effects on preoperative functional capacity and health-related quality of life (HRQoL), compared to standard hospital care. METHODS Adult patients awaiting elective thoracotomy for lung cancer stages I, II or IIIa, were approached to participate in an open-label, randomized controlled trial of two parallel arms: multimodal prehabilitation combining a mixed-nutrient supplement with structured supervised and home-based exercise training, and relaxation-strategies (Prehab) or standard hospital care (Control). Feasibility was assessed based on recruitment and adherence rates to the intervention and study outcome assessment. Functional capacity, measured by the 6-min walk test (6MWT), and HRQoL were measured at baseline and after four weeks (preoperative). RESULTS Within 5 months, 34 patients were enrolled and randomized (2:1) to Prehab (n = 24; median age = 67 years) or Control (n = 10; median age = 69 years); recruitment rate of 58.6%. The study was interrupted by the COVID-19 pandemic. Adherence to the prescribed intensity of the supervised exercise program was 84.1% (SD 23.1). Self-reported adherence to the home-based exercise program was 88.2% (SD 21) and to the nutritional supplement, 93.2% (SD 14.2). Adherence to patients' preoperative assessment was 82% and 88% in Prehab and Control, respectively. The mean adjusted difference in 4-week preoperative 6MWT between groups was 37.7 m (95% CI, -6.1 to 81.4), p = 0.089. There were no differences in HRQoL between groups. CONCLUSION Within a preoperative timeframe, it was feasible to deliver this novel multimodal prehabilitation intervention in lung cancer patients awaiting surgery.
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Affiliation(s)
- Vanessa Ferreira
- Department of Kinesiology and Physical Education, McGill University, Montreal, QC, Canada; Department of Anesthesia, McGill University Health Centre, Montreal, QC, Canada
| | - Claire Lawson
- School of Human Nutrition, McGill University, Montreal, QC, Canada
| | - Francesco Carli
- Department of Anesthesia, McGill University Health Centre, Montreal, QC, Canada
| | - Celena Scheede-Bergdahl
- Department of Kinesiology and Physical Education, McGill University, Montreal, QC, Canada; Department of Anesthesia, McGill University Health Centre, Montreal, QC, Canada
| | - Stéphanie Chevalier
- School of Human Nutrition, McGill University, Montreal, QC, Canada; Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
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5
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Tanaka S, Ozeki N, Mizuno Y, Nakajima H, Hattori K, Inoue T, Nagaya M, Fukui T, Nakamura S, Goto M, Sugiyama T, Nishida Y, Chen-Yoshikawa TF. Preoperative paraspinous muscle sarcopenia and physical performance as prognostic indicators in non-small-cell lung cancer. J Cachexia Sarcopenia Muscle 2021; 12:646-656. [PMID: 33665984 PMCID: PMC8200441 DOI: 10.1002/jcsm.12691] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 01/12/2021] [Accepted: 02/01/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Despite the associations of both preoperative sarcopenia and physical performance with post-operative mortality in non-small-cell lung cancer (NSCLC), there have been no comprehensive studies of the impact of physical status on prognosis. This study was performed to investigate the prognostic significance of preoperative sarcopenia and physical performance in NSCLC. METHODS This retrospective cohort study was performed in NSCLS patients undergoing curative lung resection at a university hospital between January 2014 and December 2017. The patients were divided into four groups according to the skeletal muscle index [sarcopenia (lowest sex-specific tertile) and non-sarcopenia] and 6 min walking distance (6MWD) [short distance (<400 m) and long distance (≥400 m)]. Sarcopenia was assessed by preoperative cross-sectional areas of right and left paraspinous muscles at the level of the 12th thoracic vertebra from computed tomography images, and physical performance was determined by preoperative 6MWD. The primary and secondary endpoints were post-operative overall survival (OS) and disease-free survival (DFS). RESULTS The 587 patients [mean age: 68.5 ± 8.8 years, 399 men (68%)] included in the study were divided into the non-sarcopenia/long-distance group (58%), sarcopenia/long-distance group (26%), non-sarcopenia/short-distance group (9%), and sarcopenia/short-distance group (7%). A total of 109 (18.6%) deaths and 209 (35.6%) combined endpoints were observed over a mean follow-up of 3.1 ± 1.3 years. After adjusting for other covariates, the sarcopenia/short-distance group showed significant associations with shorter OS (hazard ratio, 3.38; 95% confidence interval, 1.79-6.37; P < 0.001) and DFS (hazard ratio, 2.11; 95% confidence, 1.27-3.51; P = 0.004) compared with the non-sarcopenia/long-distance group on multivariate analyses. Although not significant, adding skeletal muscle index and 6MWD to the pre-existing risk model increased the area under the curve on time-dependent receiver operating characteristic curve analysis for OS and DFS, except within 2 years of surgery. CONCLUSIONS The presence of both preoperative paraspinous muscle sarcopenia and short distance in 6MWD had an adverse effect on post-operative prognosis in patients with NSCLC, suggesting that preoperative assessment of thoracic sarcopenia and physical performance may be useful for risk stratification of surgical candidates with potential for targeted interventions.
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Affiliation(s)
- Shinya Tanaka
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
| | - Naoki Ozeki
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yota Mizuno
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
| | - Hiroki Nakajima
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
| | - Keiko Hattori
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
| | - Takayuki Inoue
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
| | - Motoki Nagaya
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
| | - Takayuki Fukui
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shota Nakamura
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masaki Goto
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomoshi Sugiyama
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshihiro Nishida
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan.,Department of Orthopaedic Surgery, Nagoya University Graduate School and School of Medicine, Nagoya, Japan
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Zhou L, Chen Q, Zhang J. Effect of Exercise on Fatigue in Patients with Lung Cancer: A Systematic Review and Meta-Analysis of Randomized Trials. J Palliat Med 2021; 24:932-943. [PMID: 33835877 DOI: 10.1089/jpm.2020.0504] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Abstract
Background: Fatigue is a frequent debilitating symptom among patients with lung cancer. The effect of exercise on fatigue remains to be quantified. Objective: This review aimed to examine the effect of exercise on fatigue by synthesizing findings from randomized controlled trials (RCTs). Methods: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic search was conducted in five electronic databases from inception to March 2020. Only RCT was included. The primary outcome was fatigue and the secondary outcomes included depression, anxiety, quality of life, and functional capacity. Pooled weighted or standardized mean difference (WMD or SMD) with 95% confidence interval (CI) was calculated. Results: Eight RCTs were included. The exercise intervention was delivered in the supervised environment (n = 6) or free-living settings (n = 2). Exercise reduced the level of fatigue (SMD = -0.33; 95% CI = -0.54 to -0.13). Exercise also decreased depressive symptom (WMD = -1.57; 95% CI = -2.69 to -0.44) and anxiety (WMD = -1.39; 95% CI = -2.60 to -0.18). Exercise showed a moderate effect on the quality of life, with an SMD of 0.33 (95% CI = 0.08 to 0.58). Exercise intervention increased functional capacity as measured by the six-minute walk test by 20 meters (95% CI = 14.2 to 55.0), but the effect was not significant (p = 0.247). Conclusion: Exercise demonstrated a moderate effect on fatigue in patients with lung cancer. Exercise also improved depressive symptoms, anxiety, and quality of life; however, its impact on functional capacity was not significant. More clinical trials are warranted to explore the mechanisms underlying the impact of exercise on fatigue. Strategies improving adherence to exercise prescription should be developed to help these patients overcome potential challenges.
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Affiliation(s)
- Liang Zhou
- Second Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Qijiu Chen
- Second Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Jianyong Zhang
- Second Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
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7
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Lee H, Kim HK, Kang D, Kong S, Lee JK, Lee G, Shin S, Cho J, Zo JI, Shim YM, Park HY. Prognostic Value of 6-Min Walk Test to Predict Postoperative Cardiopulmonary Complications in Patients With Non-small Cell Lung Cancer. Chest 2020; 157:1665-1673. [DOI: 10.1016/j.chest.2019.12.039] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 12/12/2019] [Accepted: 12/16/2019] [Indexed: 12/25/2022] Open
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8
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Nordic Pole Walking for Individuals With Cancer: A Feasibility Randomized Controlled Trial Assessing Physical Function and Health-Related Quality of Life. REHABILITATION ONCOLOGY 2020. [DOI: 10.1097/01.reo.0000000000000204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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9
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Guinan EM, Bennett AE, Doyle SL, O'Neill L, Gannon J, Foley G, Elliott JA, O'Sullivan J, Reynolds JV, Hussey J. Measuring the impact of oesophagectomy on physical functioning and physical activity participation: a prospective study. BMC Cancer 2019; 19:682. [PMID: 31299920 PMCID: PMC6624943 DOI: 10.1186/s12885-019-5888-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 06/26/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Oesophagectomy remains the only curative intervention for oesophageal cancer, with defined nutritional and health-related quality of life (HR-QOL) consequences. It follows therefore that there is a significant risk of decline in physical wellbeing with oesophagectomy however this has been inadequately quantified. This study prospectively examines change in physical functioning and habitual physical activity participation, from pre-surgery through 6-months post-oesophagectomy. METHODS Patients scheduled for oesophagectomy with curative intent were recruited. Key domains of physical functioning including exercise tolerance (six-minute walk test (6MWT)) and muscle strength (hand-grip strength), and habitual physical activity participation, including sedentary behaviour (accelerometry) were measured pre-surgery (T0) and repeated at 1-month (T1) and 6-months (T2) post-surgery. HR-QOL was measured using the EORTC-QOL C30. RESULTS Thirty-six participants were studied (mean age 62.4 (8.8) years, n = 26 male, n = 26 transthoracic oesophagectomy). Mean 6MWT distance decreased significantly from T0 to T1 (p = 0.006) and returned to T0 levels between T1 and T2 (p < 0.001). Percentage time spent sedentary increased throughout recovery (p < 0.001) and remained significantly higher at T2 in comparison to T0 (p = 0.003). In contrast, percentage time spent engaged in either light or moderate-to-vigorous intensity activity, all reduced significantly (p < 0.001 for both) and remained significantly lower at T2 in comparison to T0 (p = 0.009 and p = 0.01 respectively). Patients reported deficits in multiple domains of HR-QOL during recovery including global health status (p = 0.04), physical functioning (p < 0.001) and role functioning (p < 0.001). Role functioning remained a clinically important 33-points lower than pre-operative values at T2. CONCLUSION Habitual physical activity participation remains significantly impaired at 6-months post-oesophagectomy. Physical activity is a measurable and modifiable target for physical rehabilitation, which is closely aligned with patient-reported deficits in role functioning. Rehabilitation aimed at optimising physical health in oesophageal cancer survivorship is warranted.
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Affiliation(s)
- E M Guinan
- School of Medicine, Trinity College Dublin, Dublin, Ireland.
| | - A E Bennett
- Department of Clinical Medicine, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - S L Doyle
- School of Biological Sciences, Dublin Institute of Technology, Dublin, Ireland
| | - L O'Neill
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - J Gannon
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - G Foley
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - J A Elliott
- Department of Surgery, St. James' Hospital, Dublin, Ireland
| | - J O'Sullivan
- Trinity Translational Medicine Institute, Department of Surgery, Trinity College Dublin, Dublin, Ireland
| | - J V Reynolds
- Department of Surgery, St. James' Hospital, Dublin, Ireland.,Trinity Translational Medicine Institute, Department of Surgery, Trinity College Dublin, Dublin, Ireland
| | - J Hussey
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
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Home-based rehabilitation in inoperable non-small cell lung cancer-the patient experience. Support Care Cancer 2019; 28:99-112. [PMID: 30982092 DOI: 10.1007/s00520-019-04783-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 03/27/2019] [Indexed: 12/26/2022]
Abstract
PURPOSE Exercise is important in lung cancer, yet most people do not meet the physical activity guidelines. The aim of this study was to characterise the views and experiences of participants with inoperable lung cancer who completed a home-based rehabilitation program. METHODS Ninety-two participants were recruited (45 intervention group [IG], 47 usual care). Individual semi-structured interviews were conducted with participants randomised to the IG of a trial of home-based exercise, behaviour change and symptom management. Data were independently coded by two researchers, cross-checked and analysed using content analysis with a summary of arising themes. RESULTS Of the IG (25/45), 55% were interviewed: mean (SD) age 67 (13) years; male 52%; disease stage n (%) III = 9 (36), IV = 11 (44); radical treatment intent n (%) 13 (52). The majority of participants reported program benefits, both in the physical domain (reduced sedentary time and improved strength, fitness and function) and the mental domain (motivation to keep healthy, preventing boredom). Support to self-manage symptoms was well received and many participants reported increased confidence in managing their symptoms. Exercise enablers included having expert health professional support; motivation to be stronger and better prepared for future challenges; and having an achievable and familiar program that was monitored. Treatment side-effects, pain from comorbidities and the weather were exercise barriers. For the majority of participants the use of a Fitbit™ activity tracker, text message exercise reminders and an exercise diary helped to promote adherence. CONCLUSIONS This home-based rehabilitation program was acceptable to most participants with multiple benefits reported including improved fitness, motivation and ability to manage symptoms.
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11
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Granger CL, Edbrooke L, Denehy L. The nexus of functional exercise capacity with health-related quality of life in lung cancer: how closely are they related? ANNALS OF TRANSLATIONAL MEDICINE 2019; 6:S131. [PMID: 30740452 DOI: 10.21037/atm.2018.12.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Catherine L Granger
- Department of Physiotherapy, The University of Melbourne, Parkville, Victoria, Australia.,Department of Physiotherapy, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Lara Edbrooke
- Department of Physiotherapy, The University of Melbourne, Parkville, Victoria, Australia.,Allied Health, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Linda Denehy
- Allied Health, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Melbourne School of Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
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Peddle‐McIntyre CJ, Singh F, Thomas R, Newton RU, Galvão DA, Cavalheri V. Exercise training for advanced lung cancer. Cochrane Database Syst Rev 2019; 2:CD012685. [PMID: 30741408 PMCID: PMC6371641 DOI: 10.1002/14651858.cd012685.pub2] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Patients with advanced lung cancer have a high symptom burden, which is often complicated by coexisting conditions. These issues, combined with the indirect effects of cancer treatment, can cumulatively lead patients to continued deconditioning and low exercise capacity. This is a concern as exercise capacity is considered a measure of whole body health, and is critical in a patient's ability to participate in life activities and tolerate difficult treatments. There is evidence that exercise training improves exercise capacity and other outcomes, such as muscle force and health-related quality of life (HRQoL), in cancer survivors. However, the effectiveness of exercise training on these outcomes in people with advanced lung cancer is currently unclear. OBJECTIVES The primary aim of this review was to investigate the effects of exercise training on exercise capacity in adults with advanced lung cancer. Exercise capacity was defined as the six-minute walk distance (6MWD; in meters) measured during a six-minute walk test (6MWT; i.e. how far an individual can walk in six minutes on a flat course), or the peak oxygen uptake (i.e. VO₂peak) measured during a maximal incremental cardiopulmonary exercise test (CPET).The secondary aims were to determine the effects of exercise training on the force-generating capacity of peripheral muscles, disease-specific global HRQoL, physical functioning component of HRQoL, dyspnoea, fatigue, feelings of anxiety and depression, lung function, level of physical activity, adverse events, performance status, body weight and overall survival in adults with advanced lung cancer. SEARCH METHODS We searched CENTRAL, MEDLINE (via PubMed), Embase (via Ovid), CINAHL, SPORTDiscus, PEDro, and SciELO on 7 July 2018. SELECTION CRITERIA We included randomised controlled trials (RCTs) which compared exercise training versus no exercise training in adults with advanced lung cancer. DATA COLLECTION AND ANALYSIS Two review authors independently screened the studies and selected those for inclusion. We performed meta-analyses for the following outcomes: exercise capacity, disease-specific global HRQoL, physical functioning HRQoL, dyspnoea, fatigue, feelings of anxiety and depression, and lung function (forced expiratory volume in one second (FEV1)). Two studies reported force-generating capacity of peripheral muscles, and we presented the results narratively. Limited data were available for level of physical activity, adverse events, performance status, body weight and overall survival. MAIN RESULTS We identified six RCTs, involving 221 participants. The mean age of participants ranged from 59 to 70 years; the sample size ranged from 20 to 111 participants. Overall, we found that the risk of bias in the included studies was high, and the quality of evidence for all outcomes was low.Pooled data from four studies demonstrated that, on completion of the intervention period, exercise capacity (6MWD) was significantly higher in the intervention group than the control group (mean difference (MD) 63.33 m; 95% confidence interval (CI) 3.70 to 122.96). On completion of the intervention period, disease-specific global HRQoL was significantly better in the intervention group compared to the control group (standardised mean difference (SMD) 0.51; 95% CI 0.08 to 0.93). There was no significant difference between the intervention and control groups in physical functioning HRQoL (SMD 0.11; 95% CI -0.36 to 0.58), dyspnoea (SMD -0.27; 95% CI -0.64 to 0.10), fatigue (SMD 0.03; 95% CI -0.51 to 0.58), feelings of anxiety (MD -1.21 units on Hospital Anxiety and Depression Scale; 95% CI -5.88 to 3.45) and depression (SMD -1.26; 95% CI -4.68 to 2.17), and FEV1 (SMD 0.43; 95% CI -0.11 to 0.97). AUTHORS' CONCLUSIONS Exercise training may improve or avoid the decline in exercise capacity and disease-specific global HRQoL for adults with advanced lung cancer. We found no significant effects of exercise training on dyspnoea, fatigue, feelings of anxiety and depression, or lung function. The findings of this review should be viewed with caution because of the heterogeneity between studies, the small sample sizes, and the high risk of bias of included studies. Larger, high-quality RCTs are needed to confirm and expand knowledge on the effects of exercise training in this population.
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Affiliation(s)
- Carolyn J Peddle‐McIntyre
- Edith Cowan UniversityExercise Medicine Research Institute270 Joondalup DriveJoondalupAustralia6027
- Edith Cowan UniversitySchool of Medical and Health Sciences270 Joondalup DriveJoondalupWestern AustraliaAustralia6027
| | - Favil Singh
- Edith Cowan UniversityExercise Medicine Research Institute270 Joondalup DriveJoondalupAustralia6027
- Edith Cowan UniversitySchool of Medical and Health Sciences270 Joondalup DriveJoondalupWestern AustraliaAustralia6027
| | - Rajesh Thomas
- University of Western AustraliaSchool of Medicine and PharmacologyHospital AvenuePerthAustralia
- Institute for Respiratory Health, Sir Charles Gairdner HospitalPerthAustralia
| | - Robert U Newton
- Edith Cowan UniversityExercise Medicine Research Institute270 Joondalup DriveJoondalupAustralia6027
- Edith Cowan UniversitySchool of Medical and Health Sciences270 Joondalup DriveJoondalupWestern AustraliaAustralia6027
- The University of QueenslandSchool of Human Movement and Nutrition SciencesBrisbaneAustralia
| | - Daniel A Galvão
- Edith Cowan UniversityExercise Medicine Research Institute270 Joondalup DriveJoondalupAustralia6027
- Edith Cowan UniversitySchool of Medical and Health Sciences270 Joondalup DriveJoondalupWestern AustraliaAustralia6027
| | - Vinicius Cavalheri
- Curtin UniversitySchool of Physiotherapy and Exercise Science, Faculty of Health SciencesKent StreetPerthWestern AustraliaAustralia6102
- Sir Charles Gairdner HospitalInstitute for Respiratory HealthPerthWestern AustraliaAustralia
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Prognostic value of preoperative exercise capacity in patients undergoing thoracoscopic lobectomy for non-small cell lung cancer. Lung Cancer 2019; 128:47-52. [DOI: 10.1016/j.lungcan.2018.12.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 12/11/2018] [Accepted: 12/14/2018] [Indexed: 12/12/2022]
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14
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Ngo-Huang A, Parker NH, Bruera E, Lee RE, Simpson R, O’Connor DP, Petzel MQB, Fontillas RC, Schadler K, Xiao L, Wang X, Fogelman D, Sahai SK, Lee JE, Basen-Engquist K, Katz MHG. Home-Based Exercise Prehabilitation During Preoperative Treatment for Pancreatic Cancer Is Associated With Improvement in Physical Function and Quality of Life. Integr Cancer Ther 2019; 18:1534735419894061. [PMID: 31858837 PMCID: PMC7050956 DOI: 10.1177/1534735419894061] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/03/2019] [Accepted: 11/16/2019] [Indexed: 12/18/2022] Open
Abstract
Purpose: To investigate relationships among physical activity, changes in physical function, and health-related quality of life (HRQOL) among patients with pancreatic adenocarcinoma enrolled in a home-based exercise prehabilitation program. Methods: Patients with resectable pancreatic adenocarcinoma receiving preoperative chemotherapy and/or chemoradiation were enrolled on this prospective, single-arm trial and were advised to perform ≥60 minutes each of moderate-intensity aerobic exercise and strengthening exercise weekly. Activity was measured via self-report and accelerometers, including moderate-to-vigorous physical activity (MVPA), light physical activity (LPA), and sedentary activity (SA). Physical function measures at baseline and restaging follow-up included 6-minute walk test (6MWT), 5 times sit-to-stand (5×STS), handgrip strength (HGS), 3-m walk for gait speed (GS), and the PROMIS Physical Function Short Form. HRQOL was measured via the FACT-Hep questionnaire. Results: Fifty participants with mean age 66 years (standard deviation = 8 years) were enrolled. The 6MWT, 5×STS, and GS significantly improved from baseline to restaging follow-up (P=.001, P=.049, and P=.009, respectively). Increases in self-reported aerobic exercise, weekly MVPA, and LPA were associated with improvement in 6MWT (β=.19, P=.048; β=.18, P=.03; and β=.08, P=.03, respectively) and self-reported physical functioning (β=.02, P=.03; β=.03, P=.005; and β=.01, P=.02, respectively). Increased weekly LPA was associated with increased HRQOL (β=.03, P=.02). Increased SA was associated with decreased HRQOL (β=-.02,P=.01). Conclusions: Patients with potentially resectable pancreatic cancer exhibit meaningful improvement in physical function with prehabilitation; physical activity was associated with improved physical function and HRQOL. These data highlight the importance of physical activity during treatment for pancreatic cancer.
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Affiliation(s)
- An Ngo-Huang
- The University of Texas MD Anderson
Cancer Center, Houston, TX, USA
| | - Nathan H. Parker
- The University of Texas MD Anderson
Cancer Center, Houston, TX, USA
| | - Eduardo Bruera
- The University of Texas MD Anderson
Cancer Center, Houston, TX, USA
| | | | | | | | | | | | - Keri Schadler
- The University of Texas MD Anderson
Cancer Center, Houston, TX, USA
| | - Lianchun Xiao
- The University of Texas MD Anderson
Cancer Center, Houston, TX, USA
| | - Xuemei Wang
- The University of Texas MD Anderson
Cancer Center, Houston, TX, USA
| | - David Fogelman
- The University of Texas MD Anderson
Cancer Center, Houston, TX, USA
| | - Sunil K. Sahai
- The University of Texas MD Anderson
Cancer Center, Houston, TX, USA
| | - Jeffrey E. Lee
- The University of Texas MD Anderson
Cancer Center, Houston, TX, USA
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O’Neill L, Moran J, Guinan EM, Reynolds JV, Hussey J. Physical decline and its implications in the management of oesophageal and gastric cancer: a systematic review. J Cancer Surviv 2018; 12:601-618. [DOI: 10.1007/s11764-018-0696-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 05/08/2018] [Indexed: 12/14/2022]
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Edbrooke L, Denehy L, Parry SM, Astin R, Jack S, Granger CL. How is physical activity measured in lung cancer?A systematic review of outcome measures and their psychometric properties. Respirology 2017; 22:263-277. [PMID: 28102971 DOI: 10.1111/resp.12975] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 08/02/2016] [Accepted: 11/10/2016] [Indexed: 12/18/2022]
Abstract
Physical activity (PA) levels are low in patients with lung cancer. Emerging evidence supports the use of interventions to increase PA in this population. We aimed to (1) identify and synthesize outcome measures which assess PA levels in patients with lung cancer and (2) to evaluate, synthesize and compare the psychometric properties of these measures. A systematic review of articles from searches was conducted of five electronic databases and personal records. Eligible studies were those which assessed PA using either performance-based or patient-reported measures. For aim 2, studies identified in aim 1 reporting on at least one psychometric property (validity, reliability, responsiveness or measurement error) were included. Two independent reviewers assessed eligibility and risk of bias with the COnsensus-based Standards for the selection of health status Measurement INstruments. Thirty-four studies using 21 different measures of PA were identified. Seventeen studies used performance-based measures. The Godin Leisure Time Exercise Questionnaire (GLTEQ) was the most frequently used patient-reported measure. Psychometric properties were reported for 13 of these measures and most frequently for movement sensors. Two studies reported on properties of the GLTEQ. Quality ratings for risk of bias were low. There is significant heterogeneity amongst studies regarding method of PA measurement along the lung cancer continuum. Greater consensus could be achieved by using a consensus approach such as a Delphi process. Future studies should include assessment of psychometric properties of the measurement tool being used. Currently, it is recommended where feasible, both performance-based and patient-reported measurements of PA should be undertaken.
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Affiliation(s)
- Lara Edbrooke
- Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - Linda Denehy
- Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Melbourne, Victoria, Australia
| | - Selina M Parry
- Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ronan Astin
- Institute for Human Health and Performance, University College London, London, UK
| | - Sandy Jack
- University Hospital Southampton, Southampton, UK
| | - Catherine L Granger
- Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Melbourne, Victoria, Australia.,Department of Physiotherapy, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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Peddle‐McIntyre CJ, Singh F, Thomas R, Newton RU, Galvão DA, Cavalheri V. Exercise training for advanced lung cancer. Cochrane Database Syst Rev 2017; 2017:CD012685. [PMCID: PMC6481894 DOI: 10.1002/14651858.cd012685] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: The primary aim of this study is to investigate the effects of exercise training on exercise capacity in adults with advanced lung cancer. Exercise capacity is defined as the Six‐Minute Walk Distance (6MWD; in meters) measured during a 6MWT (i.e. how far an individual can walk in 6 minutes on a flat course) or the peak oxygen uptake (i.e. VO₂peak) measured during a maximal incremental CPET. The secondary aims are to determine the effects of exercise training on the force‐generating capacity of peripheral muscles, HRQoL, dyspnea, fatigue, feelings of anxiety and depression, lung function, and physical activity levels in adults with advanced lung cancer.
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Sebio Garcia R, Yáñez Brage MI, Giménez Moolhuyzen E, Granger CL, Denehy L. Functional and postoperative outcomes after preoperative exercise training in patients with lung cancer: a systematic review and meta-analysis. Interact Cardiovasc Thorac Surg 2016; 23:486-97. [PMID: 27226400 DOI: 10.1093/icvts/ivw152] [Citation(s) in RCA: 136] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 03/21/2016] [Indexed: 12/13/2022] Open
Abstract
Lung cancer is the leading cause of cancer-related death worldwide. For early stages of the disease, lung resection surgery remains the best treatment with curative intent, but significant morbidity is associated, especially among patients with poor pulmonary function and cardiorespiratory fitness. In those cases, the implementation of a preoperative exercise-based intervention could optimize patient's functional status before surgery and improve postoperative outcomes and enhance recovery. The aim of this systematic review is to provide the current body of knowledge regarding the effectiveness of a preoperative exercise-based intervention on postoperative and functional outcomes in patients with lung cancer submitted to lung resection surgery. A systematic review of the literature using CINAHL, EMBASE, MEDLINE, Pubmed, PEDro and SCOPUS was undertaken in September 2015 yielding a total of 1656 references. Two independent reviewers performed the assessment of the potentially eligible records against the inclusion criteria and finally, 21 articles were included in the review. Articles were included if they examined the effects of an exercise-based intervention on at least one of the selected outcomes: pulmonary function, (functional) exercise capacity, health-related quality of life (HRQoL) and postoperative outcomes (length of stay and postoperative complications). Fourteen studies were further selected for a meta-analysis to quantify the mean effect of the intervention and generate 95% confidence intervals (CIs) using the Cochrane Review Manager 5.0.25. For two of the outcomes included (exercise capacity and HRQoL), studies showed large heterogeneity and thus, a meta-analysis was considered inappropriate. Pulmonary function (forced vital capacity and forced expiratory volume in 1 s) was significantly enhanced after the intervention [standardized mean difference (SMD) = 0.38; 95% CI 0.14, 0.63 and SMD = 0.27, 95% CI 0.11, 0.42, respectively]. In comparison with the patients in the control groups, patients in the experimental groups spent less days in the hospital (mean difference = -4.83, 95% CI -5.9, -3.76) and had a significantly reduced risk for developing postoperative complications (risk ratios = 0.45; 95% CI 0.28, 0.74). In conclusion, preoperative exercise-based training improves pulmonary function before surgery and reduces in-hospital length of stay and postoperative complications after lung resection surgery for lung cancer.
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Affiliation(s)
- Raquel Sebio Garcia
- Faculty of Physiotherapy, University of A Coruña, Research Group in Psychological Wellbeing and Functional Rehabilitation, A Coruña, Spain
| | | | | | | | - Linda Denehy
- School of Health Sciences, University of Melbourne, Melbourne, Australia
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Liu Y, Li H, Ding N, Wang N, Wen D. Functional Status Assessment of Patients With COPD: A Systematic Review of Performance-Based Measures and Patient-Reported Measures. Medicine (Baltimore) 2016; 95:e3672. [PMID: 27196472 PMCID: PMC4902414 DOI: 10.1097/md.0000000000003672] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Presently, there is no recommendation on how to assess functional status of chronic obstructive pulmonary disease (COPD) patients. This study aimed to summarize and systematically evaluate these measures.Studies on measures of COPD patients' functional status published before the end of January 2015 were included using a search filters in PubMed and Web of Science, screening reference lists of all included studies, and cross-checking against some relevant reviews. After title, abstract, and main text screening, the remaining was appraised using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) 4-point checklist. All measures from these studies were rated according to best-evidence synthesis and the best-rated measures were selected.A total of 6447 records were found and 102 studies were reviewed, suggesting 44 performance-based measures and 14 patient-reported measures. The majority of the studies focused on internal consistency, reliability, and hypothesis testing, but only 21% of them employed good or excellent methodology. Their common weaknesses include lack of checks for unidimensionality, inadequate sample sizes, no prior hypotheses, and improper methods. On average, patient-reported measures perform better than performance-based measures. The best-rated patient-reported measures are functional performance inventory (FPI), functional performance inventory short form (FPI-SF), living with COPD questionnaire (LCOPD), COPD activity rating scale (CARS), University of Cincinnati dyspnea questionnaire (UCDQ), shortness of breath with daily activities (SOBDA), and short-form pulmonary functional status scale (PFSS-11), and the best-rated performance-based measures are exercise testing: 6-minute walk test (6MWT), endurance treadmill test, and usual 4-meter gait speed (usual 4MGS).Further research is needed to evaluate the reliability and validity of performance-based measures since present studies failed to provide convincing evidence. FPI, FPI-SF, LCOPD, CARS, UCDQ, SOBDA, PFSS-11, 6MWT, endurance treadmill test, and usual 4MGS performed well and are preferable to assess functional status of COPD patients.
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Affiliation(s)
- Yang Liu
- From the School of Public Health (YL, HL, DW); The Research Centre for Medical Education (ND), China Medical University, Shenyang; and School of Public Health (NW), Dalian Medical University, Dalian, Liaoning, China
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Affiliation(s)
- Catherine L Granger
- Department of Physiotherapy, University of Melbourne; Department of Physiotherapy, Royal Melbourne Hospital; Institute for Breathing and Sleep, Melbourne, Australia
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Granger CL, Denehy L, Parry SM, Martin J, Dimitriadis T, Sorohan M, Irving L. Which field walking test should be used to assess functional exercise capacity in lung cancer? An observational study. BMC Pulm Med 2015; 15:89. [PMID: 26264470 PMCID: PMC4534028 DOI: 10.1186/s12890-015-0075-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 07/16/2015] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND There is emerging evidence regarding the efficacy of exercise training to improve exercise capacity for individuals with non-small cell lung cancer (NSCLC). Cardiopulmonary exercise testing (CPET) is the gold standard measure of exercise capacity; however this laboratory test has limitations for use in research and clinical practice. Alternative field walking tests are the six-minute walk test (6MWT), incremental-shuttle walk test (ISWT) and endurance-shuttle walk test (ESWT); however there is limited information about their clinimetric properties in NSCLC. AIMS In NSCLC to determine the 1) criterion validity of the 6MWT, ISWT and ESWT against CPET; 2) construct validity of the 6MWT, ISWT and ESWT against measures of function, strength, respiratory function and health-related quality of life (HRQoL); and 3) clinical applicability of the tests. METHODS Twenty participants (40 % male, mean ± SD age 66.1 ± 6.5 years) with stage I-IIIb NSCLC completed the 6MWT, ISWT, ESWT and CPET within six months of treatment. Testing order was randomised. Additional measures included Eastern Cooperative Oncology Group Performance-Status (ECOG-PS, function), respiratory function, hand-grip dynamometry and HRQoL. Correlations and regression analyses were used to assess relationships. RESULTS The ISWT demonstrated criterion validity with a moderate relationship between ISWT distance and CPET peak oxygen consumption (r = 0.61, p = 0.007). Relationships between CPET and six minute walk distance (6MWD) (r = 0.24, p = 0.329) or ESWT time (r = 0.02, p = 0.942) were poor. Moderate construct validity existed for the 6MWD and respiratory function (forced vital capacity % predicted r = 0.53, p = 0.019; forced expiratory volume in the first second % predicted r = 0.55, p = 0.015). There were no relationships between the walking tests and measures of function, strength or HRQoL. The ESWT had a ceiling effect with 18 % reaching maximum time. No floor effects were seen in the tests. The mean ± SD time required to perform the individual 6MWT, ISWT and ESWT was 12.8 ± 2.5, 14.7 ± 3.7 and 16.3 ± 5.0 min respectively; in comparison to CPET which was 51.2 ± 12.7 min. Only one assessor was required to perform all field walking tests and no adverse events occurred. CONCLUSIONS The ISWT is a promising measure of functional exercise capacity in lung cancer. Findings need to be confirmed in a larger sample prior to translation into practice.
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Affiliation(s)
- Catherine L Granger
- Department of Physiotherapy, Royal Melbourne Hospital, Grattan Street, Parkville, VIC, Australia.
- Department of Physiotherapy, The University of Melbourne, 161 Barry Street, Parkville, VIC, Australia.
- Institute for Breathing and Sleep, Heidelberg Road, Heidelberg, VIC, Australia.
| | - Linda Denehy
- Department of Physiotherapy, The University of Melbourne, 161 Barry Street, Parkville, VIC, Australia.
- Institute for Breathing and Sleep, Heidelberg Road, Heidelberg, VIC, Australia.
| | - Selina M Parry
- Department of Physiotherapy, The University of Melbourne, 161 Barry Street, Parkville, VIC, Australia.
| | - Joel Martin
- Department of Physiotherapy, Royal Melbourne Hospital, Grattan Street, Parkville, VIC, Australia.
| | - Tim Dimitriadis
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Grattan Street, Parkville, VIC, Australia.
| | - Maeve Sorohan
- Department of Physiotherapy, Royal Melbourne Hospital, Grattan Street, Parkville, VIC, Australia.
| | - Louis Irving
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Grattan Street, Parkville, VIC, Australia.
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Lee AL, Harrison SL, Beauchamp MK, Janaudis-Ferreira T, Brooks D. Alternative field exercise tests for people with respiratory conditions. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2015. [DOI: 10.1007/s40141-015-0097-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Collins JT, Noble S, Chester J, Davies HE, Evans WD, Lester J, Parry D, Pettit RJ, Byrne A. Association of sarcopenia and observed physical performance with attainment of multidisciplinary team planned treatment in non-small cell lung cancer: an observational study protocol. BMC Cancer 2015. [PMID: 26204885 PMCID: PMC4513758 DOI: 10.1186/s12885-015-1565-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Non-small cell lung cancer (NSCLC) frequently presents in advanced stages. A significant proportion of those with reportedly good ECOG performance status (PS) fail to receive planned multidisciplinary team (MDT) treatment, often for functional reasons, but an objective decline in physical performance is not well described. Sarcopenia, or loss of muscle mass, is an integral part of cancer cachexia. However, changes in both muscle mass and physical performance may predate clinically overt cachexia, and may be present even with normal body mass index. Physical fitness for treatment is currently subjectively assessed by means of the PS score, which may be inadequate in predicting tolerance to treatment. This study aims to evaluate whether measuring physical performance and muscle mass at baseline in NSCLC patients, in addition to PS score, is able to predict commencement and successful completion of MDT-planned treatment. METHODS/DESIGN This is a prospective, single-centre exploratory study of NSCLC patients attending a Rapid Access Lung Cancer clinic. Baseline data collected are (methods in brackets): physical performance (Short Physical Performance Battery), muscle mass (bioelectrical impedance ± dual energy x-ray absorptiometry), patient and physician-assessed PS (ECOG and Karnofsky), nutritional status and presence of cachexia. Longitudinal data consists of receipt and completion of MDT treatment plan. The primary outcome measure is commencement of MDT-planned treatment, and important secondary outcomes include successful completion of treatment, length of stay in surgical patients, and risk of chemotherapy- and radiotherapy-related side effects. DISCUSSION A more comprehensive assessment of phenotype, particularly with regards to physical performance and muscle mass, will provide additional discriminatory information of patients' fitness for treatment. If positive, this study has the potential to identify targets for early intervention in those who are at risk of deterioration. This will subsequently enable optimisation of performance of patients with NSCLC, in anticipation of systemic treatment.
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Affiliation(s)
- Jemima T Collins
- Department of Palliative Medicine, University Hospital Llandough, Penarth, UK. .,Cardiff University, Cardiff, UK.
| | | | | | - Helen E Davies
- Department of Respiratory Medicine, University Hospital Llandough, Penarth, UK.
| | - William D Evans
- Department of Medical Physics and Clinical Engineering, University Hospital of Wales, Cardiff, UK.
| | | | - Diane Parry
- Department of Respiratory Medicine, University Hospital Llandough, Penarth, UK.
| | - Rebecca J Pettit
- Department of Medical Physics and Clinical Engineering, University Hospital of Wales, Cardiff, UK.
| | - Anthony Byrne
- Department of Palliative Medicine, University Hospital Llandough, Penarth, UK.
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La prueba de escaleras. En búsqueda de la necesaria simplicidad. Arch Bronconeumol 2015; 51:259-60. [DOI: 10.1016/j.arbres.2015.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 02/06/2015] [Accepted: 02/06/2015] [Indexed: 11/23/2022]
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Maeda K, Higashimoto Y, Honda N, Shiraishi M, Hirohata T, Minami K, Iwasaki T, Chiba Y, Yamagata T, Terada K, Matsuo Y, Shuntoh H, Tohda Y, Fukuda K. Effect of a postoperative outpatient pulmonary rehabilitation program on physical activity in patients who underwent pulmonary resection for lung cancer. Geriatr Gerontol Int 2015; 16:550-5. [PMID: 25953128 DOI: 10.1111/ggi.12505] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2015] [Indexed: 11/27/2022]
Abstract
AIM Physical activity (PA) has been associated with an improvement in survival for individuals with cancer. However, little is known about the effect of postoperative pulmonary rehabilitation on PA after lobectomy in patients with lung cancer. The present study investigated the effect of outpatient rehabilitation on PA in patients with cancer after lung resection. METHODS A total of 19 patients with lung cancer were recruited for this study and completed a preoperative rehabilitation program. One group of nine patients completed a postoperative outpatient pulmonary rehabilitation program (rehabilitation) and another group of 10 patients did not (control), but were similarly followed up. Preoperative lung function, assessed by forced expiratory volume in 1 s (FEV1 ), body mass index (BMI) and St. George's Respiratory Questionnaire (SGRQ) score were not different between groups. PA was measured before and 2 months after surgery using a three-axis accelerometer for 5-6 days. PA level (PAL) was defined as total energy expenditure divided by basal metabolic rate. RESULTS Preoperative PAL was not different between groups. However, postoperative versus preoperative PAL was significantly lower in the control versus the rehabilitation group (P < 0.01), and PAL decline was less for the rehabilitation versus the control group (P < 0.001). A subgroup analysis showed improvement in postoperative PAL in rehabilitation patients aged <75 years and older. CONCLUSIONS Two months after lung resection surgery, patients had not recovered to the preoperative PAL. However, compared with the control group, there was an improvement in the postoperative PAL in patients, including older patients, who underwent outpatient pulmonary rehabilitation. Geriatr Gerontol Int 2016; 16: 550-555.
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Affiliation(s)
- Kazushige Maeda
- Department of Rehabilitation Medicine, Kinki University, Faculty of Medicine, Osakasayama, Osaka, Japan
| | - Yuji Higashimoto
- Department of Respiratory Medicine and Allergology, Kinki University, Faculty of Medicine, Osakasayama, Osaka, Japan
| | - Noritsugu Honda
- Department of Rehabilitation Medicine, Kinki University, Faculty of Medicine, Osakasayama, Osaka, Japan
| | - Masashi Shiraishi
- Department of Rehabilitation Medicine, Kinki University, Faculty of Medicine, Osakasayama, Osaka, Japan
| | - Takeshi Hirohata
- Department of Surgery, Division of Thoracic Surgery, Kinki University, Faculty of Medicine, Osakasayama, Osaka, Japan
| | - Kenji Minami
- Department of Surgery, Division of Thoracic Surgery, Kinki University, Faculty of Medicine, Osakasayama, Osaka, Japan
| | - Takuya Iwasaki
- Department of Surgery, Division of Thoracic Surgery, Kinki University, Faculty of Medicine, Osakasayama, Osaka, Japan
| | - Yasutaka Chiba
- Division of Biostatistics, Clinical Research Center, Kinki University, Faculty of Medicine, Osakasayama, Osaka, Japan
| | - Toshiyuki Yamagata
- Department of Rehabilitation Medicine, Kinki University, Faculty of Medicine, Osakasayama, Osaka, Japan
| | - Katsuhiko Terada
- Department of Rehabilitation Medicine, Kinki University, Faculty of Medicine, Osakasayama, Osaka, Japan
| | - Yoshimi Matsuo
- Research Institute for Health and Exercise Sciences, Graduate School of Health and Sports Sciences, Mukogawa Women's University, Nishinomiya, Hyogo Prefecture, Japan
| | - Hisato Shuntoh
- Faculty of Rehabilitation, Kobe Gakuin University, Kobe, Hyogo Prefecture, Japan
| | - Yuji Tohda
- Department of Respiratory Medicine and Allergology, Kinki University, Faculty of Medicine, Osakasayama, Osaka, Japan
| | - Kanji Fukuda
- Department of Rehabilitation Medicine, Kinki University, Faculty of Medicine, Osakasayama, Osaka, Japan
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Parry SM, Denehy L, Beach LJ, Berney S, Williamson HC, Granger CL. Functional outcomes in ICU – what should we be using? – an observational study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2015; 19:127. [PMID: 25888469 PMCID: PMC4404223 DOI: 10.1186/s13054-015-0829-5] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 02/20/2015] [Indexed: 02/08/2023]
Abstract
Introduction With growing awareness of the importance of rehabilitation, new measures are being developed specifically for use in the intensive care unit (ICU). There are currently 26 measures reported to assess function in ICU survivors. The Physical Function in Intensive care Test scored (PFIT-s) has established clinimetric properties. It is unknown how other functional measures perform in comparison to the PFIT-s or which functional measure may be the most clinically applicable for use within the ICU. The aims of this study were to determine (1) the criterion validity of the Functional Status Score for the ICU (FSS-ICU), ICU Mobility Scale (IMS) and Short Physical Performance Battery (SPPB) against the PFIT-s; (2) the construct validity of these tests against muscle strength; (3) predictive utility of these tests to predict discharge to home; and (4) the clinical applicability. This was a nested study within an ongoing controlled study and an observational study. Methods Sixty-six individuals were assessed at awakening and ICU discharge. Measures included: PFIT-s, FSS-ICU, IMS and SPPB. Bivariate relationships (Spearman’s rank correlation coefficient) and predictive validity (logistic regression) were determined. Responsiveness (effect sizes); floor and ceiling effects; and minimal important differences were calculated. Results Mean ± SD PFIT-s at awakening was 4.7 ± 2.3 out of 10. On awakening a large positive relationship existed between PFIT-s and the other functional measures: FSS-ICU (rho = 0.87, p < 0.005), IMS (rho = 0.81, p < 0.005) and SPPB (rho = 0.70, p < 0.005). The PFIT-s had excellent construct validity (rho = 0.8, p < 0.005) and FSS-ICU (rho = 0.69, p < 0.005) and IMS (rho = 0.57, p < 0.005) had moderate construct validity with muscle strength. The PFIT-s and FSS-ICU had small floor/ceiling effects <11% at awakening and ICU discharge. The SPPB had a large floor effect at awakening (78%) and ICU discharge (56%). All tests demonstrated responsiveness; however highest effect size was seen in the PFIT-s (Cohen’s d = 0.71). Conclusions There is high criterion validity for other functional measures against the PFIT-s. The PFIT-s and FSS-ICU are promising functional measures and are recommended to measure function within the ICU. Trial registration Clinicaltrials.gov NCT02214823. Registered 7 August 2014). Electronic supplementary material The online version of this article (doi:10.1186/s13054-015-0829-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Selina M Parry
- Department of Physiotherapy, The University of Melbourne, Level 7 Alan Gilbert Building, 161 Barry St, Parkville, 3010, Melbourne, VIC, Australia.
| | - Linda Denehy
- Department of Physiotherapy, The University of Melbourne, Level 7 Alan Gilbert Building, 161 Barry St, Parkville, 3010, Melbourne, VIC, Australia. .,Institute for Breathing and Sleep, 3084, Melbourne, VIC, Australia.
| | - Lisa J Beach
- Department of Physiotherapy, Melbourne Health, 3050, Melbourne, VIC, Australia.
| | - Sue Berney
- Institute for Breathing and Sleep, 3084, Melbourne, VIC, Australia. .,Department of Physiotherapy, Austin Health, 3084, Melbourne, VIC, Australia.
| | - Hannah C Williamson
- Department of Physiotherapy, Austin Health, 3084, Melbourne, VIC, Australia.
| | - Catherine L Granger
- Department of Physiotherapy, The University of Melbourne, Level 7 Alan Gilbert Building, 161 Barry St, Parkville, 3010, Melbourne, VIC, Australia. .,Department of Physiotherapy, Melbourne Health, 3050, Melbourne, VIC, Australia. .,Institute for Breathing and Sleep, 3084, Melbourne, VIC, Australia.
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Granger CL, Parry SM, Denehy L. The self-reported Physical Activity Scale for the Elderly (PASE) is a valid and clinically applicable measure in lung cancer. Support Care Cancer 2015; 23:3211-8. [PMID: 25808104 DOI: 10.1007/s00520-015-2707-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 03/16/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE Physical activity (PA) is an important outcome in lung cancer; however, there is lack of consensus as to the best method for assessment. The Physical Activity Scale for the Elderly (PASE) is a commonly used questionnaire. The aim of this study was to assess the clinimetric properties of the PASE in lung cancer, specifically validity, predictive utility and clinical applicability (floor/ceiling effects, responsiveness and minimal important difference [MID]). METHODS This is a prospective observational study. Sixty-nine participants (62 % male, median [IQR] age 68 years [61-74]) with lung cancer completed the PASE at diagnosis at 2, 4 and 6 months. Additional measures included movement sensors (steps/day), physical function, health-related quality of life, functional capacity (6-min walk distance [6MWD]), and muscle strength. Spearman's rank correlation coefficient was used to assess relationships. Linear regression analyses were conducted to determine predictive utility of the PASE for health status at 6 months. Responsiveness (effect size) and MID (distribution-based estimation) were calculated. RESULTS The PASE was administered on 176 occasions. The PASE had moderate convergent validity with movement sensors (rho = 0.50 [95 %CI = 0.29-0.66], p < 0.005) and discriminated between participants classed as sedentary/insufficient/sufficient according to PA guidelines (p < 0.005). The PASE had fair-moderate construct validity with measures of physical function (rho = 0.57 [95 %CI = 0.46-0.66], p < 0.005), 6MWD (rho = 0.40 [95 %CI = 0.23-0.55], p < 0.005), and strength (rho = 0.37 [95 %CI = 0.18-0.54], p < 0.005). The PASE (at diagnosis) exhibited predictive utility for physical function (Bcoef = 0.35, p = 0.008) and quality of life (Bcoef = 0.35, p = 0.023) at 6 months. A small floor effect was observed (3 %); however, there was no ceiling effect. There was a small responsiveness to change (effect size = 0.23) and MID between 17 and 25 points. CONCLUSIONS The PASE is a valid measure of self-reported PA in lung cancer.
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Affiliation(s)
- Catherine L Granger
- Department of Physiotherapy, The University of Melbourne, Level 7 Alan Gilbert Building, 161 Barry Street, Melbourne, Victoria, 3010, Australia. .,Department of Physiotherapy, Royal Melbourne Hospital, Grattan Street, Melbourne, Victoria, 3010, Australia. .,Institute for Breathing and Sleep, Studley Road, Heidelberg, Victoria, 3084, Australia.
| | - Selina M Parry
- Department of Physiotherapy, The University of Melbourne, Level 7 Alan Gilbert Building, 161 Barry Street, Melbourne, Victoria, 3010, Australia
| | - Linda Denehy
- Department of Physiotherapy, The University of Melbourne, Level 7 Alan Gilbert Building, 161 Barry Street, Melbourne, Victoria, 3010, Australia.,Institute for Breathing and Sleep, Studley Road, Heidelberg, Victoria, 3084, Australia
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Granger CL, Holland AE, Gordon IR, Denehy L. Minimal important difference of the 6-minute walk distance in lung cancer. Chron Respir Dis 2015; 12:146-54. [DOI: 10.1177/1479972315575715] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The 6-minute walk distance (6MWD) is one of the most commonly used measures of functional capacity in lung cancer, however, the minimal important difference (MID) has not been established. The aims of this exploratory study are, in lung cancer, to estimate (1) the MID of the 6MWD and (2) relationship between 6MWD, demographic and disease-related factors. Fifty-six participants with stage I–IV lung cancer completed the 6MWD prior to treatment and 10 weeks later. No exercise intervention occurred. Additional measures included European Organization for Research and Treatment of Cancer questionnaire (EORTC-QLQ-C30) and questionnaires assessing function, physical activity and symptoms. MID was calculated using anchor- and distribution-based methods. The mean 6MWD decline in participants classed as deteriorated was 60 m compared with 16 m in participants classed as not-deteriorated ( p = 0.01). The receiver operating curve indicated a cut-off value for clinically relevant change to be 42 m (95% confidence interval (CI) 6–75) (area under curve = 0.66, 95% CI 0.51–0.81) or a 9.5% change. Distribution-based methods indicated an MID between 22 m (95% CI 18–26) and 32 m (95% CI 20–42). Higher 6MWD correlated with better function ( r = −0.42, p = 0.001), physical activity ( r = 0.56, p < 0.005) and dyspnoea ( r = −0.44, p = 0.001). The MID for deterioration of the 6MWD in lung cancer is estimated to be between 22 m and 42 m or a change of 9.5%.
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Affiliation(s)
- Catherine L Granger
- Department of Physiotherapy, The University of Melbourne, Parkville, Victoria, Australia
- Department of Physiotherapy, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Institute for Breathing and Sleep, Austin Hospital, Heidelberg, Victoria, Australia
| | - Anne E Holland
- Institute for Breathing and Sleep, Austin Hospital, Heidelberg, Victoria, Australia
- Department of Physiotherapy, La Trobe University, Melbourne, Victoria, Australia
- Department of Physiotherapy, Alfred Hospital, Prahran, Victoria, Australia
| | - Ian R Gordon
- Statistical Consulting Centre, The University of Melbourne, Parkville, Victoria, Australia
| | - Linda Denehy
- Department of Physiotherapy, The University of Melbourne, Parkville, Victoria, Australia
- Institute for Breathing and Sleep, Austin Hospital, Heidelberg, Victoria, Australia
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Zhang XL, Dang YW, Li P, Rong MH, Hou XX, Luo DZ, Chen G. Expression of Tumor Necrosis Factor Receptor-associated Factor 6 in Lung Cancer Tissues. Asian Pac J Cancer Prev 2015; 15:10591-6. [DOI: 10.7314/apjcp.2014.15.24.10591] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Prognostic validation of the body mass index, airflow obstruction, dyspnea, and exercise capacity (BODE) index in inoperable non-small-cell lung cancer. J Thorac Oncol 2015; 8:1545-50. [PMID: 24389436 DOI: 10.1097/jto.0000000000000032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION To investigate the prognostic utility of the body mass index, severity of airflow obstruction, measures of exertional dyspnea, and exercise capacity (BODE) index in patients with inoperable non-small-cell lung cancer (NSCLC). METHODS One hundred consecutive patients with inoperable NSCLC and performance status 0 to 3 completed pulmonary function testing, the modified Medical Research Council dyspnea scale, a 6-minute walk test, and body mass index-the multidimensional 10-point BODE index. Cox proportional models were used to estimate the risk of all-cause mortality according to the BODE index with or without adjustment for traditional prognostic factors. RESULTS Median follow-up was 31.5 months; 61 deaths (61%) were reported during this period. There was a significant univariate association between the BODE index score and mortality (adjusted p(trend) = 0.027). Compared with patients with a BODE index of 0, the adjusted hazard ratio for risk of death was 1.37 (95% confidence interval [CI], 0.74-2.55) for a BODE index of 1, 1.22 (95% CI, 0.45-3.25) for a BODE index of 2, and 2.44 (95% CI, 1.19-4.99) for a BODE index more than 2. The BODE index provided incremental prognostic information beyond that provided traditional markers of prognosis (adjusted p(trend) = 0.051). Every one-point increase in the BODE index, the risk of death increased by 25% (hazard ratio = 1.25; 95% CI, 1.27-4.64). CONCLUSIONS The BODE index is a strong independent predictor of survival in inoperable NSCLC beyond traditional risk factors. Use of this multidimensional tool may improve risk stratification and prognostication in NSCLC.
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Collins J, Noble S, Chester J, Coles B, Byrne A. The assessment and impact of sarcopenia in lung cancer: a systematic literature review. BMJ Open 2014; 4:e003697. [PMID: 24384894 PMCID: PMC3902311 DOI: 10.1136/bmjopen-2013-003697] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES There is growing awareness of the relationship between sarcopenia (loss of muscle mass and function), and outcomes in cancer, making it a potential target for future therapies. In order to inform future research and practice, we undertook a systematic review of factors associated with loss of muscle mass, and the relationship between muscle function and muscle mass in lung cancer, a common condition associated with poor outcomes. DESIGN We conducted a computerised systematic literature search on five databases. Studies were included if they explored muscle mass as an outcome measure in patients with lung cancer, and were published in English. SETTING Secondary care. PARTICIPANTS Patients with lung cancer. PRIMARY OUTCOME Factors associated with loss of muscle mass and muscle function, or sarcopenia, and the clinical impact thereof in patients with lung cancer. RESULTS We reviewed 5726 citations, and 35 articles were selected for analysis. Sarcopenia, as defined by reduced muscle mass alone, was found to be very prevalent in patients with lung cancer, regardless of body mass index, and where present was associated with poorer functional status and overall survival. There were diverse studies exploring molecular and metabolic factors in the development of loss of muscle mass; however, the precise mechanisms that contribute to sarcopenia and cachexia remain uncertain. The effect of nutritional supplements and ATP infusions on muscle mass showed conflicting results. There are very limited data on the correlation between degree of sarcopenia and muscle function, which has a non-linear relationship in older non-cancer populations. CONCLUSIONS Loss of muscle mass is a significant contributor to morbidity in patients with lung cancer. Loss of muscle mass and function may predate clinically overt cachexia, underlining the importance of evaluating sarcopenia, rather than weight loss alone. Understanding this relationship and its associated factors will provide opportunities for focused intervention to improve clinical outcomes.
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Affiliation(s)
| | - Simon Noble
- Department of Palliative Medicine, Cardiff University, Cardiff, South Wales, UK
| | - John Chester
- Department of Medical Oncology, Cardiff University, Cardiff, South Wales, UK
| | - Bernadette Coles
- Cancer Research Wales Library, Velindre NHS Trust, Cardiff, South Wales, UK
| | - Anthony Byrne
- Marie Curie Palliative Care Research Centre, Cardiff University, Cardiff, South Wales, UK
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Kroman SL, Roos EM, Bennell KL, Hinman RS, Dobson F. Measurement properties of performance-based outcome measures to assess physical function in young and middle-aged people known to be at high risk of hip and/or knee osteoarthritis: a systematic review. Osteoarthritis Cartilage 2014; 22:26-39. [PMID: 24216060 DOI: 10.1016/j.joca.2013.10.021] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 10/10/2013] [Accepted: 10/29/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To systematically appraise the evidence on measurement properties of performance-based outcome measures to assess physical function in young and middle-aged people known to be at high risk of hip and/or knee osteoarthritis (OA). METHODS Electronic searches were performed in MEDLINE, CINAHL, Scopus and SPORTDiscus in May 2013. Two reviewers independently rated the measurement properties using the 4-point COSMIN checklist. Best evidence synthesis was made using COSMIN quality, consistency and direction of findings and sample size. RESULTS Twenty of 2736 papers were eligible for inclusion and 24 different performance-based outcome measures knee or obese populations were evaluated. No tests related to hip populations were included. Twenty-five measurement properties including reliability (nine studies), construct validity (hypothesis testing) (nine studies), measurement error (three studies), structural validity (two studies), interpretability (one study) and responsiveness (one study) were evaluated. A positive rating was given to 12.5% (30/240) of all possible measurement ratings. Tests were grouped into two categories based on the population characteristics. The one-legged hop for distance, followed by the 6-m timed hop and cross over hop for distance were the best-rated tests for the knee-injured population. Whereas the 6-min walk test was the only included test for the obese population. CONCLUSION This review highlights the many gaps in knowledge about the measurement properties of performance-based outcome measures for young and middle-aged people known to be at high risk of hip and/or knee OA. There is a need for consensus on which outcome measures should be used and/or combined when assessing physical function in this population. Further good quality research is required.
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Affiliation(s)
- S L Kroman
- Institute of Sports Science and Clinical Biomechanics, The University of Southern Denmark, Denmark.
| | - E M Roos
- Institute of Sports Science and Clinical Biomechanics, The University of Southern Denmark, Denmark.
| | - K L Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Australia.
| | - R S Hinman
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Australia.
| | - F Dobson
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Australia.
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