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Zhao JY, Presley C, Madariaga ML, Ferguson M, Merritt RE, Kneuertz PJ. Prehabilitation for Older Adults Undergoing Lung Cancer Surgery: A Literature Review and Needs Assessment. Clin Lung Cancer 2024:S1525-7304(24)00142-6. [PMID: 39122607 DOI: 10.1016/j.cllc.2024.07.004] [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: 07/04/2023] [Revised: 04/14/2024] [Accepted: 07/07/2024] [Indexed: 08/12/2024]
Abstract
Early-stage lung cancer patients are increasingly considered for preoperative systemic therapy. Older adults in particular are among the most vulnerable patients, with little known on how preoperative therapies affect the risk-benefit of surgery. We sought to summarize the current literature and elucidate existing evidence gaps on the effects of prehabilitation interventions relative to age-related functional impairments and the unique needs of older patients undergoing lung cancer surgery. A literature review was performed using PubMed and Google Scholar databases, of all scientific articles published through April 2022 which report on the effects of prehabilitation on patients undergoing lung cancer surgery. We extracted current prehabilitation protocols and their impact on physical functioning, resilience, and patient-reported outcomes of older patients. Emerging evidence suggests that prehabilitation may enhance functional capacity and minimize the untoward effects of surgery for patients following lung resection similar to, or potentially even better than, traditional postoperative rehabilitation. The impact of preoperative interventions on surgical risk due to frailty remains ill-defined. Most studies evaluating prehabilitation include older patients, but few studies report on activities of daily living, self-care, mobility activities, and psychological resilience in older individuals. Preliminary data suggest the feasibility of physical therapy and resilience interventions in older individuals concurrent with systemic therapy. Future research is needed to determine best prehabilitation strategies for older lung cancer patients aimed to optimize age-related impairments and minimize surgical risk.
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Affiliation(s)
- Jane Y Zhao
- Division of Thoracic Surgery, Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN.
| | - Carolyn Presley
- Division of Medical Oncology, Department of Internal Medicine, College of Medicine, The Ohio State University Comprehensive Cancer Center, James Cancer Hospital and Solove Research Institute, Columbus, OH
| | - M Lucia Madariaga
- Division of Thoracic Surgery, Department of Surgery, University of Chicago, Chicago, IL
| | - Mark Ferguson
- Division of Thoracic Surgery, Department of Surgery, University of Chicago, Chicago, IL
| | - Robert E Merritt
- Thoracic Surgery Division, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Peter J Kneuertz
- Thoracic Surgery Division, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
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Navarro-Meléndez A, Gimenez MJ, Robledo-Donascimento Y, Río-González A, Lendínez-Mesa A. Physiotherapy applied to palliative care patients: a descriptive practice-based study. BMC Palliat Care 2023; 22:99. [PMID: 37474943 PMCID: PMC10357741 DOI: 10.1186/s12904-023-01188-3] [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: 01/10/2023] [Accepted: 05/30/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Over the last few years, the presence of physiotherapists in Palliative Care Units (PCU) has considerably grown based on evidence from studies supporting the use of non-pharmacological measures as part of Palliative Care (PC) treatments. However, more accumulated data are needed to definitively establish its added value. The present study describes the type of patients receiving physiotherapy in a PCU and the benefits obtained in relation to their degree of functional dependence. METHODS An observational, prospective, descriptive, practice-based study was undertaken involving patients admitted to the PCU of Fundación Instituto San José (Madrid, Spain), who according to the PCU´s clinical practice, met the criteria for physiotherapy intervention. Daily clinical practice was unchanged for study reasons. Participants were assessed prior to initiating and at the end of the physiotherapy program using the following standard scales: the Barthel Index, the Functional Ambulation Categories scale, the Palliative Performance Scale, and the Braden scale. A descriptive analysis was performed and scale scores prior to and after treatment were compared using the Wilcoxon signed-rank test. Significance was set at 0.05. RESULTS A total of 63 patients were included (mean age 71.98 ± 12.72; 61.9% males). Fifty-eight patients (92.1%) were oncological patients; of them, 35 (60.3%) had metastases. Prior to treatment, 28 (44.4%) participants had total dependence according to the Barthel index, and 37 (58.7%) were non-functional ambulator according to the FAC scale. At the end of treatment, the number of patients with total dependence decreased to 15 (23.8%) and those non-functional ambulator to 12 (19.0%). CONCLUSIONS Patients who benefited from physical therapy during their admission to our PCU were predominantly males with oncological processes, mainly lung cancer. PC including physiotherapy improved their functionality, independence and skills for activities of daily living in this sample of PCU patients.
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Affiliation(s)
- A Navarro-Meléndez
- Rehabilitation area, Hospital Fundación Instituto San José, Avenida de la Hospitalidad s/n, Madrid, 28054 Spain
- Department of Health Sciences, “San Juan de Dios” School of Nursing and Physical Therapy, Comillas Pontifical University, Avenida San Juan de Dios, 1, Ciempozuelos, 28350 Spain
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Calle Tajo s/n, Villaviciosa de Odón, 28670 Spain
| | - MJ Gimenez
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Calle Tajo s/n, Villaviciosa de Odón, 28670 Spain
| | - Y Robledo-Donascimento
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Calle Tajo s/n, Villaviciosa de Odón, 28670 Spain
- Hospital Universitario del Henares and Centro de Investigación Fisioterapia y Dolor, Avenida de Marie Curie 0, Coslada, 28822 Spain
| | - A Río-González
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Calle Tajo s/n, Villaviciosa de Odón, 28670 Spain
| | - A Lendínez-Mesa
- Department of Nursing, Neurology Service. Grupo de Investigación en Cuidados (InveCuid), Hospital 12 de Octubre, Avenida de Córdoba s/n, Madrid, 28041 Spain
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Björnsdóttir EB, Hjörleifsdóttir E, Sigurðardóttir Þ, Baruchello G, Þormóðsson FR. Experiences of cancer rehabilitation among patients in rural areas in northern Iceland: physical and psychosocial well-being, coping, quality of life, and satisfaction with care. A qualitative study. Int J Circumpolar Health 2021; 80:1936974. [PMID: 34114531 PMCID: PMC8204953 DOI: 10.1080/22423982.2021.1936974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 05/24/2021] [Accepted: 05/27/2021] [Indexed: 10/31/2022] Open
Abstract
Physical rehabilitation and psychosocial support are a part of cancer patients well-being and their ability to cope. Physical geography and healthcare provider barriers may have negative influences on patients' health outcomes. To explore the perceptions and experiences of cancer rehabilitation in a rural area in northern Iceland. A further aim was to explore patients' physical and psychosocial well-being, coping and satisfaction with care. A qualitative study using semi-structured interviews and thematic analysis was completed with a purposive sample of 21 patients at a tertiary hospital in northern Iceland. Three main themes emerged: 1) Rehabilitation - the need for improved access support and continuity; 2) Coping and quality of life - balancing life as it was before cancer against the present situation in order to achieve normality; 3) Satisfaction - encountering caring behaviours enhances satisfaction and well-being. Specifically targeted rehabilitation programmes need to be included in the treatment options for cancer patients. Survival instinct, coping mechanisms and a strong urge to maintain general functionality are of paramount importance intertwined with patients' ability to cope with the disease and treatment, and their satisfaction with care.
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Affiliation(s)
| | | | | | - Giorgio Baruchello
- Department of Social Sciences, University of Akureyri, Akureyri, Iceland
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Lee J. Physiologic and psychologic adaptation to exercise interventions in lung cancer patients undergoing chemotherapy: a systematic review and meta-analysis of randomized controlled trials. Support Care Cancer 2021; 29:2863-2873. [PMID: 33404814 DOI: 10.1007/s00520-020-05939-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 12/09/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The purpose of this meta-analysis is to investigate the effectiveness of exercise interventions in patients with lung cancer (LC) during chemotherapy regarding physiological and psychological outcomes. METHODS Databases including MEDLINE and EMBASE were used to find relevant randomized controlled trails that explored outcomes of exercise interventions for patients with LC during chemotherapy up to June 2020. Effect sizes were calculated by standardized mean difference statistics. RESULTS Six studies were included that involved 244 participants with average age of 65 years. Patients with LC participating in exercise interventions during chemotherapy had significantly increased strength, forced expired volume, and quality of life as well as significantly decreased pain. Effective exercise intervention characteristics were combined aerobic and resistance exercise, performance more than 5 times a week, moderate to vigorous intensity, and 1-h sessions. CONCLUSION Supervised participation in exercise improves strength, forced expired volume, and quality of life and relieves pain and depression during chemotherapy.
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Affiliation(s)
- Junga Lee
- Sports Medicine and Science, KyungHee University, 1732 Deogyeong-daero, Giheung-gu, Yongin-si, Gyeonggi-do, 17104, Republic of Korea.
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Cavalheri V, Granger CL. Exercise training as part of lung cancer therapy. Respirology 2020; 25 Suppl 2:80-87. [PMID: 32567236 DOI: 10.1111/resp.13869] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/04/2020] [Accepted: 05/10/2020] [Indexed: 12/13/2022]
Abstract
Exercise training is playing an increasing role in lung cancer care. Lung cancer is associated with significant burden to the individual and healthcare system. There is now substantial evidence that exercise training is safe, feasible and effective at improving several outcomes in people with lung cancer, especially in those with NSCLC. Exercise is beneficial across the lung cancer disease and treatment pathway, including in patients with early stage disease before and after surgery, and in patients with advanced disease. This review describes the impact of lung cancer and lung cancer treatment on patient health outcomes and summarizes the aims, safety, feasibility and effects of exercise training in the context of both early stage and advanced stage lung cancer. The paper also includes a discussion of current topical discussion areas including the use of exercise in people with bone metastases and the potential effect of exercise on suppression of tumour growth. Finally, seven clinical questions are included, which are a priority to be addressed by future research over the next decade as we strive to progress the field of lung cancer and improve patient outcomes.
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Affiliation(s)
- Vinicius Cavalheri
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, WA, Australia.,Allied Health, South Metropolitan Health Service, Perth, WA, Australia
| | - Catherine L Granger
- Department of Physiotherapy, The University of Melbourne, Melbourne, VIC, Australia.,Department of Physiotherapy, Royal Melbourne Hospital, Melbourne, VIC, Australia
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Effects of an exercise intervention for patients with advanced inoperable lung cancer undergoing chemotherapy: A randomized clinical trial. Lung Cancer 2020; 145:76-82. [PMID: 32416432 DOI: 10.1016/j.lungcan.2020.05.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/14/2020] [Accepted: 05/02/2020] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Exercise can improve treatment-related side effects, quality of life, and function in patients with various types of cancer; however, more evidence is needed for patients with advanced inoperable lung cancer. MATERIAL AND METHODS We randomized 218 patients with advanced inoperable lung cancer to a 12-week supervised, structured exercise training program (aerobic, strength, and relaxation training) twice weekly versus usual care. Primary outcome was change in maximal oxygen uptake (VO2 peak). Secondary outcomes were muscle strength, functional capacity, forced expiratory volume in 1 s, health-related quality of life, anxiety, and depression. RESULTS There was no significant difference between the intervention and control groups in VO2 peak. There was a significant improvement in muscle strength. There was also a significant difference between the two for social well-being (Functional Assessment of Cancer Therapy-Lung, FACT-L), anxiety, and depression. CONCLUSION There was a significant reduction in the level of anxiety and depression and a significant increase in all muscle strength outcomes in the intervention group compared to patients randomized to usual care. There was a significant difference between the groups for social well-being. The primary outcome did not show a significant improvement in VO2 peak. Based on our results, future patients with advanced inoperable lung cancer should be considered for supervised exercise during the course of their disease.
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Chang PH, Lin CR, Lee YH, Liu YL, Chang GC, Hoogland AI, Lai YH. Exercise experiences in patients with metastatic lung cancer: A qualitative approach. PLoS One 2020; 15:e0230188. [PMID: 32240205 PMCID: PMC7117721 DOI: 10.1371/journal.pone.0230188] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 02/24/2020] [Indexed: 01/14/2023] Open
Abstract
Background Patients with metastatic lung cancer can have severe cancer-related symptoms and treatment-induced side effects. Exercise is beneficial for patients with metastatic lung cancer; however, little information is available on guiding patients how to perform exercise during hospitalization. The purpose of this qualitative study was to understand exercise experiences in patients with metastatic lung cancer. Methods Patients with metastatic lung cancer (n = 24) participated in face-to-face in-depth interviews at an inpatient ward of a medical center in central Taiwan. Interview transcripts were evaluated using narrative analysis to extract and validate themes. Results Three primary themes were identified: (1) modifying exercise to maximize physical functions; (2) living with symptoms and frustration, but still exercising; and (3) doing exercise to sustain hopes, inner power, and life. Secondary findings included: (1) adopting walking as their main form of exercise because of its convenience; and (2) among patients with severe symptoms, adjusting exercise towards shorter time durations and shorter distances, slower speeds, and higher frequencies. Conclusions The study found physically active lung cancer patients, although with metastatic condition, adjusted their exercise activities to balance disease and treatment-induced deteriorations and boost themselves to feel hope and fight for cancer. However, the results may not be applicable to physically inactive patients. Future research to explore experiences from those with even worse physical conditions and further helping them to take some mild exercise to enhance the positive side of cancer experiences are suggested.
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Affiliation(s)
- Pi-Hua Chang
- Department of Nursing, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan, Republic of China
| | - Ching-Rong Lin
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan City, Taiwan, Republic of China
- Proton and Radiation Therapy Center, Department of Radiation Oncology, Chang Gung Memorial Hospital, Taoyuan City, Taiwan, Republic of China
| | - Yun-Hsiang Lee
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan, Republic of China
| | - Yi-Lin Liu
- Department of Nursing, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China
| | - Gee-Chen Chang
- Division of Chest Medicine, and Comprehensive Cancer Center, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China
- School of Medicine, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China
| | - Aasha I. Hoogland
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, United States of America
| | - Yeur-Hur Lai
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan, Republic of China
- National Taiwan University Cancer Center, Taipei, Taiwan, Republic of China
- * E-mail:
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Chronic Obstructive Pulmonary Disease and Lung Cancer: Underlying Pathophysiology and New Therapeutic Modalities. Drugs 2019; 78:1717-1740. [PMID: 30392114 DOI: 10.1007/s40265-018-1001-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) and lung cancer are major lung diseases affecting millions worldwide. Both diseases have links to cigarette smoking and exert a considerable societal burden. People suffering from COPD are at higher risk of developing lung cancer than those without, and are more susceptible to poor outcomes after diagnosis and treatment. Lung cancer and COPD are closely associated, possibly sharing common traits such as an underlying genetic predisposition, epithelial and endothelial cell plasticity, dysfunctional inflammatory mechanisms including the deposition of excessive extracellular matrix, angiogenesis, susceptibility to DNA damage and cellular mutagenesis. In fact, COPD could be the driving factor for lung cancer, providing a conducive environment that propagates its evolution. In the early stages of smoking, body defences provide a combative immune/oxidative response and DNA repair mechanisms are likely to subdue these changes to a certain extent; however, in patients with COPD with lung cancer the consequences could be devastating, potentially contributing to slower postoperative recovery after lung resection and increased resistance to radiotherapy and chemotherapy. Vital to the development of new-targeted therapies is an in-depth understanding of various molecular mechanisms that are associated with both pathologies. In this comprehensive review, we provide a detailed overview of possible underlying factors that link COPD and lung cancer, and current therapeutic advances from both human and preclinical animal models that can effectively mitigate this unholy relationship.
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Smith MP, Müller J, Neidenbach R, Ewert P, Hager A. Better lung function with increased handgrip strength, as well as maximum oxygen uptake, in congenital heart disease across the lifespan. Eur J Prev Cardiol 2018; 26:492-501. [DOI: 10.1177/2047487318816508] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background The respiratory benefits of muscle strength are well-known in heart-healthy populations, but recommendations and research often focus instead on aerobic fitness (peak oxygen uptake) or total activity. Independent benefits of strength thus may be underestimated, especially in congenital heart disease where perceived dangers of certain types of exercise may outweigh perceived benefits. To assess whether it is plausible that pulmonary benefits of strength in heart-healthy populations also apply in congenital heart disease, we simultaneously correlated these patients’ lung function with fitness, strength, and cardiac diagnosis. Methods Lung function (forced expiratory volume in one second percentage predicted (FEV1%pred)) was modeled as function of handgrip strength, congenital heart disease diagnosis, peak oxygen uptake and the interactions of handgrip with sex and diagnosis in 538 Germans (58% male, ages 6–82 years) in linear models corrected for age, sex, height and weight. Congenital heart disease diagnoses were: complex cyanotic; Fallot/Truncus arteriosus communis (common arterial trunk) (TAC); shunts; transposition of the great arteries (TGA); left heart; and other/none. Results Each kg of handgrip was associated with 0.74% higher FEV1%pred ( p < 0.001) and handgrip explained almost 10% of variance in FEV1%pred. While some groups had higher FEV1%pred than others ( p for global null <0.0001), all experienced similar associations with strength ( p for interaction with handgrip >0.10 for both sex and diagnosis.) Correction for peak oxygen uptake eliminated the association with congenital heart disease, but not handgrip. Conclusion Strength was associated with better lung function in all ages even after correction for peak oxygen uptake, regardless of sex and congenital heart disease. This suggests that strength may be at least as important for lung function as aerobic fitness. Heart-safe strength training may improve pulmonary function in congenital heart disease.
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Affiliation(s)
- Maia P Smith
- Department of Public Health and Preventive Medicine, St George’s University, West Indies
| | - Jan Müller
- Department of Pediatric Cardiology and Congenital Heart Disease, Technical University of Munich, Germany
- Institute of Preventive Pediatrics, Technical University of Munich, Germany
| | - Rhoia Neidenbach
- Department of Pediatric Cardiology and Congenital Heart Disease, Technical University of Munich, Germany
| | - Peter Ewert
- Department of Pediatric Cardiology and Congenital Heart Disease, Technical University of Munich, Germany
| | - Alfred Hager
- Department of Pediatric Cardiology and Congenital Heart Disease, Technical University of Munich, Germany
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Park YS, Lee J, Keum B, Oh BM. Feasibility of an eight-week outpatient-based pulmonary rehabilitation program for advanced lung cancer patients undergoing cytotoxic chemotherapy in Korea. Thorac Cancer 2018; 9:1069-1073. [PMID: 29932301 PMCID: PMC6068450 DOI: 10.1111/1759-7714.12788] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 05/21/2018] [Accepted: 05/23/2018] [Indexed: 01/16/2023] Open
Abstract
The scientific evidence supporting pulmonary rehabilitation (PR) for lung cancer patients undergoing cytotoxic chemotherapy is accumulating; however, the feasibility of outpatient-based PR in these patients has not yet been evaluated in Korea. We conducted an eight-week outpatient-based PR feasibility study in a tertiary referral hospital setting. Patients with advanced lung cancer (non-small cell lung cancer IIIB-IV and small-cell lung cancer extensive disease) scheduled to undergo first-line cytotoxic chemotherapy underwent PR consisting of 60-minute sessions twice a week under the guidance and supervision of a physical therapist, for a total of eight weeks. Feasibility was assessed based on completion of the PR program. In total, 12 patients (median age 68 years) were enrolled; 11 (91.7%) were male with a history of smoking. Among these 12 patients, 9 (75%) completed the eight-week outpatient-based PR program. Three patients could not complete the PR program: two were unwilling and one died from complications of lung cancer. This study showed a 75% completion rate of an eight-week outpatient-based PR program for advanced lung cancer patients undergoing cytotoxic chemotherapy, which supports its feasibility.
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Affiliation(s)
- Young Sik Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Jinwoo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Bhumsuk Keum
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, South Korea
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Smith MP, Standl M, Berdel D, von Berg A, Bauer CP, Schikowski T, Koletzko S, Lehmann I, Krämer U, Heinrich J, Schulz H. Handgrip strength is associated with improved spirometry in adolescents. PLoS One 2018; 13:e0194560. [PMID: 29641533 PMCID: PMC5894972 DOI: 10.1371/journal.pone.0194560] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 03/06/2018] [Indexed: 11/18/2022] Open
Abstract
Introduction Pulmonary rehabilitation, including aerobic exercise and strength training, improves function, such as spirometric indices, in lung disease. However, we found spirometry did not correlate with physical activity (PA) in healthy adolescents (Smith ERJ: 42(4), 2016). To address whether muscle strength did, we measured these adolescents’ handgrip strength and correlated it with spirometry. Methods In 1846 non-smoking, non-asthmatic Germans (age 15.2 years, 47% male), we modeled spirometric indices as functions of handgrip strength by linear regression in each sex, corrected for factors including age, height, and lean body mass. Results Handgrip averaged 35.4 (SD 7.3) kg in boys, 26.6 (4.2) in girls. Spirometric volumes and flows increased linearly with handgrip. In boys each kg handgrip was associated with about 28 mL greater FEV1 and FVC; 60 mL/sec faster PEF; and 38 mL/sec faster FEF2575. Effects were 10–30% smaller in girls (all p<0.0001) and stable when Z-scores for spirometry and grip were modeled, after further correction for environment and/or other exposures, and consistent across stages of puberty. Conclusions Grip strength was associated with spirometry in a cohort of healthy adolescents whose PA was not. Thus, research into PA’s relationship with lung function should consider strength as well as total PA. Strength training may benefit healthy lungs; interventions are needed to prove causality.
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Affiliation(s)
- Maia Phillips Smith
- Institute of Epidemiology, Helmholtz Zentrum München–German Research Center for Environmental Health, Neuherberg, Germany
- Department of Public Health and Preventive Medicine, St. George’s University, Grenada, West Indies
- * E-mail:
| | - Marie Standl
- Institute of Epidemiology, Helmholtz Zentrum München–German Research Center for Environmental Health, Neuherberg, Germany
| | - Dietrich Berdel
- Research Institute, Department of Pediatrics, Marien-Hospital Wesel, Wesel, Germany
| | - Andrea von Berg
- Research Institute, Department of Pediatrics, Marien-Hospital Wesel, Wesel, Germany
| | - Carl-Peter Bauer
- Department of Pediatrics, Technical University of Munich, Munich, Germany
| | - Tamara Schikowski
- IUF Leibniz Research Institute for Environmental Medicine and Medical Faculty, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
| | - Sibylle Koletzko
- Dr von Hauner Children’s Hospital, Ludwig Maximilians University of Munich, Munich, Germany
| | - Irina Lehmann
- Department Umweltimmunologie / Core Facility Studien Helmholtz-Zentrum für Umweltforschung–UFZ Leipzig, Germany
| | - Ursula Krämer
- IUF Leibniz Research Institute for Environmental Medicine and Medical Faculty, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
| | - Joachim Heinrich
- Institute of Epidemiology, Helmholtz Zentrum München–German Research Center for Environmental Health, Neuherberg, Germany
| | - Holger Schulz
- Institute of Epidemiology, Helmholtz Zentrum München–German Research Center for Environmental Health, Neuherberg, Germany
- Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research, Munich, Germany
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Exercise behavior and physical fitness in patients with advanced lung cancer. Support Care Cancer 2018; 26:2725-2736. [PMID: 29480444 DOI: 10.1007/s00520-018-4105-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 02/11/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE The aim of this work was to evaluate exercise behavior and physical fitness of advanced lung cancer patients shortly after primary diagnosis. METHODS Between November 2013 and December 2016, advanced lung cancer patients (n = 227, mean age 62.2 years) were enrolled shortly after diagnosis and 211 patients were tested for endurance capacity (six-minute walk test) and strength performance (maximum voluntary isometric contraction of upper and lower extremities). Current and previous exercise and walking behavior were assessed using a self-reported questionnaire regarding type, frequency, intensity, and duration. Paired Student's t tests were used to compare physical fitness to reference data. The relation of potential determinants with physical fitness was assessed using linear regression analysis. RESULTS Exercise behavior was superior in the year before diagnosis compared to the time of study enrollment. Patients reduced frequency, intensity, and duration of sports/exercise after their lung cancer diagnosis. We observed significantly lower endurance capacity (p < .01) and strength performance in lower extremities (p < .01) in male and female patients compared to age and sex-matched reference data. We found significant correlations of previous exercise and walking behavior with physical fitness shortly after diagnosis in patients with advanced lung cancer. CONCLUSION Patients with advanced lung cancer showed impaired physical fitness regarding endurance and strength capacity. The strong decline in participation of sports/exercise shortly after diagnosis supports early implementation of physical exercise during anti-cancer treatment. TRIAL REGISTRATION ClinicalTrials.gov NCT02055508.
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Edbrooke L, Aranda S, Granger CL, McDonald CF, Krishnasamy M, Mileshkin L, Irving L, Braat S, Clark RA, Gordon I, Denehy L. Benefits of home-based multidisciplinary exercise and supportive care in inoperable non-small cell lung cancer - protocol for a phase II randomised controlled trial. BMC Cancer 2017; 17:663. [PMID: 28962608 PMCID: PMC5622453 DOI: 10.1186/s12885-017-3651-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 09/22/2017] [Indexed: 12/31/2022] Open
Abstract
Background Lung cancer is one of the most commonly diagnosed cancers, and is a leading cause of cancer mortality world-wide. Due to lack of early specific symptoms, the majority of patients present with advanced, inoperable disease and five-year relative survival across all stages of non-small cell lung cancer (NSCLC) is 14%. People with lung cancer also report higher levels of symptom distress than those with other forms of cancer. Several benefits for survival and patient reported outcomes are reported from physical activity and exercise in other tumour groups. We report the protocol for a study investigating the benefits of exercise, behaviour change and symptom self-management for patients with recently diagnosed, inoperable, NSCLC. Methods This multi-site, parallel-group, assessor-blinded randomised controlled trial, powered for superiority, aims to assess functional and patient-reported outcomes of a multi-disciplinary, home-based exercise and supportive care program for people commencing treatment. Ninety-two participants are being recruited from three tertiary-care hospitals in Melbourne, Australia. Following baseline testing, participants are randomised using concealed allocation, to receive either: a) 8 weeks of home-based exercise (comprising an individualised endurance and resistance exercise program and behaviour change coaching) and nurse-delivered symptom self-management intervention or b) usual care. The primary outcome is the between-group difference in the change in functional exercise capacity (six-minute walk distance) from baseline to post-program assessment. Secondary outcomes include: objective and self-reported physical activity levels, physical activity self-efficacy, behavioural regulation of motivation to exercise and resilience, muscle strength (quadriceps and grip), health-related quality of life, anxiety and depression and symptom interference. Discussion There is a lack of evidence regarding the benefit of exercise intervention for people with NSCLC, particularly in those with inoperable disease receiving treatment. This trial will contribute to evidence currently being generated in national and international trials by implementing and evaluating a home-based program including three components not yet combined in previous research, for people with inoperable NSCLC receiving active treatment and involving longer-term follow-up of outcomes. This trial is ongoing and currently recruiting. Trial registration This trial was prospectively registered on the Australian New Zealand Clinical Trials Registry (ACTRN12614001268639: (4/12/14). Electronic supplementary material The online version of this article (10.1186/s12885-017-3651-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lara Edbrooke
- Department of Physiotherapy, The University of Melbourne, Level 7, 161 Barry St, Parkville, VIC, 3010, Australia.
| | - Sanchia Aranda
- Cancer Council Australia, Sydney, NSW, Australia.,Department of Nursing, The University of Melbourne, Parkville, VIC, Australia
| | - Catherine L Granger
- Department of Physiotherapy, The University of Melbourne, Level 7, 161 Barry St, Parkville, VIC, 3010, Australia.,Institute for Breathing and Sleep, Heidelberg, VIC, Australia.,Department of Physiotherapy, Melbourne Health, Parkville, VIC, Australia
| | - Christine F McDonald
- Institute for Breathing and Sleep, Heidelberg, VIC, Australia.,Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, VIC, Australia
| | - Mei Krishnasamy
- Department of Nursing, The University of Melbourne, Parkville, VIC, Australia.,The University of Melbourne Centre for Cancer Research, Parkville, VIC, Australia
| | - Linda Mileshkin
- The Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Louis Irving
- Department of Respiratory and Sleep Medicine, Melbourne Health, Parkville, VIC, Australia
| | - Sabine Braat
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Ross A Clark
- University of the Sunshine Coast, Sunshine Coast, QLD, Australia
| | - Ian Gordon
- Statistical Consulting Centre, The University of Melbourne, Parkville, VIC, Australia
| | - Linda Denehy
- Department of Physiotherapy, The University of Melbourne, Level 7, 161 Barry St, Parkville, VIC, 3010, Australia.,Institute for Breathing and Sleep, Heidelberg, VIC, Australia
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14
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Integrating Function-Directed Treatments into Palliative Care. PM R 2017; 9:S335-S346. [DOI: 10.1016/j.pmrj.2017.07.073] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 07/28/2017] [Accepted: 07/31/2017] [Indexed: 02/06/2023]
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15
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Titz C, Hummler S, Thomas M, Wiskemann J. Physical exercise in advanced cancer patients undergoing palliative treatment. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/23809000.2016.1251292] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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16
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Weimann A, Gockel I, Hölscher AH, Meyer HJ. [Impact of perioperative nutritional therapy on risk and complication management in patients undergoing esophagectomy for cancer]. Chirurg 2016; 87:1046-1053. [PMID: 27492377 DOI: 10.1007/s00104-016-0256-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Esophagectomy is considered to be a high risk procedure regarding postoperative morbidity and mortality. Therefore, in Germany, these operations are limited to hospitals fulfilling a minimum quantity. This systematic review focuses on risk and complication management regarding the impact of perioperative nutritional therapy, including the recent S3-guideline recommendations and comments of the German Working Group of Medical Societies (AWMF) which were established with contributions from the authors.
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Affiliation(s)
- A Weimann
- Klinik für Allgemein-, Viszeral- und Onkologische Chirurgie, Klinikum St. Georg gGmbH, Delitzscher Straße 141, 04129, Leipzig, Deutschland.
| | - I Gockel
- Klinik und Poliklinik für Viszeral-, Transplantations-, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland
| | - A H Hölscher
- Zentrum für Speiseröhren- und Magenchirurgie, Agaplesion Markuskrankenhaus Frankfurt, Wilhelm-Epstein-Straße 4, 60431, Frankfurt am Main, Deutschland
| | - H-J Meyer
- Deutsche Gesellschaft für Chirurgie e. V., Luisenstr. 58/59, 10117, Berlin, Deutschland
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17
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Lehto RH. Symptom burden in lung cancer: management updates. Lung Cancer Manag 2016; 5:61-78. [PMID: 30643551 PMCID: PMC6310300 DOI: 10.2217/lmt-2016-0001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 04/20/2016] [Indexed: 12/25/2022] Open
Abstract
Lung cancer is recognized to carry a high symptom burden with associated lowered quality of life as compared with other cancers. Research has shown that symptom severity can be a prognostic indicator of poorer clinical outcomes and survival post treatment. The purpose of this paper is to review current literature relative to symptom burden associated with diagnosis, medical and/or surgical intervention, assessment and management updates, and emerging initiatives that promote positive outcomes based on updated evidence. Discussion relative to interdisciplinary coordination of supportive services and palliative care initiation is provided.
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Affiliation(s)
- Rebecca H Lehto
- C-344 Bogue, College of Nursing, Michigan State University, East Lansing, MI 48824-1317, USA
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18
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Activité physique et cancer : mise au point et revue de la littérature. Rev Med Interne 2016; 37:399-405. [DOI: 10.1016/j.revmed.2015.12.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 11/04/2015] [Accepted: 12/24/2015] [Indexed: 12/29/2022]
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19
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Vilchynska T, Beard B. Cancer-related fatigue in palliative care: a global perspective. Int J Palliat Nurs 2016; 22:244-52. [DOI: 10.12968/ijpn.2016.22.5.244] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Tetyana Vilchynska
- Director of Patient Services, Clinic of Children's Palliative Care, Kiev, Ukraine
| | - Barbara Beard
- Senior Lecturer, Sheffield Hallam University, Sheffield, UK
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20
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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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21
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Møller T, Lillelund C, Andersen C, Bloomquist K, Christensen KB, Ejlertsen B, Nørgaard L, Wiedenbein L, Oturai P, Breitenstein U, Adamsen L. The challenge of preserving cardiorespiratory fitness in physically inactive patients with colon or breast cancer during adjuvant chemotherapy: a randomised feasibility study. BMJ Open Sport Exerc Med 2015; 1:e000021. [PMID: 27900123 PMCID: PMC5117008 DOI: 10.1136/bmjsem-2015-000021] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2015] [Indexed: 12/11/2022] Open
Abstract
Introduction Anti-neoplastic treatment is synonymous with an inactive daily life for a substantial number of patients. It remains unclear what is the optimal setting, dosage and combination of exercise and health promoting components that best facilitate patient adherence and symptom management in order to support cardio-respiratory fitness and lifestyle changes in an at-risk population of pre-illness physically inactive cancer patients. Methods Patients with breast or colon cancer referred to adjuvant chemotherapy and by the oncologists pre-screening verified as physically inactive were eligible to enter a randomised three-armed feasibility study comparing a 12-week supervised hospital-based moderate to high intensity exercise intervention or alternate an instructive home-based12-week pedometer intervention, with usual care. Results Using a recommendation based physical activity screening instrument in order to correspond with cardio-respiratory fitness (VO2 peak) proved to be an applicable method to identify pre-illness physically inactive breast and colon cancer patients. The study demonstrated convincing recruitment (67%), safety and intervention adherence among breast cancer patients; while the attendance rate for colon cancer patients was notably lower (33%). VO2-peak declined on average 12% across study groups from baseline to 12 weeks though indices towards sustaining watt performance and reduce fat mass favoured the hospital-based intervention. Pedometer use was well adapted in both breast and colon cancer patients. Conclusions Despite a fair adherence and safety, the current study calls into question whether aerobic exercise, regardless of intensity, is able to increase VO2-peak during texane-based chemotherapy in combination with Neulasta in physically inactive breast cancer patients. Trial Registration: ISRCTN24901641
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Affiliation(s)
- Tom Møller
- The University Hospitals Centre for Health Care Research, UCSF Copenhagen University Hospital Rigshospitalet Department 9701 , Copenhagen , Denmark
| | - Christian Lillelund
- The University Hospitals Centre for Health Care Research, UCSF Copenhagen University Hospital Rigshospitalet Department 9701 , Copenhagen , Denmark
| | - Christina Andersen
- The University Hospitals Centre for Health Care Research, UCSF Copenhagen University Hospital Rigshospitalet Department 9701 , Copenhagen , Denmark
| | - Kira Bloomquist
- The University Hospitals Centre for Health Care Research, UCSF Copenhagen University Hospital Rigshospitalet Department 9701 , Copenhagen , Denmark
| | - Karl Bang Christensen
- Faculty of Health and Medical Sciences, Section of Biostatistics , University of Copenhagen , Copenhagen , Denmark
| | - Bent Ejlertsen
- Department of Oncology 5073 , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark
| | - Lone Nørgaard
- Department of Oncology 5073 , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark
| | - Liza Wiedenbein
- Department of Oncology 5073 , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark
| | - Peter Oturai
- Department of Clinical Physiology, Nuclear Medicine and PET , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark
| | - Ulla Breitenstein
- Department of Oncology 5073 , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark
| | - Lis Adamsen
- The University Hospitals Centre for Health Care Research, UCSF Copenhagen University Hospital Rigshospitalet Department 9701, Copenhagen, Denmark; Faculty of Health and Medical Sciences, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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22
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Zhao SG, Alexander NB, Djuric Z, Zhou J, Tao Y, Schipper M, Feng FY, Eisbruch A, Worden FP, Strath SJ, Jolly S. Maintaining physical activity during head and neck cancer treatment: Results of a pilot controlled trial. Head Neck 2015; 38 Suppl 1:E1086-96. [PMID: 26445898 DOI: 10.1002/hed.24162] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2015] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Concurrent chemoradiotherapy (concurrent CRT) to treat head and neck cancer is associated with significant reductions of weight, mobility, and quality of life (QOL). An intervention focusing on functional exercise may attenuate these losses. METHODS We allocated patients to a 14-week functional resistance and walking program designed to maintain physical activity during cancer treatment (MPACT group; n = 11), or to usual care (control group; n = 9). Outcomes were assessed at baseline, and 7 and 14 weeks. RESULTS Compared to controls, the MPACT participants had attenuated decline or improvement in several strength, mobility, physical activity, diet, and QOL endpoints. These trends were statistically significant (p < .05) in knee strength, mental health, head and neck QOL, and barriers to exercise. CONCLUSION In this pilot study of patients with head and neck cancer undergoing concurrent CRT, MPACT training was feasible and maintained or improved function and QOL, thereby providing the basis for larger future interventions with longer follow-up. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1086-E1096, 2016.
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Affiliation(s)
- Shuang G Zhao
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Neil B Alexander
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.,Geriatrics Research, Education and Clinical Center, University of Michigan, Ann Arbor, Michigan
| | - Zora Djuric
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
| | - Jessica Zhou
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Yebin Tao
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Matthew Schipper
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.,Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Felix Y Feng
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Francis P Worden
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Scott J Strath
- Department of Kinesiology, Center for Aging and Translational Research, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin
| | - Shruti Jolly
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.,Department of Radiation Oncology, Veterans Affairs Ann Arbor Health Care System, Ann Arbor, Michigan
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23
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Guibert N, Noel-Savina E, Mazières J. Perspective of a pulmonologist: what might we expect and what do we need to know? Lung Cancer 2015. [DOI: 10.1183/2312508x.10011014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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24
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Rivas-Perez H, Nana-Sinkam P. Integrating pulmonary rehabilitation into the multidisciplinary management of lung cancer: A review. Respir Med 2015; 109:437-42. [DOI: 10.1016/j.rmed.2015.01.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 12/30/2014] [Accepted: 01/03/2015] [Indexed: 10/24/2022]
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25
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Quist M, Adamsen L, Rørth M, Laursen JH, Christensen KB, Langer SW. The Impact of a Multidimensional Exercise Intervention on Physical and Functional Capacity, Anxiety, and Depression in Patients With Advanced-Stage Lung Cancer Undergoing Chemotherapy. Integr Cancer Ther 2015; 14:341-9. [DOI: 10.1177/1534735415572887] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
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.
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Affiliation(s)
- Morten Quist
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lis Adamsen
- University of Copenhagen, Copenhagen, Denmark
| | - Mikael Rørth
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Seppo W. Langer
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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26
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Hojman P, Fjelbye J, Zerahn B, Christensen JF, Dethlefsen C, Lonkvist CK, Brandt C, Gissel H, Pedersen BK, Gehl J. Voluntary exercise prevents cisplatin-induced muscle wasting during chemotherapy in mice. PLoS One 2014; 9:e109030. [PMID: 25268807 PMCID: PMC4182656 DOI: 10.1371/journal.pone.0109030] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 08/28/2014] [Indexed: 11/18/2022] Open
Abstract
Loss of muscle mass related to anti-cancer therapy is a major concern in cancer patients, being associated with important clinical endpoints including survival, treatment toxicity and patient-related outcomes. We investigated effects of voluntary exercise during cisplatin treatment on body weight, food intake as well as muscle mass, strength and signalling. Mice were treated weekly with 4 mg/kg cisplatin or saline for 6 weeks, and randomized to voluntary wheel running or not. Cisplatin treatment induced loss of body weight (29.8%, P < 0.001), lean body mass (20.6%, P = 0.001), as well as anorexia, impaired muscle strength (22.5% decrease, P < 0.001) and decreased glucose tolerance. In addition, cisplatin impaired Akt-signalling, induced genes related to protein degradation and inflammation, and reduced muscle glycogen content. Voluntary wheel running during treatment attenuated body weight loss by 50% (P < 0.001), maintained lean body mass (P < 0.001) and muscle strength (P < 0.001), reversed anorexia and impairments in Akt and protein degradation signalling. Cisplatin-induced muscular inflammation was not prevented by voluntary wheel running, nor was glucose tolerance improved. Exercise training may preserve muscle mass in cancer patients receiving cisplatin treatment, potentially improving physical capacity, quality of life and overall survival.
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Affiliation(s)
- Pernille Hojman
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jonas Fjelbye
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Bo Zerahn
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - Jesper F. Christensen
- Copenhagen University Hospital, The University Hospitals Centre for Health Care Research (UCSF), Copenhagen, Denmark
| | - Christine Dethlefsen
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Camilla K. Lonkvist
- Department of Oncology, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - Claus Brandt
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Hanne Gissel
- Institute of Biomedicine, University of Aarhus, Aarhus C, Denmark
| | - Bente Klarlund Pedersen
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Julie Gehl
- Department of Oncology, Copenhagen University Hospital Herlev, Herlev, Denmark
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