Feasibility and preliminary efficacy of progressive resistance exercise training in lung cancer survivors☆
Introduction
Lung cancer accounts for 15% of all new cancer diagnoses and the most cancer deaths in North America [1]. Overall five year relative survival is only about 16%, however, if detected early the survival rate is 53% [2]. Lung cancer survivors, defined as anyone previously diagnosed with lung cancer [3], often exhibit poor functional capacity [4], [5], poor patient-reported physical functioning, and compromised quality of life (QoL) [6], [7]. In addition to the expected age-related losses in physical function, lung cancer survivors often present with comorbidities and disease burden which can lead to disability, loss of function and decreased QoL [8], [9]. Few interventions have been developed to attenuate functional declines in lung cancer survivors [4], [10], [11], [12].
Progressive resistance exercise training (PRET) is a well tolerated intervention for improving muscular strength, body composition, physical fitness, physical functioning, and QoL in clinical and older adult populations, including some cancer survivor groups [13], [14], [15], [16]. No studies to date, however, have focused exclusively on PRET in lung cancer survivors. Consequently, there is a need for feasibility studies to address a series of questions regarding the interest, acceptability, and preliminary efficacy of PRET for improving strength, physical function, and QoL in post-treatment lung cancer survivors [15], [17], [18]. Here, we present the results of a prospective single-group study designed to evaluate the feasibility and preliminary efficacy of a PRET program in lung cancer survivors following treatment. We hypothesized that the training program would be feasible and result in improvements in objective health-related fitness as well as patient-reported outcomes.
Section snippets
Setting and participants
The study was conducted at the Cross Cancer Institute and the University of Alberta in Edmonton, Canada. Ethical approval was obtained from the Alberta Cancer Research Ethics Committee and the Health Research Ethics Board at the University of Alberta. Informed consent was obtained from all participants. Eligibility criteria were: (1) histologically confirmed stage I-IIIB non-small cell lung cancer (NSCLC) and limited stage small-cell lung cancer; (2) approval of treating physician; (3) not
Results
Participant flow through the trial is outlined in Fig. 1. The demographic, medical, and behavioral profile of the participants is reported in Table 1. Participants had a mean age of 67, the majority were early stage (64.6%) NSCLC survivors (94.1%), had received surgery (82.4%), and were on average three and a half years post-diagnosis. Participants had a mean 6MWD of 445 ± 70, equivalent to 63% of age and sex predicted.
Discussion
To our knowledge, this is the first study to pilot PRET with a sample of lung cancer survivors. The eligibility rate in our study was low at 10%. In exercise training studies in post-treatment cancer survivors, reported eligibility rates are between 27 and 34% [37], [38], [39]. The main reasons for ineligibility in our study were medical contraindications and living outside the intervention area. Our recruitment rate of 42.5% however is similar to that of previous supervised exercise
Conclusion
In conclusion, PRET appears to be a feasible intervention with potential for health benefits in a small portion of lung cancer survivors. Therefore, additional feasibility research is warranted to focus on improving eligibility rates by testing less intense or medically supervised exercise, or offering home-based programs to facilitate training for those unable to access supervised centres.
Conflict of interest statement
None declared.
Acknowledgements
The authors gratefully acknowledge Mrs. Janel Park, B.S. for her assistance in data collection. Carolyn Peddle-McIntyre was supported by a Research Studentship from the Canadian Cancer Society Research Institute. Kerry Courneya is supported by the Canada Research Chairs Program.
This research had no funding sources to disclose.
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Accepted for presentation in part at International Society of Behavioral Nutrition and Physical Activity Annual Meeting, June 2011.