Elsevier

Lung Cancer

Volume 75, Issue 1, January 2012, Pages 126-132
Lung Cancer

Feasibility and preliminary efficacy of progressive resistance exercise training in lung cancer survivors

https://doi.org/10.1016/j.lungcan.2011.05.026Get rights and content

Abstract

Lung cancer survivors exhibit poor functional capacity, physical functioning, and quality of life (QoL). Here, we report the feasibility and preliminary efficacy of a progressive resistance exercise training (PRET) intervention in post-treatment lung cancer survivors. Seventeen post-treatment lung cancer survivors (10 female), with a mean age of 67 (range 50–85), mean BMI of 25, and diagnosed with non-small cell lung cancer (94%) were recruited in Edmonton, Canada between August 2009 and August 2010 to undergo PRET. The primary outcomes focused on feasibility including eligibility and recruitment rate, loss to follow-up, measurement completion, exercise adherence, and program evaluation. Secondary outcomes addressed preliminary efficacy and included changes in muscular strength (1 repetition maximum), muscular endurance (repetitions at 70% of 1 repetition maximum), body composition (DXA scan), physical functioning (6-minute-walk-test, up-and-go, sit-to-stand, arm curls), and patient-reported outcomes including QoL (SF-36, FACT-L), fatigue (FACT-F), dyspnea (MRCD), and patient-rated function (LLFI). Forty of 389 lung cancer survivors were eligible (10%) and 17 of the 40 (43%) were recruited. Over 80% of participants were able to complete all testing; two participants were lost to follow-up, and the median adherence rate was 96% (range: 25–100%). Ratings of testing burden were low (i.e., less than two out of seven for all items), and trial evaluation was high (i.e., greater than six out of seven for all measures). Paired t-tests showed significant increases in muscular strength (p < .001), muscular endurance (p < .001), six-minute walk distance (p < .001), up-and-go time (p < .05), number of arm curls (p < .001), and number of chair stands (p < .001). There were no significant changes in body composition or patient-reported outcomes. PRET is a feasible intervention with potential health benefits for a small proportion of lung cancer survivors in the post-treatment setting.

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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