Exercise for Lung cancer

After posting this originally, I found another study that looked at exercise for lung cancer, which used a well established exercise program given to patients with Chronic Obstructive Pulmonary Disease to patients who have lung cancer. Please click the read more link to find out about that study as well.

I found a new study that tested an exercise intervention for people with non-small cell lung cancer who had undergone a thoracotomy.

The exercise program was: twice daily strength and mobility training from day 1 post-operation until day 5, then they were given a 12 week program to complete at home. The exercise was walking or recumbent biking at 60-80% of maximum heart rate for 5-10 minutes at a time. They also completed seated leg raises with 2-4lb ankle weights, and were encouraged to participate in any other activities they enjoyed, like golf.

Outcomes and discussion after the jump



The outcomes of the study were: how far they could walk in 6 minutes; quadriceps muscle strength; and quality of life as measured by the EORTC QLQ-CL13 questionnaire. Measurements were taken at pre-operation, 5 days post-operation, and at 12 weeks post operation.

Results:

• no difference in quality of life at any point for either the exercise or control group; 
• for the walking test, there were no differences between the exercise or control group at any point. Both groups decreased dramatically from pre-operation to 5 days post operation, and then returned to about pre-operation levels by the 12 week follow up.
• for quadriceps strength, the control group significantly decreased from pre-operation to 5 days post operation, and then started climbing back toward pre-operation levels by the 12 week follow up. The exercise group improved slightly from pre-operation to 5 days post, then came back to pre-operation levels at the 12 week follow up.

Overall, they were discussing the importance of doing the minimal activity to combat muscle atrophy during hospitalization, and the quadriceps exercise was good at maintaining strength and function. This is a big part of rehab consideration after any surgery and treatment, and can be described as the decay cycle. The treatment and associated bed rest lead to a decrease in capacity to exercise, which usually means people exercise less, which then further decreases their tolerance to exercise, and the cycle continues. It's very important for people to do literally ANYTHING to keep their strength up, and this study proves that even a fairly minimal effort can make a big difference, and it shows just how important putting forth at least that minimal effort can be in the short term. I am surprised that the control group returned to baseline at week 12. I wonder if maybe they were doing exercises on their own, or if it was truly a natural and spontaneous recovery.

Study cited: 

Arbane G, Tropman D, Jackson D, Garrod R. (2011) Evaluation of an early exercise intervention after thoracotomy for non-small cell lung cancer (NSCLC), effects on quality of life, muscle strength and exercise tolerance: randomised controlled trial. Lung Cancer. 2011 Feb;71(2):229-34.

And the second study:
This study had a majority of patients with non small cell lung cancer, but a few with other exact diagnoses. Some were in treatment but most were post treatment. Most patients were "inoperable," by which I assume they mean they couldn't undergo surgical removal, but could take chemo or radiation therapy.

Exercise sessions: twice a week for 7 weeks of group exercise sessions, with the patients instructed to complete exercise at home on the other days of the week. 

Group exercise sessions: 90 minutes total with the first 15 minutes spent on discussion and education; warm up of seated upper and lower body exercises (not fully described), then walking for the majority of the session, with the pace determined and monitored by the attending physiotherapist. They were instructed to walk at 85% VO2 max, which is a very high intensity (frankly I'm surprised they could reach that just through walking---I'd figure you'd have to at least be jogging). At the end of their walking training, they were also given 2 sets of 2 minutes on bicycling, stair stepping, and chair squats, where they were instructed to push themselves to the max so they would induce dyspnea, with the idea being that they would put themselves into this painful condition in a controlled environment so they could learn to control it if it came on outside of the program. 

Results: 12 out of 17 patients improved their cardiovascular and functional capacity as measured by the Incremental Shuttle Walk Test by 9% (p=0.021) and 15 out of 17 significantly improved on the Endurance Shuttle Walk Test by 109% (p=0.002).

These results are much more encouraging than from the above study, though you must remember that the first study was looking at people immediately post treatment, so they were going to be worse off. This second study indicates that patients should be pushed pretty hard on their aerobic exercise to help them recover from lung cancer. They had a high drop out rate due to this higher intensity, but I think this study is in line with my hypothesis that cancer survivors need to be pushed in their exercise, and that we as health professionals really need to help patients get motivated and stay on top of their recovery.

Citation: Andersen et al., (2011) Do patients with lung cancer benefit from physical exercise? Acta Oncologica, 50: 307-313.