Exercise training as part of lung cancer therapy

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.

Preoperative paraspinous muscle sarcopenia and physical performance as prognostic indicators in non‐small‐cell lung cancer

“…Physical performance and mobility are closely related to physical activity, 35,36 and physical activity has been suggested to counteract some specific hallmarks of cancer and to prevent chemotherapy‐related adverse events 37 . In addition, the anti‐tumorigenic effect of exercise is related to immunomodulation, particularly by increasing pro‐inflammatory cytokine levels and natural killer cell infiltration in the tumour micro‐environment 38 . Patients with low physical performance may not benefit from these effects, and therefore, these associations may be related to the high incidence of post‐operative adverse events in patients with ‘sarcopenia with limited mobility’.…”

“…It is important to accurately assess preoperative sarcopenia and physical performance because both can be targeted for treatment before and after surgery with various interventions, including nutritional recommendations and rehabilitation 43–45 . Exercise is a non‐pharmacological intervention that improves fatigue, quality of life, pulmonary function, muscle mass, physical performance, and psychological status of patients with lung cancer 37,38 . In addition, the performance of resistance training and use of nutritional supplements, including branched‐chain amino acids, vitamin D, whey protein, and hydroxymethylbutyrate‐enriched milk, play important roles in the prevention and improvement of sarcopenia, 15 and these interventions may result in improved post‐operative outcomes for frail NSCLC patients.…”

Endurance Exercise Mitigates Immunometabolic Adipose Tissue Disturbances in Cancer and Obesity

“…Since then the number of studies in this field rose substantially and exercise started to be considered a tool for the treatment for cancer-related fatigue [ 146 ], for functional, psychological and emotional well-being [ 147 ] and for cancer cachexia [ 148 ]. Recently, it has been suggested that exercise is a worthy therapy in many cancer treatments at all stages [ 149 ], along with radiotherapy, chemotherapies and immunotherapies [ 150 ], including for cancer-related cognitive impairment [ 151 ].…”

Short-Term Changes in Quality of Life in Patients with Advanced Lung Cancer during In-Hospital Exercise Training and Chemotherapy Treatment: A Randomized Controlled Trial

“…In recent years, the implementation of pulmonary rehabilitation in patients with lung cancer has gained recognition in the world of medicine. It has been shown that rehabilitation is safe and acceptable to patients; improves fitness, physical efficiency, and oxygen consumption; and reduces fatigue [14,15,[17][18][19]. The reason for this is that exercise training challenges the entire oxygen transport pathway from the lungs, to the circulation, to the tissues-delivering oxygen to the cells.…”