Resistance and aerobic exercise intervention during chemotherapy in patients with metastatic cancer: a pilot study in South Korea

Abstract

Background: We investigated the feasibility and safety of an exercise intervention in patients with metastatic solid cancer.Methods: Patients scheduled to receive first-line chemotherapy for metastatic cancer with a life expectancy of ≥4 months, no brain metastases, and no high risk of fracture were recruited to participate in a 12-week, combined resistance and aerobic exercise program consisting of supervised, hospital-based (2×/week) and home-based training (3×/week) during palliative chemotherapy. Feasibility and safety of the exercise intervention were the primary outcomes. The secondary outcomes were skeletal muscle mass and strength, functional capacity, quality of life (QoL), and fatigue.Results: Nineteen patients were enrolled in this pilot study. Five patients withdrew consent before the exercise intervention due to fear of exacerbating cancer-related symptoms (n=2), transportation issues (n=2), and unknown reasons (n=1). Ten patients (71.4%) completed the 12-week exercise program. Mean attendance rate of the supervised exercise sessions was 64.9% (range, 16.7-95.8%). No adverse events or skeletal complications occurred during the supervised exercise sessions. Among participants, there were no significant changes in muscle area at the third lumbar level (mean change=−0.7 cm 2 , P=0.869) or appendicular skeletal muscle mass (mean change=0.1 kg, P=0.661). The overall QoL assessed using the Functional Assessment of Cancer Therapy-General significantly improved post-exercise interventions (P=0.037). There were significant improvements in the QoL subdomains of emotional well-being and physical, social, and cognitive functions. Conclusions: Exercise interventions are feasible and safe in patients with metastatic cancer. Exercise interventions can improve QoL and prevent skeletal muscle loss during palliative chemotherapy.

Integration of exercise prescription into medical provision as a treatment for non-communicable diseases: A scoping review

“…Cancer-related studies (68%): lung ( 32–38 ), colon ( 39 ), acute myeloid leukemia and solid tumors ( 40 ), breast ( 37 , 41 ), pediatric cancer ( 42–46 ), prostate cancer (PCa) ( 47 ), colorectal ( 48 ), lower and upper gastrointestinal tract gastrointestinal tract (GI) ( 37 ), gynecological ( 37 ), multiple myeloma ( 37 ), lymphoma ( 37 ), leukemia ( 37 , 49 ), renal ( 37 ), other ( 37 ), metastatic cancer ( 50 ), pancreatic ( 38 ), and biliary tract ( 38 ).…”

“…A total of 21 studies were conducted in the inpatient setting ( 29–31 , 33 , 35 , 38–42 , 44–49 , 51–55 ) and two studies were conducted in an outpatient setting ( 28 , 32 ). For the remainder of the studies, two were conducted in a mixed-setting (inpatient and outpatient) ( 34 , 43 ), and three combined hospital-based and home-based exercise interventions ( 36 , 37 , 50 ). Nine of the selected studies were published during 2012–2016 ( 28 , 32–34 , 39–41 , 51 , 54 ).…”

“…A randomized control trial (RCT) research design comprised 54% of the studies ( 28–33 , 35 , 36 , 39–42 , 44 , 51 , 52 ); pilot study research designs were used in another 14% ( 34 , 43 , 48 , 50 , 55 ); the other designs were interviews (10%) ( 38 , 47 , 49 ); experimental designs (10%) ( 37 , 46 , 53 ); a crossover control study (4%) ( 54 ); a cohort study (4%) ( 45 ); and a feasibility study (4%) ( 48 ). In total, 10 types of exercise interventions were used: these included aerobic exercise ( 28 , 32–35 , 37–42 , 44–47 , 49 , 50 , 52–54 ); resistance exercise ( 31 , 33–35 , 37–42 , 44–51 , 55 ); balance exercise ( 38 , 39 ); core exercise ( 39 ); computer-based exercise intervention ( 43 ); sling exercise therapy ( 29 ); video-guided exercise ( 30 ); flexibility exercise ( 38 ); respiratory exercise ( 35 ); and progressive relaxation exercises ( 36 ). The studies all included positive results, except for one.…”

“…Some studies’ exercise intervention durations depended on the length of the patients’ hospital stays ( 39 , 49 , 51 , 52 ). The length of each individual exercise intervention also varied substantially: in one study being more than 2 h ( 35 ); in others 60 ~ 70-min ( 37 , 41 , 42 , 44–47 , 54 ); in some 30 ~ 45-min ( 28 , 29 , 32 , 33 , 36 , 39 , 40 , 43 , 48 , 50 , 53 , 55 ); or along with conventional therapy (40-min) for an additional 15-min ( 31 ), or 15 ~ 45-min ( 49 ). The intervention frequency ranged from every day ( 33 , 36 , 39 , 48 , 53 , 55 ); to five times a week ( 29 , 31 , 34 , 35 , 40 ); three times a week ( 32 , 34 , 42 , 44 , 46 ); twice a week ( 28 , 38 , 41 , 45 , 47 , 49 , 50 ); or once per week ( 37 , 47 ).…”

“…For patients with non-communicable diseases, exercise interventions should be supervised and adjusted by the clinician or physical therapist based on the individual’s exercise response and the medical condition of patients. The studies were conducted using supervised exercise interventions by physical therapists ( 29 , 30 , 32 , 37 , 39 , 41 , 47 , 50 , 51 ); by fitness instructors ( 42 ); sport scientists ( 34 , 43 , 46 , 49 ); team kinesiologists ( 48 ); medical staff ( 35 , 38 , 45 , 55 ); or by study investigators ( 36 ). Patients in one study expressed that they felt less motivated when exercising independently and most of the participants seemed to prefer a structured, class exercise model as outlined previously ( 47 ).…”