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Meta-Analysis
. 2019 Feb 11;2(2):CD012685.
doi: 10.1002/14651858.CD012685.pub2.

Exercise training for advanced lung cancer

Carolyn J Peddle-McIntyre  1 , Favil Singh, Rajesh Thomas, Robert U Newton, Daniel A Galvão, Vinicius Cavalheri
Affiliations
Meta-Analysis

Exercise training for advanced lung cancer

Carolyn J Peddle-McIntyre et al. Cochrane Database Syst Rev. .

Abstract

Background: Patients with advanced lung cancer have a high symptom burden, which is often complicated by coexisting conditions. These issues, combined with the indirect effects of cancer treatment, can cumulatively lead patients to continued deconditioning and low exercise capacity. This is a concern as exercise capacity is considered a measure of whole body health, and is critical in a patient's ability to participate in life activities and tolerate difficult treatments. There is evidence that exercise training improves exercise capacity and other outcomes, such as muscle force and health-related quality of life (HRQoL), in cancer survivors. However, the effectiveness of exercise training on these outcomes in people with advanced lung cancer is currently unclear.

Objectives: The primary aim of this review was to investigate the effects of exercise training on exercise capacity in adults with advanced lung cancer. Exercise capacity was defined as the six-minute walk distance (6MWD; in meters) measured during a six-minute walk test (6MWT; i.e. how far an individual can walk in six minutes on a flat course), or the peak oxygen uptake (i.e. VO₂peak) measured during a maximal incremental cardiopulmonary exercise test (CPET).The secondary aims were to determine the effects of exercise training on the force-generating capacity of peripheral muscles, disease-specific global HRQoL, physical functioning component of HRQoL, dyspnoea, fatigue, feelings of anxiety and depression, lung function, level of physical activity, adverse events, performance status, body weight and overall survival in adults with advanced lung cancer.

Search methods: We searched CENTRAL, MEDLINE (via PubMed), Embase (via Ovid), CINAHL, SPORTDiscus, PEDro, and SciELO on 7 July 2018.

Selection criteria: We included randomised controlled trials (RCTs) which compared exercise training versus no exercise training in adults with advanced lung cancer.

Data collection and analysis: Two review authors independently screened the studies and selected those for inclusion. We performed meta-analyses for the following outcomes: exercise capacity, disease-specific global HRQoL, physical functioning HRQoL, dyspnoea, fatigue, feelings of anxiety and depression, and lung function (forced expiratory volume in one second (FEV1)). Two studies reported force-generating capacity of peripheral muscles, and we presented the results narratively. Limited data were available for level of physical activity, adverse events, performance status, body weight and overall survival.

Main results: We identified six RCTs, involving 221 participants. The mean age of participants ranged from 59 to 70 years; the sample size ranged from 20 to 111 participants. Overall, we found that the risk of bias in the included studies was high, and the quality of evidence for all outcomes was low.Pooled data from four studies demonstrated that, on completion of the intervention period, exercise capacity (6MWD) was significantly higher in the intervention group than the control group (mean difference (MD) 63.33 m; 95% confidence interval (CI) 3.70 to 122.96). On completion of the intervention period, disease-specific global HRQoL was significantly better in the intervention group compared to the control group (standardised mean difference (SMD) 0.51; 95% CI 0.08 to 0.93). There was no significant difference between the intervention and control groups in physical functioning HRQoL (SMD 0.11; 95% CI -0.36 to 0.58), dyspnoea (SMD -0.27; 95% CI -0.64 to 0.10), fatigue (SMD 0.03; 95% CI -0.51 to 0.58), feelings of anxiety (MD -1.21 units on Hospital Anxiety and Depression Scale; 95% CI -5.88 to 3.45) and depression (SMD -1.26; 95% CI -4.68 to 2.17), and FEV1 (SMD 0.43; 95% CI -0.11 to 0.97).

Authors' conclusions: Exercise training may improve or avoid the decline in exercise capacity and disease-specific global HRQoL for adults with advanced lung cancer. We found no significant effects of exercise training on dyspnoea, fatigue, feelings of anxiety and depression, or lung function. The findings of this review should be viewed with caution because of the heterogeneity between studies, the small sample sizes, and the high risk of bias of included studies. Larger, high-quality RCTs are needed to confirm and expand knowledge on the effects of exercise training in this population.

PubMed Disclaimer

Conflict of interest statement

Carolyn Peddle‐McIntyre: none known.

Favil Singh: none known.

Rajesh Thomas: none known.

Robert Newton: none known.

Daniel Galvão: none known.

Vinicius Cavalheri: none known.

Figures

1
1
Study flow diagram.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
3
3
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
4
4
Forest plot of comparison: 1 Exercise training versus control, outcome: 1.1 Exercise capacity measured by Six‐Minute Walk Distance.
5
5
Forest plot of comparison: 1 Exercise training versus control, outcome: 1.2 Disease‐specific global health‐related quality of life
6
6
Forest plot of comparison: 1 Exercise training versus control, outcome: 1.4 Dyspnoea.
1.1
1.1. Analysis
Comparison 1 Exercise training versus control, Outcome 1 Exercise capacity (6MWD).
1.2
1.2. Analysis
Comparison 1 Exercise training versus control, Outcome 2 Disease‐specific global health‐related quality of life.
1.3
1.3. Analysis
Comparison 1 Exercise training versus control, Outcome 3 Physical functioning component of health‐related quality of life.
1.4
1.4. Analysis
Comparison 1 Exercise training versus control, Outcome 4 Dyspnoea.
1.5
1.5. Analysis
Comparison 1 Exercise training versus control, Outcome 5 Fatigue.
1.6
1.6. Analysis
Comparison 1 Exercise training versus control, Outcome 6 Feelings of anxiety.
1.7
1.7. Analysis
Comparison 1 Exercise training versus control, Outcome 7 Feelings of depression.
1.8
1.8. Analysis
Comparison 1 Exercise training versus control, Outcome 8 Lung Function (FEV1).
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD012685

References

References to studies included in this review

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References to ongoing studies

ACTRN12614001268639 {published data only (unpublished sought but not used)}
    1. ACTRN12614001268639. In people with inoperable non small cell lung cancer, what is the effect of home‐based multi‐disciplinary rehabilitation compared to usual care, on physical function, symptoms and health related quality of life?. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367489&... (first received 23 November 2014).
CTRI/2015/01/005348 {published data only (unpublished sought but not used)}
    1. CTRI/2015/01/005348. Exercise for the management of the cancer‐related fatigue in advanced lung cancer planned for systemic palliative therapy: randomized controlled trial. ‐ ExAL. http://www.ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=10425 (first received 05 January 2015).
NCT01881906 {published data only (unpublished sought but not used)}
    1. NCT01881906. "EXHALE" A randomized clinical trial comparing the effects of a 12 week supervised exercise intervention versus usual care for advanced stage lung cancer patients. https://clinicaltrials.gov/show/NCT01881906 (first received 20 June 2013). - PMC - PubMed
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NCT02055508 {published data only (unpublished sought but not used)}
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NCT03066271 {published data only (unpublished sought but not used)}
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NCT03334071 {published data only (unpublished sought but not used)}
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NCT03482323 {published data only (unpublished sought but not used)}
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NCT03500393 {published data only (unpublished sought but not used)}
    1. NCT03500393. A remotely supervised exercise program for lung cancer patients undergoing chemoradiation (REM). https://clinicaltrials.gov/ct2/show/record/NCT03500393?term=A+Remotely+S... (first received 17 April 2018).

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