The Effects of Exercise Training on Muscle Function, Insulin Resistance, Exercise Capacity and Quality of Life in Patients with Lung cancer
Date Issued
2011
Date
2011
Author(s)
Hwang, Chueh-Lung
Abstract
Lung cancer with high incidence is the leading cancer-related mortality worldwide. Non-small cell lung cancer (NSCLC) accounts about 80 to 85% of all lung cancer cases, and most patients with NSCLC were in advanced stage at diagnosis. Recently, targeted therapy has been widely used to treat this population due to its low toxicity and less side effects. Commonly seen features associated with chronic inflammation and insulin resistance in patients with NSCLC include skeletal muscle wasting with/ or without fat loss, weight loss, decreased exercise capacity, limited physical activity and even cachexia. These might lead to poor quality of life (QOL). Furthermore, exercise capacity or physical performance is associated with treatment indication, post-operative complications or long-term survival. Previous studies suggested exercise could improve cancer-related symptoms, muscle function, exercise capacity and QOL in patients with breast cancer or mixed cancer types. Whether exercise has a positive impact in patients with NSCLC remains unclear. The purpose of this study was to investigate the effect of 8-week exercise training compared with usual care on muscle function, insulin resistance, exercise capacity, QOL and other cancer-related outcomes in patients with NSCLC receiving targeted therapy.
Twenty-four outpatients with diagnosis of NSCLC receiving targeted therapy were recruited and randomly assigned into control (n=11) or exercise groups (n=13). Participants in control group received usual care while participants in exercise group underwent individualized aerobic interval exercise training for 8 weeks. The exercise program consisted of treadmill or cycling training, three times a week under supervision of physical therapist. A total time of each exercise session was 30 to 40 minutes including warm up and cool down with bouts of high-intensity interval (80% VO2peak or 15~17 in rate of perceived exertion, RPE) separated by an active recovery at moderate intensity (60% VO2peak or 11~13 in RPE). Physical therapist adjusted exercise program every 1~2 weeks based on participant tolerance. Outcome measures, including muscle strength and endurance of right quadriceps, muscle oxygenation during exercise, homestasis model assessment of insulin resistance (HOMA-IR), peak oxygen consumption (VO2peak) and questionnaire inventory of QOL, were assessed at baseline and 8 weeks after. Other cancer-related outcomes were C-reactive protein (CRP), total body fat and free-fat mass. Physical activity and dietary intake were also monitored by questionnaire. SPSS was used to make group comparisons by two-way repeated measures analysis of variance (ANOVA). Pearson correlation was used to examine the relationship of exercise capacity to other outcome measures. Alpha level was set at 0.05.
Twenty-four participants completed the baseline assessment, and relative low exercise capacity was noted compared to normal subjects with same age, gender, and body size (the mean of percentage of predicted VO2peak [pred VO2peak]: 49.1±9.8%). Pred VO2peak was related with muscle oxygenation during exercise (r=-0.50, p=0.02), CRP (r=-0.53, p=0.02), dyspnea (r=-0.55, p=0.01) and physical activity (r=0.44, p=0.02). Participants in control and exercise group had similar basic characteristics, and there was no between-group difference in any outcome measures at baseline. All participants maintained physical activity and dietary intake throughout the study period. Six participants discontinued this study because of personal reasons or medical changes (2 in exercise group and 4 in control group), the exercise adherence was 71.2%. VO2peak and pred VO2peak increased by 1.6 mi/kg/min and 5.3% (p<0.005) respectively after 8-week training, and these improvements were associated with the ameliorations in peripheral, heart and respiratory function during exercise (all p=0.001). Subjects in exercise group significantly reduced their dypnea after 8 weeks (p=0.01) with no between-group difference in fatigue (p=0.30). Their muscle strength and enduranc also increased, however, no changes in muscle oxygenation, HOMA-IR, CRP, total body fat and free-fat mass were found after 8-week intervention.
Even with improving QOL and better survival rate, patients with NSCLC receiving targeted therapy still have lower exercise capacity compared to healthy people. This was the first study to investigate the effects of exercise training in such patient population. No adverse event was observed during exercise. Patients following exercise training had improvement in exercise capacity and ameliorations in dyspnea. Exercise training is recommended for this population to improve exercise capacity and normalized symptoms. Further studies with large sample size and long-term follow-ups are needed.
Subjects
Non-small cell lung cancer
Targeted therapy
Interval training
Exercise capacity
Quality of life
Skeletal muscle
Insulin resistance
SDGs
Type
thesis
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