Personalized exercise intervention beneficial to lung cancer patients

A personalized, perioperative, home-based exercise intervention for patients undergoing lung cancer helps improve physical function in women and prevent fatigue worsening in all groups, according to the results of the phase III Precision-Exercise-Prescription (PEP) trial.

The intention-to-treat population included 182 patients (mean age 62.7 years, 59 percent female) with primary lung cancer (stages I-IIIa) or oligometastatic disease to the lung (where all disease could be removed) and were scheduled to undergo a surgical procedure to remove the cancer.

The patients were randomly assigned to undergo a perioperative exercise program (n=92) or receive standard care (n=90). Patients in the exercise arm underwent a home-based exercise program that was personalized based on mobility scores and monitored remotely by a licensed physical therapist. The program was initiated approximately 2 weeks before surgery and continued after. Patients in the standard care arm used incentive spirometer and were encouraged to exercise without a formal program.

Outcomes included physical function (6-minute walk test [6MWT]), the Short Physical Performance Battery, and cancer-related fatigue (Functional Assessment of Chronic Illness Therapy–Fatigue). These were evaluated at baseline and 2 months after surgery.

At baseline, 89 patients (49 percent) had low mobility scores (Activity Measure for Post-Acute Care scores, 1-3). Two months after surgery, physical function increased in the exercise arm (mean 6MWT: from 467.9 m at baseline to 482.2 m at 2 months) but decreased in the standard-care arm (mean 6MWT: from 481.4 m at baseline to 471.5 m at 2 months). Mean (SE) between-group changes in 6MWT distance from baseline to 2 months were 22.7 m (p=0.08), with greater effect sizes among women (mean, 37.8 m; p=0.03). Additionally, women had significant improvements in the Short Physical Performance Battery (mean, 0.9; p=0.04).

From baseline to month 2, fatigue scores remained stable in the exercise arm but significantly deteriorated in the standard-care arm (mean, 3.7; p=0.009), with greater effect sizes among individuals who were younger, from rural areas, had overweight or obesity, and had primary lung cancer.