1Department of Rehabilitation Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
2Konyang University Myunggok Medical Research Institute, Daejeon, Korea
3Department of Physical Medicine & Rehabilitation Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
4Department of Internal Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
5Department of Rehabilitation Medicine, Konyang University Hospital, Daejeon, Korea
Correspondence: Ji Woong Son Department of Internal Medicine, Konyang University Hospital, Konyang University College of Medicine, 158 Gwanjeodong-ro, Seo-gu, Daejeon 35365, Korea. Tel: +82-42-612-2180 Fax: +82-42-600-8982 E-mail: sk1609@kyuh.ac.kr
• Received: August 5, 2024 • Revised: April 11, 2025 • Accepted: May 12, 2025
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
To investigate the effects of a home-based rehabilitation program on physical capacity, lung function, and health-related quality of life (QOL) in patients with advanced lung cancer undergoing platinum-based chemotherapy.
Methods
Between December 2021 and December 2023, participants were randomly assigned to exercise and control groups. The exercise group engaged in a home-based exercise program, including respiratory, aerobic, and resistance training, for 60 minutes per session, three times per week, before the first tumor response evaluation. Outcome evaluations included the 6-minute walk test, spirometry to measure lung function (specifically assessing forced expiratory volume in 1 second [FEV1] and forced vital capacity, hand grip strength, and QOL assessments using the Short Form 36-Item Health Survey and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Lung Cancer Module 29. Participants were assessed at baseline, post-intervention, and followed up for 1 year.
Results
Twenty-one of the 26 participants completed the study. The control group showed a significant decrease in FEV1 (p=0.011). Delays in chemotherapy occurred in 40.0% of participants in the control group but none in the exercise group (p=0.019). Mental health showed improvement in the exercise group (p=0.041), whereas adverse effects were more common in the control group (p=0.007), according to QOL questionnaire results.
Conclusion
Home-based rehabilitation during chemotherapy may help maintain lung function, improve mental health, and reduce side effects in patients with lung cancer, warranting further research.
Lung cancer is a leading cause of cancer-related deaths worldwide, accounting for approximately 1.8 million mortalities annually [1]. Although lung cancer is associated with high mortality and poor survival rates, next-generation targeted therapies and immune checkpoint inhibitors have considerably improved long-term survival for some patients [2]. Advanced-stage lung cancers include non-small cell lung cancer (NSCLC) stages IIIB–IV and small cell lung cancer (SCLC) extensive disease, characterized by tumors that have metastasized or extended beyond the limits of the area treatable with a radiation field. Most patients with advanced lung cancer are not candidates for surgery and undergo chemotherapy instead [3,4]. While chemotherapy is crucial for treating advanced lung cancer, it can have adverse effects [5].
As the number of cancer survivors continues to rise, more individuals are facing significant pain, fatigue, and physical limitations that impact their quality of life (QOL) [6]. These individuals face limitations in daily activities due to treatment-related side effects or complications or as their illness progresses to its final stages [7]. A 2012 study on health-related QOL (HRQOL) among United States cancer survivors found that their physical and mental QOL scores were lower than the population average, with physical problems having a greater impact [8].
Cancer requires long-term systematic management, thereby emphasizing the need for evidence-based rehabilitation interventions [9]. Exercise interventions enhance the physical health and QOL of patients with cancer and survivors [10]. Recent findings indicate that aerobic and resistance training improve key physical and psychological outcomes, such as fatigue, functional independence, QOL, and sleep, supporting the recommendations for patients with advanced-stage cancer to participate in physical exercise programs [11]. Exercise capacity is associated with lung cancer prognosis, and pulmonary rehabilitation is an effective intervention for managing pulmonary diseases [12]. However, the implementation of exercise interventions faces several barriers, including legal and organizational obstacles, a shortage of specialized rehabilitation services, poor awareness, and insufficient recommendations from healthcare providers [13]. From the patient’s perspective, the barriers include inconvenient locations, time constraints, and a lack of facilities capable of providing physical exercise rehabilitation programs [14]. Although home-based rehabilitation programs may provide a viable alternative, current evidence remains limited due to challenges such as low adherence rates [15].
Platinum-based chemotherapy is frequently used as an adjuvant treatment postoperatively or as the primary chemotherapy option for advanced-stage lung cancer [16]. However, its side effects, including gastrointestinal toxicity, neurotoxicity, and myelosuppression, usually result in significant physical and mental challenges for cancer survivors, such as cancer-related fatigue and muscle atrophy [17]. Despite these issues, research on the impact of exercise interventions tailored to the type of chemotherapy on patients with advanced-stage lung cancer is limited.
Therefore, we aimed to evaluate the effects of a home-based exercise program on physical capacity, lung function, and HRQOL, making physical activity more feasible for patients with advanced-stage lung cancer undergoing platinum-based chemotherapy.
METHODS
Study design
This study aimed to assess the impact of a home-based exercise program on patients with advanced-stage lung cancer undergoing chemotherapy. To achieve this, a single-center randomized controlled trial was conducted following the Consolidated Standards of Reporting Trial guidelines and the ethical principles of the Declaration of Helsinki. This study protocol was approved by the Konyang University Hospital’s Institutional Review Board and Ethics Committee (approval no. 2021-09-005-003). An independent ethics review was conducted to assess the study’s risks and benefits to participants. Prior to participation, all study procedures were thoroughly explained to each participant, emphasizing confidentiality and data protection measures. Participants then provided written informed consent. Data handling was conducted with strict adherence to confidentiality protocols, and all personal information was anonymized to ensure participant privacy. The trial was registered in the Clinical Research Information Service database (registration number: KCT0010054).
Study participants
Individuals indicated their interest in participating, and upon verifying their suitability, the researcher arranged an in-person meeting to conduct an initial evaluation. Enrollment was conducted between December 2021 and December 2023. In total, 28 participants were enrolled in the study. However, two participants were excluded during screening, resulting in 26 participants who were randomly allocated to the exercise (n=14) and control (n=12) groups using block randomization by a separate individual responsible for the allocation (Fig. 1). Participants were eligible for inclusion in the study if they met the following criteria: (1) aged ≥18 years; (2) provided voluntary consent to participate; (3) were diagnosed with advanced-stage lung cancer (NSCLC IIIB–IV or SCLC extensive disease) and scheduled to undergo first-line platinum-based chemotherapy; (4) could understand and adhere to the exercise protocol at home. Exclusion criteria included (1) any medical issues or physical disabilities that could interfere with exercise participation and (2) inability to comprehend and follow the instructions in the exercise manual.
Interventions
A study flowchart is shown in Fig. 2. The intervention period extended from the initiation of chemotherapy to the first evaluation of tumor response. Before intervention, both exercise and control group participants underwent an initial assessment. A tumor response evaluation was done, followed by a final assessment. Subsequently, the patients were followed for 1 year, during which progression-free survival and mortality rates were monitored. All measurements and participant’s education were performed by the same experienced physiotherapist who was blinded to the study.
Exercise protocol
The exercise types and intensities were determined according to the recommendations of the American College of Sports Medicine [18]. We added a breathing exercise known to improve exercise performance, dyspnea, and HRQOL in patients with lung disease [19]. Each exercise session lasted ≥15 minutes, including 3-minute warm-up and cool-down phases. The participants received one-on-one training on proper exercise techniques from a specialized physical therapist. The intervention program comprised sessions lasting 60 minutes each, conducted three times per week. The exercise regimen included (1) respiratory training, including diaphragmatic, pursed-lip, and glossopharyngeal breathing; (2) stretching exercises for the chest, shoulders, and neck; (3) aerobic exercises, which involved brisk walking or running, either outdoors or on a treadmill at home; and (4) resistance training exercises, including squats, bridge exercises, and upper limb strength training with bands (targeting shoulder flexors, extensors, abductors, and elbow movements). Aerobic exercise intensity was set at 50%–60% of maximal heart rate (calculated as 220 minus ages [18]), and the target heart rate was determined using the Karvonen formula [20]. Patients were instructed to self-monitor their heart rate during aerobic exercise and were trained to report their perceived exertion using the Borg scale. Additionally, a personalized resistance training program with weights was recommended based on individual assessments.
During exercise, the participants were provided with a pulse oximeter to measure their oxygen saturation (SpO2) and heart rate, and their symptoms were evaluated using the Borg scale. Exercise was discontinued if the SpO2 level dropped by 4% or fell below 95%, or if a three-point increase from the baseline occurred on the Borg scale. Sessions were also discontinued if the heart rate increased by more than 20 beats per minute or if symptoms such as dizziness, excessive sweating, headache, or chest pressure occurred [18].
Participant in the exercise group received exercise re-education every 3 weeks during hospital visits for chemotherapy. Additionally, they were provided with exercise guide leaflets that could be followed at home. To ensure the execution of the home exercise program, an exercise diary was provided to each patient, and diary follow-ups were conducted by a physiotherapist. Additionally, the researcher monitored the patients weekly via phone calls.
Participants in the control group underwent scheduled chemotherapy and initial and final assessments. They were educated about the necessity of general physical activity and breathing exercises.
Measurements
The outcomes of each group were evaluated at the beginning of the study and after the intervention. Subsequently, the patients were followed for 1 year. An experienced physiotherapist performed all assessments.
Functional exercise capacity was evaluated using the 6-minute walk test (6MWT), following the American Thoracic Society 2002 guidelines [21]. Pulmonary function was assessed using spirometry (SpirOx; Meditech) following the European Respiratory Society’s (ERS) recommendations. Spirometry was conducted to measure forced expiratory volume in 1 second (FEV1) and forced vital capacity according to the ERS recommendations [22].
Handgrip strength in the nondominant hand was assessed using a Jamar dynamometer (Sammons Preston Rolyan). Patients sat comfortably with their shoulders adducted, forearm in neutral rotation, elbow at 90º angle, and forearm and wrist in a neutral position. The participants were instructed to perform maximal isometric contractions. Furthermore, the test was performed three times within a 30-second interval and the highest value was used for analysis.
QOL was assessed using the validated Short Form 36-Item Health Survey (SF-36) and the European Organization for Research and Treatment of Cancer (EORTC) questionnaire. The SF-36 consists of 36 items and includes the following eight scales: physical functioning, bodily pain, social functioning, general health, role-physical, role-emotional, vitality, and mental health. Furthermore, the scores for each item were recorded, summed, and converted into a scale ranging from 0 (worst health status) to 100 (best health status) according to these parameters. We used the Arabic version of the tool, which has been validated for reliability and accuracy [23].
The updated EORTC Quality of Life Questionnaire-Lung Cancer Module 29 (QLQ-LC29) comprises 29 items. It includes five multi-item scales (coughing, shortness of breath, adverse effects, fear of progression, and surgery-related symptoms) and five single items (hemoptysis, chest pain, arm or shoulder pain, pain in other parts of the body, and weight loss) [24]. The category “surgical symptoms” was excluded from the questionnaire. Following the EORTC manual, all scores were linearly transformed to a 0–100 scale. For functional scores, a high score indicates good function; high scores on symptom scales signify a high symptom burden.
Statistical analysis
Baseline characteristics were compared between groups using appropriate statistical tests based on the type of data as follows: The Mann–Whitney U-test for continuous variables, Fisher’s exact test for categorical variables with small expected counts, and the chi-squared test for larger categorical variables. Within-group changes from pre- to post-exercise measurements were assessed using the Wilcoxon signed-rank test, while between-group comparisons were conducted using the Mann–Whitney U-test.
All data analyses were performed using IBM SPSS Statistics for Windows, version 21.0 (IBM Corp.). Descriptive statistics including means, standard deviations, medians, and interquartile ranges were calculated, with statistical significance set at p<0.05. Additionally, logistic regression analysis was used to identify independent factors associated with improved outcomes specifically within the exercise group.
RESULTS
The flow of participants throughout this study is depicted in Fig. 1. Of the 26 participants recruited, 21 completed the study. Two participants in the control group withdrew their consent. In the exercise group, one participant withdrew consent, and two requested to discontinue the exercise intervention because of worsening cancer-related conditions. Among the participants who continued the exercise program, the average frequency sessions was 3.13 times per week, indicating good adherence to the prescribed home-based protocol. Table 1 present the characteristics of the exercise and control groups. No significant differences in baseline characteristics were found between the groups.
Table 2 shows the comparisons of outcomes within the two groups. During the first chemotherapy, both groups experienced a decline in physical capacity and lung function, with a significant decrease in FEV1 observed in the control group (p=0.011). The post-intervention differences between the groups were compared (Table 3) and no significant difference was found in the amount of change between them.
Table 4 presents the outcomes following chemotherapy and the 1-year follow-up results in both groups. During the first tumor response evaluation, delays in chemotherapy were observed in four participants (40.0%) in the control group, whereas no chemotherapy delays were observed in the exercise group (p=0.019). Additionally, two cases of chemotherapy discontinuation and one of dose reduction occurred in the control group. No deaths occurred during the study period. However, during the subsequent 1-year follow-up period, five participants from each group died, accounting for 41.7% of the exercise group and 50.0% of the control group. The causes of death included two cases of immunotherapy-related adverse effects and leptomeningeal metastasis in the exercise group as well as brain metastasis and progression of lung cancer in the control group. Furthermore, the side effects of chemotherapy included anemia, radiation pneumonitis, leukopenia, thrombocytopenia, and liver dysfunction, all of which were managed with appropriate interventions as needed.
Regarding the QOL metrics, analysis of the SF-36 and EORTC QLQ-LC29 questionnaires showed non-significant changes in all analyzed domains in both groups, except for mental health and adverse effects (Fig. 3). The SF-36 analysis showed that the mental health of the exercise group significantly improved throughout chemotherapy (p=0.041). According to the results of the EORTC QLQ-LC29, side effects were significantly more common during chemotherapy in the control group than in the exercise group (p=0.007).
Overall, these findings indicate that while physical and survival outcomes were similar across the groups, exercise intervention contributed to significant improvements in mental health and reduced adverse effects during chemotherapy, suggesting benefits for QOL in patients undergoing intensive cancer treatment.
DISCUSSION
This study is among the few that evaluate the effect of home-based rehabilitation during chemotherapy in patients with advanced-stage lung cancer. Our findings provide valuable insights into the potential benefits of rehabilitation for this patient population.
Patients with lung cancer usually experience symptoms such as cough and dyspnea, as well as systemic symptoms including weight loss, anorexia, and weakness [25]. When these patients undergo systemic chemotherapy, their physical capacity is further reduced because of the adverse effects of the chemotherapeutic agents. Functional capacity independently predicts survival in patients with advanced-stage NSCLC [12,26]. Systematic reviews report that exercise training is safe for patients with lung cancer and can improve their functional capacity [27,28].
Numerous studies have demonstrated that exercise during cancer treatment improves cardiorespiratory fitness, strength, fatigue, and other patient-reported outcomes [29]. Although our study found that both groups experienced a decline in physical capacity and lung function during the first chemotherapy session, the control group showed a more significant decrease in FEV1. A Cochrane review on exercise training in individuals with advanced-stage lung cancer found that it might improve or prevent a decline in exercise capacity and enhance disease-specific HRQOL. However, exercise training does not significantly affect dyspnea, fatigue, anxiety, depression, or lung function [30].
Patients with lung cancer may experience physical and psychological symptoms that significantly affect their QOL, including dyspnea, fatigue, pain, and depression [31]. Consequently, these patients prioritize the overall effect of these symptoms on their QOL and maintain independence and the ability to perform daily activities independently [32]. In this study, most domains of the QOL questionnaire did not change significantly; however, mental health significantly improved in the exercise group. This finding suggests a potential psychosocial benefit of exercise during chemotherapy, consistent with existing evidence indicating that physical activity exerts beneficial effects on mental health [33]. Moreover, the control group reported significantly more adverse effects during chemotherapy than the exercise group. Previous studies indicate that exercise lowers mortality and recurrence rates and reduces treatment-related adverse effects compared to no exercise [34]. Yang et al. [35] found in their meta-analysis that supervised physical rehabilitation improve strength, physical activity, QOL, and mental health while reducing fatigue in patients with advanced-stage cancer. They also found that supervised settings provided greater benefits than non-supervised ones. In our study, we incorporated weekly telephone monitoring, exercise re-education every 3 weeks, and exercise diary tracking. However, the absence of objective monitoring tools and in-person exercise supervision may have limited improvements in physical capacity or lung function.
Currently, many patients with lung cancer receive outpatient chemotherapy. Additionally, many patients live in areas with limited access to hospitals. In this study, home-based rehabilitation programs can provide patients with opportunities for a better QOL, maintenance of independence, and the ability to perform daily activities. Research on the effects of home-based exercise in advanced-stage cancer has shown that, while it did not improve functional exercise capacity, it had significant effects on improving QOL as well as reducing anxiety and mood disturbances [36,37]. An 8-week home-based pulmonary rehabilitation program of 30–45 minutes, 5 days per week, showed no significant 6MWT changes in patients with thoracic cancer but improved daily physical activity levels and significantly reduced anxiety scores [33]. This intervention, which involves simple, safe, and relatively inexpensive physical exercise, has the potential to become a standard treatment. Therefore, implementing exercise interventions can improve the QOL of patients with advanced-stage lung cancer and reduce symptoms and side effects.
The intervention period lasted from the commencement of chemotherapy to the initial tumor response evaluation. Conventional platinum-based chemotherapy is administered in four cycles of 21 days, with tumor response evaluations conducted after 2–3 cycles. The chemotherapy protocol may be adjusted in terms of intervals or cycles depending on the patient’s condition or due to adverse effects [38]. In our study, the response to chemotherapy revealed some differences between the groups. The control group experienced delays in the response to chemotherapy and required more frequent dose adjustments and discontinuations than the exercise group. Exercise has been proposed as an adjunctive therapy to chemotherapy for patients with advanced-stage cancer due to its positive impact on treatment response [11]. Additionally, the mechanisms behind these benefits are believed to include exercise-induced changes in body composition, modulation of sex hormone levels, reduction of systemic inflammation, and enhancement of immune cell function [39]. However, during the 1-year follow-up, the mortality rates were similar between the groups (41.7% in the exercise group vs. 50.0% in the control group). According to the National Program of Cancer Registries for cancers diagnosed between 2007 and 2016 in the United States America, the 1-year survival rate for lung cancer was 45.6%, and the 5-year survival rate was 19.5% in metropolitan areas [40].
This study had some limitations, such as a small sample size. However, it specifically focused on advanced-stage lung cancer cases. Therefore, future studies should aim to include larger sample sizes and explore a broader range of lung cancer stages. The characteristics of SCLC and NSCLC may differ; however, they were not distinguished in this study, making it impossible to assess their impact based on pathology. Future studies should examine differences according to pathology. Additionally, exploring different types and intensities of exercise could help optimize the protocols for patients undergoing chemotherapy. As the intervention was conducted only during the first chemotherapy session, we could not ascertain the level of exercise participation thereafter. However, this approach allowed us to observe the effects of early exercise intervention during chemotherapy treatment. Despite these limitations, this study provided important insights. This demonstrates the feasibility and potential benefits of exercise interventions in patients with advanced-stage lung cancer undergoing chemotherapy, showing improvements in both HRQOL and psychological outcomes.
In conclusion, our findings suggest that rehabilitation during chemotherapy may help maintain lung function, improve mental health, and reduce the perception of adverse effects in patients with advanced-stage lung cancer. Further research with larger cohorts and randomized designs is needed to confirm these findings and refine the rehabilitation recommendations for this patient population.
CONFLICTS OF INTEREST
No potential conflict of interest relevant to this article was reported.
FUNDING INFORMATION
This work was supported (in part) by the Konyang University Myunggok Research Fund of 2021.
AUTHOR CONTRIBUTION
Conceptualization: Son JW, Hong MJ. Methodology: Son JW, Hong MJ, Lee YJ, Park JB, Lee S, Ko H. Formal analysis: Woo SY. Investigation: Hong MJ, Lee S, Ko H. Funding acquisition: Son JW, Hong MJ. Project administration: Son JW. Visualization: Hong MJ, Woo SY. Writing – original draft: Hong MJ. Writing – review and editing: Son JW, Hong MJ, Lee YJ, Park JB. Approval of final manuscript: all authors.
Fig. 1.
Consolidated Standards of Reporting Trial-2010-flow-diagram.
Fig. 2.
Flow of study interventions. ⅰ: Baseline assessments and randomization. ⅱ: 1st cycle of chemotherapy (CTx). ⅲ: 2nd cycle of CTx. ⅳ: 3rd cycle of CTx. ⅱ–ⅴ: Exercise training program. ⅴ: End of interventions, initial tumor response evaluation, and follow-up assessment. ⅵ: 1-year follow-up assessment.
Fig. 3.
Comparison of the change scores (means) of health-related qualities before and after the intervention measured by Short Form 36-Item Health Survey (SF-36) in the exercise (A)-1 and control (A)-2 groups, as well as European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Lung Cancer Module 29 (EORTC QLQ-LC29) in the exercise (B)-1 and control (B)-2 groups. *p<0.05.
Table 1.
Comparison of subject characteristics between exercise group and control group
Characteristic
Exercise group (n=14)
Control group (n=12)
p-value
Age (yr)
69.46 (63.5–74.5)
64.68 (58.0–73.0)
0.125
Sex, male
13 (92.9)
10 (83.3)
0.705
Body mass index (kg/m2)
24.18 (22.4–27.3)
22.57 (20.9–24.8)
0.176
6MWT (m)
324.23 (236.0–376.5)
373.0 (331.0–414.5)
0.247
Gait speed (m/s)
0.96 (0.80–1.05)
0.99 (0.82–1.13)
0.769
Hand grip strength (kg)
30.07 (24.8–36.5)
30.83 (28.0–32.0)
0.374
FVC pred. (%)
86.79 (74.0–103.0)
84.75 (55.3–111.0)
0.705
FEV1 pred. (%)
82.79 (70.5–96.3)
86.08 (60.0–107.0)
0.781
ECOG performance status
0.781
Grade 1
13 (92.9)
12 (100)
Grade 2
1 (7.1)
0 (0)
Tumor stage
0.820
lllB
5 (35.7)
4 (33.3)
lV
4 (28.6)
5 (41.7)
Extensive disease
5 (35.7)
3 (25.0)
Pathology
0.667
SCLC
5 (35.7)
3 (25.0)
NSCLC
9 (64.3)
9 (75.0)
Regimen of chemotherapy
0.940
Carboplatin
5 (35.7)
4 (33.3)
Cisplatin
9 (64.3)
8 (66.7)
Values are presented as median (interquartile range) or number (%).
6MWT, 6-minute walk test; FVC, forced vital capacity; pred., predicted; FEV1, forced expiratory volume in 1 second; ECOG, eastern cooperative oncology group; SCLC, small cell lung cancer; NSCLC, non-SCLC.
Table 2.
Comparison of outcomes before and after chemotherapy in each group
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Effects of Home-Based Rehabilitation for Patients With Advanced Lung Cancer Undergoing Platinum-Based Chemotherapy: A Randomized Controlled Trial
Fig. 1. Consolidated Standards of Reporting Trial-2010-flow-diagram.
Fig. 2. Flow of study interventions. ⅰ: Baseline assessments and randomization. ⅱ: 1st cycle of chemotherapy (CTx). ⅲ: 2nd cycle of CTx. ⅳ: 3rd cycle of CTx. ⅱ–ⅴ: Exercise training program. ⅴ: End of interventions, initial tumor response evaluation, and follow-up assessment. ⅵ: 1-year follow-up assessment.
Fig. 3. Comparison of the change scores (means) of health-related qualities before and after the intervention measured by Short Form 36-Item Health Survey (SF-36) in the exercise (A)-1 and control (A)-2 groups, as well as European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Lung Cancer Module 29 (EORTC QLQ-LC29) in the exercise (B)-1 and control (B)-2 groups. *p<0.05.
Graphical abstract
Fig. 1.
Fig. 2.
Fig. 3.
Graphical abstract
Effects of Home-Based Rehabilitation for Patients With Advanced Lung Cancer Undergoing Platinum-Based Chemotherapy: A Randomized Controlled Trial
Characteristic
Exercise group (n=14)
Control group (n=12)
p-value
Age (yr)
69.46 (63.5–74.5)
64.68 (58.0–73.0)
0.125
Sex, male
13 (92.9)
10 (83.3)
0.705
Body mass index (kg/m2)
24.18 (22.4–27.3)
22.57 (20.9–24.8)
0.176
6MWT (m)
324.23 (236.0–376.5)
373.0 (331.0–414.5)
0.247
Gait speed (m/s)
0.96 (0.80–1.05)
0.99 (0.82–1.13)
0.769
Hand grip strength (kg)
30.07 (24.8–36.5)
30.83 (28.0–32.0)
0.374
FVC pred. (%)
86.79 (74.0–103.0)
84.75 (55.3–111.0)
0.705
FEV1 pred. (%)
82.79 (70.5–96.3)
86.08 (60.0–107.0)
0.781
ECOG performance status
0.781
Grade 1
13 (92.9)
12 (100)
Grade 2
1 (7.1)
0 (0)
Tumor stage
0.820
lllB
5 (35.7)
4 (33.3)
lV
4 (28.6)
5 (41.7)
Extensive disease
5 (35.7)
3 (25.0)
Pathology
0.667
SCLC
5 (35.7)
3 (25.0)
NSCLC
9 (64.3)
9 (75.0)
Regimen of chemotherapy
0.940
Carboplatin
5 (35.7)
4 (33.3)
Cisplatin
9 (64.3)
8 (66.7)
Exercise group
Control group
Pre-intervention
Post-intervention
p-value
Pre-intervention
Post-intervention
p-value
6MWT (m)
352.44±79.04
341.44±80.45
0.575
373.67±62.64
346.89±58.31
0.208
Gait speed (m/s)
0.98±0.22
0.95±0.23
0.528
1.04±0.18
0.96±0.16
0.128
Hand grip strength (kg)
31.22±9.50
28.00±7.85
0.062
31.67±4.02
27.44±3.78
0.068
FVC pred. (%)
96.56±14.73
86.11±23.72
0.260
80.33±25.91
79.78±21.18
0.722
FEV1 pred. (%)
96.33±17.41
88.11±23.87
0.314
84.22±22.98
81.00±20.93
0.011*
Exercise group
Control group
p-value
6MWT (m)
-11.00±47.44
-26.78±47.16
0.730
Gait speed (m/s)
-0.03±0.13
-0.07±0.13
0.730
Hand grip strength (kg)
-3.22±4.94
-3.22±6.80
0.796
FVC pred. (%)
-10.44±26.92
-0.56±9.80
0.340
FEV1 pred. (%)
-8.22±29.14
-3.22±4.92
0.190
Exercise group (n=11)
Control group (n=10)
p-value
Duration of the chemotherapy (day)
64 (36.4–89.1)
66 (58.5–74.5)
0.295
Response rate
0.743
Complete response
4 (36.4)
3 (30.0)
Partial response
4 (36.4)
3 (30.0)
Stable disease
0 (0)
1 (10.0)
Progressive disease
3 (27.3)
3 (30.0)
Delay
0 (0)
4 (40.0)
0.019*
Dose reduction or discontinuation
0 (0)
3 (30.0)
0.05
PFS (mo)
5.2 (5.1–5.7)
7.55 (2.2–8.1)
0.931
Not reach
6 (54.5)
4 (40.0)
0.442
Death
5 (45.5)
5 (50.0)
0.835
Side effect
7 (63.6)
9 (90.0)
0.157
Prescription for EPO
4 (36.4)
5 (50.0)
0.528
Prescription for G-CSF
1 (9.1)
1 (10.0)
0.943
Prescription for appetite stimulants
5 (45.5)
3 (30.0)
0.466
Table 1. Comparison of subject characteristics between exercise group and control group
Values are presented as median (interquartile range) or number (%).
6MWT, 6-minute walk test; FVC, forced vital capacity; pred., predicted; FEV1, forced expiratory volume in 1 second; ECOG, eastern cooperative oncology group; SCLC, small cell lung cancer; NSCLC, non-SCLC.
Table 2. Comparison of outcomes before and after chemotherapy in each group
Values are presented as mean±standard deviation.
6MWT, 6-minute walk test; FVC, forced vital capacity; pred., predicted; FEV1, forced expiratory volume in 1 second.
p<0.05 by Wilcoxon signed-rank test.
Table 3. Comparison of differences in outcomes between the two groups
Values are presented as mean±standard deviation.
6MWT, 6-minute walk test; FVC, forced vital capacity; pred., predicted; FEV1, forced expiratory volume in 1 second.
Table 4. Comparison of the 1-year follow up chemotherapy response between the two groups
Values are presented as median (interquartile range) or number (%).
, Yung Jin Lee, MD1
