Supportive Care in Cancer

, Volume 20, Issue 12, pp 3169–3177 | Cite as

Effects of exercise training on exercise capacity in patients with non-small cell lung cancer receiving targeted therapy

  • Chueh-Lung Hwang
  • Chong-Jen Yu
  • Jin-Yuan Shih
  • Pan-Chyr Yang
  • Ying-Tai WuEmail author
Original Article



Peak oxygen consumption (VO2peak) is an important predictive factor for long-term prognosis in patients with non-small cell lung cancer (NSCLC). The purpose of this study was to investigate whether 8 weeks of exercise training improves exercise capacity, as assessed by VO2peak, and other related factors in patients with NSCLC receiving targeted therapy.


A total of 24 participants with adenocarcinoma were randomly assigned to either the control group (n = 11) or the exercise group (n = 13). Subjects in the exercise group participated in individualized, high-intensity aerobic interval training of exercise. The outcome measures assessed at baseline and after 8 weeks were as follows: VO2peak and the percentage of predicted VO2peak (%predVO2peak), muscle strength and endurance of the right quadriceps, muscle oxygenation during exercise, insulin resistance as calculated by the homeostasis model, high-sensitivity C-reactive protein, and quality of life (QoL) questionnaire inventory.


No exercise-related adverse events were reported. After exercise training, VO2peak and %predVO2peak increased by 1.6 mL kg−1 min−1 and 5.3% (p < 0.005), respectively; these changes were associated with improvements in circulatory, respiratory, and muscular functions at peak exercise (all p = 0.001). The exercise group also had less dyspnea (p = 0.01) and favorably lower fatigue (p = 0.05) than baseline.


Patients with NSCLC receiving targeted therapy have quite a low exercise capacity, even with a relatively high QoL. Exercise training appears to improve exercise capacity and alleviate some cancer-related symptoms.


Aerobic exercise Exercise tolerance Skeletal muscle Quality of life 


Conflict of interest

All authors claimed no disclosure and had full control of all primary data. All authors agree to allow the journal to review data if requested.


  1. 1.
    Siegel R, Naishadham D, Jemal A (2012) Cancer statistics, 2012. CA Cancer J Clin 62(1):10–29. doi: 10.3322/caac.20138 PubMedCrossRefGoogle Scholar
  2. 2.
    D'Addario G, Felip E (2009) Non-small-cell lung cancer: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol 20(Suppl 4):68–70. doi: 10.1093/annonc/mdp132 PubMedGoogle Scholar
  3. 3.
    Herbst RS, Heymach JV, Lippman SM (2008) Lung cancer. N Engl J Med 359(13):1367–1380. doi: 10.1056/NEJMra0802714 PubMedCrossRefGoogle Scholar
  4. 4.
    Sanford M, Scott LJ (2009) Gefitinib: a review of its use in the treatment of locally advanced/metastatic non-small cell lung cancer. Drugs 69(16):2303–2328. doi: 10.2165/10489100-000000000-00000 PubMedCrossRefGoogle Scholar
  5. 5.
    Shepherd FA, Rodrigues Pereira J, Ciuleanu T, Tan EH, Hirsh V, Thongprasert S, Campos D, Maoleekoonpiroj S, Smylie M, Martins R, van Kooten M, Dediu M, Findlay B, Tu D, Johnston D, Bezjak A, Clark G, Santabarbara P, Seymour L (2005) Erlotinib in previously treated non-small-cell lung cancer. N Engl J Med 353(2):123–132. doi: 10.1056/NEJMoa050753 PubMedCrossRefGoogle Scholar
  6. 6.
    Jones LW, Eves ND, Haykowsky M, Freedland SJ, Mackey JR (2009) Exercise intolerance in cancer and the role of exercise therapy to reverse dysfunction. Lancet Oncol 10(6):598–605. doi: 10.1016/S1470-2045(09)70031-2 PubMedCrossRefGoogle Scholar
  7. 7.
    Antoun S, Birdsell L, Sawyer MB, Venner P, Escudier B, Baracos VE (2010) Association of skeletal muscle wasting with treatment with sorafenib in patients with advanced renal cell carcinoma: results from a placebo-controlled study. J Clin Oncol 28(6):1054–1060. doi: 10.1200/JCO.2009.24.9730 PubMedCrossRefGoogle Scholar
  8. 8.
    Jones LW, Watson D, Herndon JE 2nd, Eves ND, Haithcock BE, Loewen G, Kohman L (2010) Peak oxygen consumption and long-term all-cause mortality in nonsmall cell lung cancer. Cancer 116(20):4825–4832. doi: 10.1002/cncr.25396 PubMedCrossRefGoogle Scholar
  9. 9.
    Win T, Jackson A, Sharples L, Groves AM, Wells FC, Ritchie AJ, Laroche CM (2005) Cardiopulmonary exercise tests and lung cancer surgical outcome. Chest 127(4):1159–1165. doi: 10.1378/chest.127.4.1159 PubMedCrossRefGoogle Scholar
  10. 10.
    Baracos VE, Reiman T, Mourtzakis M, Gioulbasanis I, Antoun S (2010) Body composition in patients with non-small cell lung cancer: a contemporary view of cancer cachexia with the use of computed tomography image analysis. Am J Clin Nutr 91(4):1133S–1137S. doi: 10.3945/ajcn.2010.28608C PubMedCrossRefGoogle Scholar
  11. 11.
    Jones LW, Eves ND, Mackey JR, Peddle CJ, Haykowsky M, Joy AA, Tankel K, Courneya KS, Reiman T (2008) Systemic inflammation, cardiorespiratory fitness, and quality of life in patients with advanced non-small cell lung cancer. J Thorac Oncol 3(2):194–195. doi: 10.1097/JTO.0b013e318160f36b PubMedCrossRefGoogle Scholar
  12. 12.
    Heber D, Chlebowski RT, Ishibashi DE, Herrold JN, Block JB (1982) Abnormalities in glucose and protein metabolism in noncachectic lung cancer patients. Cancer Res 42(11):4815–4819PubMedGoogle Scholar
  13. 13.
    Yoshikawa T, Noguchi Y, Doi C, Makino T, Nomura K (2001) Insulin resistance in patients with cancer: relationships with tumor site, tumor stage, body-weight loss, acute-phase response, and energy expenditure. Nutrition 17(7-8):590–593PubMedCrossRefGoogle Scholar
  14. 14.
    Galvao DA, Newton RU (2005) Review of exercise intervention studies in cancer patients. J Clin Oncol 23(4):899–909. doi: 10.1200/JCO.2005.06.085 PubMedCrossRefGoogle Scholar
  15. 15.
    Arbane G, Tropman D, Jackson D, Garrod R (2011) Evaluation of an early exercise intervention after thoracotomy for non-small cell lung cancer (NSCLC), effects on quality of life, muscle strength and exercise tolerance: randomised controlled trial. Lung Cancer 71(2):229–234. doi: 10.1016/j.lungcan.2010.04.025 PubMedCrossRefGoogle Scholar
  16. 16.
    Andersen AH, Vinther A, Poulsen LL, Mellemgaard A (2011) Do patients with lung cancer benefit from physical exercise? Acta Oncol 50(2):307–313. doi: 10.3109/0284186X.2010.529461 PubMedCrossRefGoogle Scholar
  17. 17.
    Riesenberg H, Lubbe AS (2010) In-patient rehabilitation of lung cancer patients—a prospective study. Support Care Cancer 18(7):877–882. doi: 10.1007/s00520-009-0727-y PubMedCrossRefGoogle Scholar
  18. 18.
    Thompson WR, Gordon NF, Pescatello LS (2010) ACSM's guidelines for exercise testing and prescription. Williams & Wilkins, PhiladelphiaGoogle Scholar
  19. 19.
    Jones LW, Eves ND, Haykowsky M, Joy AA, Douglas PS (2008) Cardiorespiratory exercise testing in clinical oncology research: systematic review and practice recommendations. Lancet Oncol 9(8):757–765. doi: 10.1016/S1470-2045(08)70195-5 PubMedCrossRefGoogle Scholar
  20. 20.
    Jones LW, Eves ND, Mackey JR, Peddle CJ, Haykowsky M, Joy AA, Courneya KS, Tankel K, Spratlin J, Reiman T (2007) Safety and feasibility of cardiopulmonary exercise testing in patients with advanced cancer. Lung Cancer 55(2):225–232. doi: 10.1016/j.lungcan.2006.10.006 PubMedCrossRefGoogle Scholar
  21. 21.
    Fairbarn MS, Blackie SP, McElvaney NG, Wiggs BR, Pare PD, Pardy RL (1994) Prediction of heart rate and oxygen uptake during incremental and maximal exercise in healthy adults. Chest 105(5):1365–1369PubMedCrossRefGoogle Scholar
  22. 22.
    Austin KG, Daigle KA, Patterson P, Cowman J, Chelland S, Haymes EM (2005) Reliability of near-infrared spectroscopy for determining muscle oxygen saturation during exercise. Res Q Exerc Sport 76(4):440–449PubMedCrossRefGoogle Scholar
  23. 23.
    Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC (1985) Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 28(7):412–419PubMedCrossRefGoogle Scholar
  24. 24.
    Wilcock A, Maddocks M, Lewis M, Howard P, Frisby J, Bell S, El Khoury B, Manderson C, Evans H, Mockett S (2008) Use of a Cybex NORM dynamometer to assess muscle function in patients with thoracic cancer. BMC Palliat Care 7:3. doi: 10.1186/1472-684X-7-3 PubMedCrossRefGoogle Scholar
  25. 25.
    Chie WC, Yang CH, Hsu C, Yang PC (2004) Quality of life of lung cancer patients: validation of the Taiwan Chinese version of the EORTC QLQ-C30 and QLQ-LC13. Qual Life Res 13(1):257–262PubMedCrossRefGoogle Scholar
  26. 26.
    Blanchon F, Grivaux M, Asselain B, Lebas FX, Orlando JP, Piquet J, Zureik M (2006) 4-year mortality in patients with non-small-cell lung cancer: development and validation of a prognostic index. Lancet Oncol 7(10):829–836. doi: 10.1016/S1470-2045(06)70868-3 PubMedCrossRefGoogle Scholar
  27. 27.
    Jones LW, Eves ND, Peddle CJ, Courneya KS, Haykowsky M, Kumar V, Winton TW, Reiman T (2009) Effects of presurgical exercise training on systemic inflammatory markers among patients with malignant lung lesions. Appl Physiol Nutr Metab 34(2):197–202. doi: 10.1139/H08-104 PubMedCrossRefGoogle Scholar
  28. 28.
    Jones LW, Peddle CJ, Eves ND, Haykowsky MJ, Courneya KS, Mackey JR, Joy AA, Kumar V, Winton TW, Reiman T (2007) Effects of presurgical exercise training on cardiorespiratory fitness among patients undergoing thoracic surgery for malignant lung lesions. Cancer 110(3):590–598. doi: 10.1002/cncr.22830 PubMedCrossRefGoogle Scholar
  29. 29.
    Jones LW, Eves ND, Peterson BL, Garst J, Crawford J, West MJ, Mabe S, Harpole D, Kraus WE, Douglas PS (2008) Safety and feasibility of aerobic training on cardiopulmonary function and quality of life in postsurgical nonsmall cell lung cancer patients: a pilot study. Cancer 113(12):3430–3439. doi: 10.1002/cncr.23967 PubMedCrossRefGoogle Scholar
  30. 30.
    Bobbio A, Chetta A, Ampollini L, Primomo GL, Internullo E, Carbognani P, Rusca M, Olivieri D (2008) Preoperative pulmonary rehabilitation in patients undergoing lung resection for non-small cell lung cancer. Eur J Cardiothorac Surg 33(1):95–98. doi: 10.1016/j.ejcts.2007.10.003 PubMedCrossRefGoogle Scholar
  31. 31.
    MacVicar MG, Winningham ML, Nickel JL (1989) Effects of aerobic interval training on cancer patients' functional capacity. Nurs Res 38(6):348–351PubMedCrossRefGoogle Scholar
  32. 32.
    Butcher SJ, Jones RL (2006) The impact of exercise training intensity on change in physiological function in patients with chronic obstructive pulmonary disease. Sports Med 36(4):307–325PubMedCrossRefGoogle Scholar
  33. 33.
    Daussin FN, Zoll J, Dufour SP, Ponsot E, Lonsdorfer-Wolf E, Doutreleau S, Mettauer B, Piquard F, Geny B, Richard R (2008) Effect of interval versus continuous training on cardiorespiratory and mitochondrial functions: relationship to aerobic performance improvements in sedentary subjects. Am J Physiol Regul Integr Comp Physiol 295(1):R264–272. doi: 10.1152/ajpregu.00875.2007 PubMedCrossRefGoogle Scholar
  34. 34.
    Tjonna AE, Lee SJ, Rognmo O, Stolen TO, Bye A, Haram PM, Loennechen JP, Al-Share QY, Skogvoll E, Slordahl SA, Kemi OJ, Najjar SM, Wisloff U (2008) Aerobic interval training versus continuous moderate exercise as a treatment for the metabolic syndrome: a pilot study. Circulation 118(4):346–354. doi: 10.1161/CIRCULATIONAHA.108.772822 PubMedCrossRefGoogle Scholar
  35. 35.
    Wisloff U, Stoylen A, Loennechen JP, Bruvold M, Rognmo O, Haram PM, Tjonna AE, Helgerud J, Slordahl SA, Lee SJ, Videm V, Bye A, Smith GL, Najjar SM, Ellingsen O, Skjaerpe T (2007) Superior cardiovascular effect of aerobic interval training versus moderate continuous training in heart failure patients: a randomized study. Circulation 115(24):3086–3094. doi: 10.1161/CIRCULATIONAHA.106.675041 PubMedCrossRefGoogle Scholar
  36. 36.
    Osoba D, Rodrigues G, Myles J, Zee B, Pater J (1998) Interpreting the significance of changes in health-related quality-of-life scores. J Clin Oncol 16(1):139–144PubMedGoogle Scholar
  37. 37.
    Kilgour RD, Vigano A, Trutschnigg B, Hornby L, Lucar E, Bacon SL, Morais JA (2010) Cancer-related fatigue: the impact of skeletal muscle mass and strength in patients with advanced cancer. J Cachex Sarcopenia Muscle 1(2):177–185. doi: 10.1007/s13539-010-0016-0 CrossRefGoogle Scholar
  38. 38.
    Temel JS, Greer JA, Goldberg S, Vogel PD, Sullivan M, Pirl WF, Lynch TJ, Christiani DC, Smith MR (2009) A structured exercise program for patients with advanced non-small cell lung cancer. J Thorac Oncol 4(5):595–601. doi: 10.1097/JTO.0b013e31819d18e5 PubMedCrossRefGoogle Scholar
  39. 39.
    Petridou ET, Sergentanis TN, Antonopoulos CN, Dessypris N, Matsoukis IL, Aronis K, Efremidis A, Syrigos C, Mantzoros CS (2011) Insulin resistance: an independent risk factor for lung cancer? Metabolism. doi: 10.1016/j.metabol.2010.12.002
  40. 40.
    Rensing KL, Houttuijn Bloemendaal FM, Weijers EM, Richel DJ, Buller HR, Koolwijk P, van der Loos CM, Twickler TB, von der Thusen JH (2010) Could recombinant insulin compounds contribute to adenocarcinoma progression by stimulating local angiogenesis? Diabetologia 53(5):966–970. doi: 10.1007/s00125-010-1687-y PubMedCrossRefGoogle Scholar
  41. 41.
    Jones JM, McGonigle NC, McAnespie M, Cran GW, Graham AN (2006) Plasma fibrinogen and serum C-reactive protein are associated with non-small cell lung cancer. Lung Cancer 53(1):97–101. doi: 10.1016/j.lungcan.2006.03.012 PubMedCrossRefGoogle Scholar
  42. 42.
    Scott HR, McMillan DC, Forrest LM, Brown DJ, McArdle CS, Milroy R (2002) The systemic inflammatory response, weight loss, performance status and survival in patients with inoperable non-small cell lung cancer. Br J Cancer 87(3):264–267. doi: 10.1038/sj.bjc.6600466 PubMedCrossRefGoogle Scholar
  43. 43.
    Forrest LM, McMillan DC, McArdle CS, Angerson WJ, Dunlop DJ (2003) Evaluation of cumulative prognostic scores based on the systemic inflammatory response in patients with inoperable non-small-cell lung cancer. Br J Cancer 89(6):1028–1030. doi: 10.1038/sj.bjc.6601242 PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Chueh-Lung Hwang
    • 1
  • Chong-Jen Yu
    • 2
  • Jin-Yuan Shih
    • 2
  • Pan-Chyr Yang
    • 2
  • Ying-Tai Wu
    • 1
    Email author
  1. 1.School and Graduate Institute of Physical Therapy, College of MedicineNational Taiwan UniversityTaipeiTaiwan
  2. 2.Department of Internal MedicineNational Taiwan University Hospital, College of Medicine, National Taiwan UniversityTaipeiTaiwan

Personalised recommendations