Exercise training in patients with non-small cell lung cancer during in-hospital chemotherapy treatment: a randomized controlled trial.

INTERVENTION: In this project, it was proposed to examine the relationship between comprehensive hospital based physiotherapy in patients with non‐small‐cell lung carcinoma during cytostatic treatment and its impact on physical fitness, patient endurance, health related quality of life, dyspnea and fatigue. The 60 patients were enrolled to research, 20 excluded. 40 randomized , 26 allocate to ETG and 14 to CG, diagnosed within the last 6 weeks, or with earlier stage of the disease, excluded from surgery or radiation), confirmed by cytology or histology test results. The research study took place at the Independent Public Clinical Hospital No. 3 of Medical University of Silesia in Katowice. The ETG group: Based on the initial 6MWT and spirometry results, subjects participated in two, two‐weeks periods of rehabilitative exercise therapy, supervised by certified Physiotherapist. Before first 2‐weeks rehabilitation program and between these two periods, patients proceed to scheduled chemotherapy in hospital condition.The CG group: There were a 6 week period between initial and final assessments; during the middle two weeks patients proceed to a scheduled chemotherapy period. Patients participated in exercise sessions 5 times per week. Sessions consisted of: Morning exercises 1. (8:30‐9:00 am) specific respiratory exercises for 30 minutes ‐ relaxation exercises for breathing muscles, strengthening exercises the diaphragm with resistance, exercises to increase costal or chest breathing, prolonged exhalation exercise, chest percussion 2. (10:00‐10:30 am) 30 minutes of fitness and respiratory exercises ‐ coordination and balance exercises, stretching exercises using elastic bands, balls rehabilitation, sensory pillows. Performed in a standing position, kneeling, sitting, lying on side, abdomen and back. 3. (11:00‐11:30 am) training on a cycle ergometer or treadmill for 20‐30 minutes, intensity 30% ‐ 80% peak work rate. Afternoon exercises 4. (1:00‐1:30 pm) Resistance exercise intensity 40% ‐ 70% 1RM, 5. (3:00‐4:00 pm) Nordic walking for 45 minutes (depending on weather and health condition of the patient), 6. (4:00 pm) relaxation training ‐ Autogenic training is a desensitation‐relaxation technique developed by the German psychiatrist Johannes Heinrich Schultz. The technique involves the daily practice of sessions that last around 15 minutes. During each session, the practitioner repeats a set of visualisations that induce a state of relaxation. Each session can be practiced in a position chosen amongst a set of recommended postures (for example, lying down, sitting meditation, sitting like a rag doll). The technique can be used to alleviate many stress‐induced psychosomatic disorders. Heart rate and O 2 saturation were monitored continuously throughout sessions exercise and blood pressure was assessed intermittently. The change of the number of participants enrolled/randomised was made after enrolment of 5 participants CONDITION: lung cancer PRIMARY OUTCOME: dyspnea assessed using MRC, BDI, Borg Scale Lung function (composite of FEV1, FVC, FEV1%FVC) assessed using spirometry physical fitness (endurance, fatigue) assessed using Functional Fitness Test SECONDARY OUTCOME: quality of life assessed using St George's Respiratory Questionnaire, SF‐36, Functional Assessment of Cancer Therapy ‐ Lung (FACT‐L) INCLUSION CRITERIA: ability to perform the 6 minute walk test, Eastern Cooperative Oncology Group performance status 0‐1 and ability to complete self‐questionnaires and willingness to participate/ cooperate in the study