Quist, M., Adamsen, L., Rorth, M., Laursen, J.H., Christensen, K.B., & Langer, S.W. (2015). The impact of a multidimensional exercise intervention on physical and functional capacity, anxiety, and depression in patients with advanced-stage lung cancer undergoing chemotherapy. Integrative Cancer Therapies, 14, 341–349. 

To determine the effects of a supervised group exercise intervention on aerobic capacity, anxiety, depression, and quality of life in patients with advanced lung cancer

The intervention consisted of physical and relaxation training in groups of 10–12 patients provided twice weekly for six weeks. Exercises included cycling and strength training supervised by a physiotherapist. Study assessments were done at baseline and at six weeks.

• N = 71
• MEAN AGE = 66 years (range = 31–88 years)
• MALES: 42.8%, FEMALES: 57.2%
• KEY DISEASE CHARACTERISTICS: All patients had advanced inoperable lung cancer and were receiving chemotherapy. Most were receiving carboplatin-based treatment.
• OTHER KEY SAMPLE CHARACTERISTICS: The majority of participants were employed full- or part-time

• SITE: Single site  
• SETTING TYPE: Outpatient  
• LOCATION: Denmark

• PHASE OF CARE: Active antitumor treatment

Quasi-experimental

• Peak VO₂ for aerobic capacity
• 6-Minute Walk Test (6MWT)
• FEV₁
• Functional Assessment of Cancer Therapy (FACT) general and L for quality of life
• Hospital Anxiety and Depression Scale (HADS)

There were significant reductions in anxiety scores (ES 0.21, -0.9 change, p = 0.007). There was no effect on depression scores. Aerobic capacity, functional capacity, and muscle strength improved significantly.

The findings of this study suggest that group exercise sessions may benefit the managing anxiety and increase functional capacity among patients with advanced lung cancer. Changes were statistically significant; however, actual change scores were small. The clinical relevance of these changes is not clear.

• Small sample (< 100)
• Risk of bias (no control group)
• Risk of bias (no blinding)
• Risk of bias (no random assignment)
• Subject withdrawals ≥ 10%  
• Other limitations/explanation: Although significant effects were seen, actual changes scores were small, calling into question the actual clinical relevance of findings. There was a withdrawal rate of about 50%, suggesting that this program may not be practical. Patients self-selected to participate in the program, so the sample was potentially biased. The intervention was provided in a group setting, so it is possible that the change in anxiety was related to participating in a group of individuals with the same problems rather than the exercise itself. An analysis of drop-outs showed that baseline functional capacity was significantly higher among those who remained in the program.

The findings of this study suggest that group exercise sessions can improve function and might reduce anxiety among patients with advanced lung cancer. This type of approach may not be feasible or acceptable for patients with very poor baseline functional capabilities. Additional well-designed research in this area would be helpful, and studies should include attentional control conditions to differentiate the affects of group support versus other aspects of the intervention.