Category: Clinical Sciences/Health Conditions
Prior studies of lung cancer survivors (LCS) has demonstrated that exercise improves survival and quality of life in these patients, but perceptions, attitudes and knowledge of the benefits of exercise are barriers to participation. The goal of the present study was to assess the longitudinal effects of a novel community-based educational and exercise program for LCS.
Thirteen (n=13) participants completed a first of its kind 5-week community-based program, (‘Be-Lung Education and Exercise Series’) that included multi-faceted educational and exercise sessions. At completion of the program the primary outcome measure was participants’ attitudes towards exercise using survey evaluation. Secondary outcomes included changes in quality of life (FACT-L), symptoms (PROMIS) and functional markers of strength and conditioning (10 meter walk test, chair rise time and grip strength).
Attitudes regarding physical activity had a trend towards improvement including ratings of importance (p = 0.071), pleasantness (p = 0.114), enjoyment (p = 0.084), and helpfulness (p = 0.089). Trend was also noted in improvement of quality of life (FACT-L, p=0.084) however PROMIS Function-Dyspnea Survey assessing shortness of breath did not show a statistical difference post intervention (p = 0.343). There were statistically significant improvements in all mobility related functional measures assessed, including the 10-meter walk test (p = 0.006) and chair rise time (p= 0.001). Grip strength of the dominant hand had trend towards improvement following the program (p=0.075), while oxygen saturation remained similar pre and post intervention.
The novel community based educational exercise program that we developed had low attrition and was associated with improvements in attitudes, quality of life and functional outcome measures. This study does provide significant preliminary evidence that interventional community-based programs are feasible, realistic for individuals afflicted with lung cancer, and may improve their function significantly.
Lung cancer is the most common cause of cancer-related death. Additionally, the physical condition of lung cancer patients is generally poor and quality of life tends to be worse in these patients compared to those with other cancers due to disease specific impacts on fatigue and dyspnea. Results from interventional studies demonstrate that exercise may benefit patients with lung caner by increasing strength and endurance, as well as improving survival and quality of life. Furthermore, preoperative exercise programs prior to curative lung surgery may improve surgical outcomes, and continued supervised maintenance exercise reduces the hospital re-admission rate for respiratory-related admissions. Prior studies have also demonstrated that perceptions, attitudes and knowledge of the benefits of exercise are barriers to participation in lung cancer survivors. There has also yet to be a study examining the effects on quality of life and functional status through a comprehensive community-based program that provides education and exercise in individuals with lung cancer.
The goal of the present study was to assess the longitudinal effects of a novel 5 week community-based educational and exercise program (‘Be-Lung Education and Exercise Series’) for lung cancer survivors.
Fourteen lung cancer survivors were enrolled in an educational and exercise series. The aim of this study was to investigate the impact of a novel community based multi-disciplinary program that was developed to address lung cancer survivors’ attitudes towards fitness, fitness knowledge and commitment to a healthy lifestyle.
The duration of the program was five weeks with nine sessions total. Participants attended an orientation session on the first week followed by two sessions each week thereafter for four weeks. The biweekly sessions included one educational session and one exercise session. All sessions took place in an inner-city location of a charity organization dedicated to wellness programing (Gilda’s Club Chicago).
The educational sessions focused on a range of topics, including: (1) Breathing Strategies and Understanding Disease, (2) Exercises For Patients With Lung Cancer, and Education About Safe Exercises, (3) Nutrition and How To More Easily Prepare Healthy Diets, and (4) Wellness and Mindfulness. Each educational session was hosted by a guest speaker with expertise on the topic. The structured exercise sessions focused on conditioning and strengthening.
The primary aim of this research study was to assess the impact of the program on the participants’ attitudes towards exercise as assessed by a survey evaluation specific to this study. This survey targeted the following topics: (1) level of physical activity, (2) views of how lung cancer impacts physical activity, and (3) perspective towards physical activity.
The secondary aims of this research study were to assess for changes in (1) quality of life as measured by the FACT-L, (2) symptom burden as assessed by the PROMIS and (3) functional markers of strength conditioning as measured by oxygen saturation, 10 meter walk test, bilateral grip strength and chair rise time.
12 participants (86%) completed the program, 3 males and 9 females. Their average age was 66.0, with education ranging from high school/GED (1 participant) to advanced degree (3 participants). 75% of the participants had stage 3-4 lung cancer, with 66% currently undergoing treatment for lung cancer.
At the start of the study 2 participants (16.7%) reported that physical activity had increased since their diagnosis, compared to 6 patients (50%) at completion of the program. Regarding how lung cancer affects exercise, pre and post intervention patients rated fatigue and difficulty breathing as their barriers, although the number of patients reporting these barriers decreased slightly (8 patients to 6, and 7 to 4 respectively). As per attitudes regarding exercise there were improvements that approached statistical significance in ratings of importance (p = 0.071), exercise being pleasant (p = 0.114), enjoyable (p = 0.084), and helpful (p = 0.089).
Quality of life of participants was assessed with the FACT-L questionnaire with a noted improvement at completion of the program that approached statistical significance (p=0.084). There were also non-significant improvements in the sub-scores of physical well being and specific lung cancer concerns sections scores (p = 0.166 and p=0.123 respectively). PROMIS Function-Dyspnea Survey assessing shortness of breath doing daily activities did not show a statistical difference post intervention (p = 0.343).
There were statistically significant improvements in all mobility related functional measures assessed, including the 10 meter walk test (p = 0.006) and chair rise time (p= 0.001). Grip strength of the dominant hand had improvement not reaching statistical significance (p=0.075), while Oxygen saturation remained similar pre and post intervention.
The novel community based educational exercise program that was developed for LCS improved both attitudes towards exercise and functional measures assessed in this study. Despite the chronic medical issues that LCS face, there was very low attrition noted in the study with high attendance at all sessions. Compliance was likely aided by the community location of the programming and the multi-disciplinary nature of the program development that included physiatrists, oncologists and community stake-holders. This study provides preliminary evidence that interventional community based programs are feasible and realistic for individuals afflicted with lung cancer and may improve their function significantly. The next step will be to assess the benefits of the program in a larger cohort with a longer duration of follow-up.
Jacqueline Spangenberg– Medical Student, Louisiana State University Health Sciences Center School of Medicine
Joshua Martin– Resident Physician, Shirley Ryan AbilityLab/ Northwestern
Chad Hanaoka– Research Assistant, Shirley Ryan AbilityLab/ Northwestern
Kathleen Boss– Director of Special Initiatives, Gildas Club Chicago
Marco Masci– Resident Physician, Shirley Ryan AbilityLab/ Northwestern
Victoria Villaflor– Associate Professor, Medicine, Thoracic oncology, Northwestern
Prakash Jayabalan– Director of Clinical Musculoskeletal Research, Shirley Ryan AbilityLab/Northwestern Feinberg School of Medicine