Combined effects of slow movement training with tonic force generation and aerobic exercise prior to cancer therapy in patients with lung cancer (START-lung): a pilot feasibility trial

Exercise is known to improve physical fitness, functional performance, muscle strength, quality of life (QoL), and treatment outcomes in patients with cancer. However, the feasibility and impact of implementing an exercise program from the first visit for suspected advanced lung cancer to treatment initiation remain unclear. This study aimed to evaluate the feasibility of a structured exercise program during this period. This prospective, single-center study included patients with suspected advanced lung cancer who were instructed to perform a pre-treatment 4-week exercise program consisting of slow movement training with tonic force generation and aerobic exercise. Attendance rates and adverse events were assessed, and changes in functional performance, exercise capacity, balance function, muscle strength and mass, physical activity levels, nutritional status, and QoL were evaluated. Patient feedback on the exercise program was collected. A total of 17 patients were analyzed, with a mean age of 70 years. The overall exercise attendance rate was 159.7 ± 54.4%. A high attendance rate (≥70.8%) was achieved by 15 patients without any adverse events. Significant improvements from baseline to after-exercise intervention were observed in the five-time sit-to-stand test and 30-second chair stand test. No significant changes in 6-minute walk distance, one-leg standing time, isometric handgrip and knee extensor strengths, skeletal muscle mass or self-reported measures were observed. Patient feedback indicated that exercise was beneficial in alleviating anxiety and maintaining physical condition during the waiting period before treatment. A structured exercise program initiated from the first visit to treatment initiation was feasible and safe in patients with advanced lung cancer. Notably, improvements in the five-time sit-to-stand test and 30-second chair stand test were observed, suggesting potential benefits for enhancing lower-limb functional performance during this period. Further studies, including randomized controlled trials, are warranted to assess its impact on clinical outcomes and long-term patient wellbeing. University Hospital Medical Information Network, UMIN000055155. Date of registration: August 5, 2024