# Exercise as it relates to Disease/Exercise effects in lung cancer

Lung cancer is the most common cancer in the Western World and has very poor survival rate (only 10–15% of patients survive 5 years or longer). In Australia, it is the fifth most common cancer but is the most common cause of deaths due to cancer. It is estimated in year 2020, 13640 people would be diagnosed with lung cancer in Australia. Physical activity has shown significant improvements on the quality of life, physical function and physical capacity in patients with lung cancer.

### What is lung Cancer?

Lung cancer is uncontrolled epithelial cell growth within the lung tissues and airways of lungs. It can originate from any part of the lungs, including the trachea, bronchi, bronchioles and alveoli. There are two main types of lung cancers
* non-small cell carcinoma (about 80% of all lung cancers)
* small cell carcinoma (about 20% of all lung cancers)

### Etiology of lung cancer

* Tobacco smoking is the main cause which accounts for 80 to 90% of all cases.
* Environmental factors such as exposure to radon, diesel air pollutants, asbestos, chromium and uranium
* Family history of lung cancer and previous lung disease.

### Symptoms and treatment of lung cancer

Majority of adults with lung cancer are symptomatic when they are diagnosed and exhibit following symptoms:
* Cough * Dyspnoea * Hoarseness* Chest pain* Wheezing* Haemoptysis* Nausea/Vomiting* Swelling of face and arm * Anorexia
* Weight Loss * Fatigue* Bone pain* Clubbing* Headache* Seizures.
Treatment of lung cancer depends upon the type and stage of the cancer, and includes# Radiotherapy # Surgery # Chemotherapy # Targeted therapy. Treatment methods have variety of associated side effects e.g. Cancer therapy has negative effects on cardiovascular system which leads to higher mortality in cancer patients.

## Benefits of Exercise in Lung Cancer

Various studies have shown that exercise has beneficial effects on patients with lungs cancers and benefits include
* Improves physical fitness and quality of life
* Improves cardio respiratory fitness by increasing VO2 peak
* Enhances both maximum aerobic capacity and walking distance
* May also diminish side-effects of chemotherapy and radiation therapy
* Improves the psychological stress connected with cancer and its treatment, improves mood and reduce anxiety
* May decrease fatigue pre- and post-operatively
* An important component of cancer rehabilitation

### Exercise Recommendations

| Exercise | Program | Duration (min/session) | Intensity (% of VO2peak) | Aims |
| Warm up | Exercises for upper and lower limbs like stationary cycling, treadmill | 10 min | Low to moderate intensity | Enhances speed and strength in muscles |
| Aerobic training | • Circuit training • Walking training • Cycling ergometry | 20–60 min 3-5 sessions / week | 55% to 90%VO2peak | Improves cardio-respiratory fitness |
| Strength training | Leg press, chest press, lateral machine, leg extension, abdominal crunch, and lower back | 20–60 min 3-5 sessions / week | 60-80% of 8-10 sets rep. max | Improves skeletal muscle function and cardio-respiratory function |
| Stretching | For large muscles | 25-45 min 3 sessions/ week | Duration of each stretch 5 min | Increase agility and flexibility |
| Yoga | Mind and body relaxation by improving respiration | 15-20 min 2-3 times /week | - | Improves fatigue, distress, and general quality of life |
Note: Breathing exercises such as diaphragmatic breathing, pursed lip breathing are helpful in improving breathlessness. Positioning of patient is also an important component during breathing exercises.

## Consideration
### Perceived barriers to exercise

* Age: average age of LC patients at the time of diagnosis is high (above 60years)
* Co-morbidities: COPD, arterial hypertension, cardiac disease, peripheral vascular disease, previous tumours and diabetes
* LC symptoms: fatigue, dyspnea, anorexia and pain
* Emotional well being: depression, anxiety, lowered self esteem and loss of sense of control

### Strategies to improve exercise participation and adherence

* Exercise programs tailored according to patient’s condition
* Management of cancer symptoms and treatment complications
* Psychological and social counseling
* Educational and motivational sessions
* Physical activity integrated into cancer treatment plan
* Encouraging Oncologist to prescribe physical activity

## Further reading

* Physical activity reducing risk of Lung Cancer
* Physical Activity, Diet And Lung Cancer

## References

* ↑ C.J Beadsmoore, N.J Screaton . Classification, staging and prognosis of lung cancer. European Journal of Radiology, Volume 45, Issue 1, January 2003, Pages 8–17
* ↑ http://canceraustralia.gov.au/affected-cancer/cancer-types/lung-cancer/lung-cancer-statistics
* 1 2 Morten Quist, Mikael Rorth, Seppo Langer, Lee W. Jones, Jorgen H. Laursen, Helle Pappot, Karl Bang Christensen, Lis Adamsen .Safety and feasibility of a combined exercise intervention for inoperable lung cancer patients undergoing chemotherapy. Lung Cancer, Volume 75, Issue 1, January 2012, Pages 126–132
* 1 2 Alan J Neville, Mridula Sara Kuruvilla. Lung cancer. Clin Evid (Online) 2010; 2010: 1504. Published online 2010 November 30. Page2
* 1 2 Lung cancer in Australia page 1-2 http://www.aihw.gov.au/publication-detail/?id=10737420419
* ↑ Stephen S. Hecht. Tobacco Smoke Carcinogens and Lung Cancer. JNCI J Natl Cancer Inst (1999) 91 (14): 1194-1210.
* ↑ Samet , Jonathan M. Environmental Causes of Lung Cancer. CHEST, May, 2004 Supplement, Vol. 125, p 80S-83S.
* ↑ http://canceraustralia.gov.au/affected-cancer/cancer-types/lung-cancer
* ↑ Linda H. Yoder. An Overview of Lung Cancer Symptoms, Pathophysiology, And Treatment. MEDSURG Nursing, August 2006, Vol. 15, No. 4
* ↑ http://www.merckmanuals.com/professional/pulmonary_disorders/tumors_of_the_lungs/lung_carcinoma.html?qt=&sc=&alt
* ↑ Sharon Parmet, Cassio Lymn, Richard M. Lung Cancer. JAMA, August 24/31, 2005, Vol 294, No. 8
* 1 2 Robert U. Newton, Daniel A. Galvao.Exercise in Prevention and Management of Cancer. Current Treatment Options in Oncology (2008) 9:135–146
* 1 2 Andersen, Andreas H. Vinther, Anders Poulsen, Lise-Lotte Mellemgaard, Anders. Do patients with lung cancer benefit from physical exercise. Acta Oncologica, Feb 2011, Vol. 50 Issue 2, p307-313.
* ↑ Amy J. Litterini, Diane U. Jette. Exercise for Managing Cancer-Related Fatigue. Physical Therapy Journal of American Physical Therapy Association, Mar2011, Vol. 91 Issue 3, p301 4p
* ↑ Chueh-Lung Hwang, Chong-Jen Yu, Jin-Yuan Shih, Pan-Chyr Yang, Ying-Tai Wu. Effects of exercise training on exercise capacity in patients with non-small cell lung cancer receiving targeted therapy. Supportive Care in Cancer, December 2012, Volume 20, Issue 12, pp 3169-3177.
* 1 2 Lee W Jones, Neil D Eves, William E Kraus, Anil Potti, Jeffrey Crawford, James A Blumenthal, Bercedis L Peterson and Pamela S Douglas. The lung cancer exercise training study: a randomized trial of aerobic training, resistance training, or both in postsurgical lung cancer patients: rationale and design. http://www.biomedcentral.com/1471-2407/10/155
* ↑ http://sportsmedicine.about.com/cs/injuryprevention/a/aa071001a.htm
* ↑ C. F. van Uden-Kraan, M. J. M Chinapaw, C. H. C. Drossaert, I. M. Verdonck-de Leeuw, L. M. Buffart. Cancer patients experiences with and perceived outcomes of yoga: results from focus groups. Supportive Care in Cancer, July 2013, Volume 21, Issue 7, pp 1861-1870.
* ↑ Cairns, Lindsay. Managing breathlessness in patients with lung cancer. Nursing Standard (NURS STAND), 2012 Nov 27; 27 (13): 44-9. (48 ref)
* 1 2 Margaret Joyce, Sue Schwartz, Maureen Huhmann. Supportive Care in Lung Cancer. Seminars in Oncology Nursing, Volume 24, Issue 1, February 2008, Pages 57–67
* ↑ Angel López-Encuentra. Comorbidity in operable lung cancer: A multicenter descriptive study on 2992 patients. Lung Cancer Volume 35, Issue 3, March 2002, Pages 263–269
* ↑ Carla Ida Ripamonti. Early supportive care for lung cancer patients. Lung Cancer, Volume 77, Supplement 1, June 2012, Pages S18–S19
* ↑ M L Irwin. Physical activity interventions for cancer survivors. British Journal of Sports Medicine, 2009, 43: 32-38