Training Effects Following Resection Surgery in Patients With Lung Cancer
Condition: Lung Cancer
MeSH terms: Lung Neoplasms
Study type: Interventional

Summary: 
      The purpose of this study is to determine the potential benefits resulting from a specific
      training on exercise tolerance and muscle function at the medium and long-time, as well as
      study its effects on plasmatic mediators (sMICA, IGF-I and IGFBP-3) in patients with lung
      cancer following resection surgery.
    

Detailed description: 
      Surgical treatment of lung cancer (LC) leads to peripheral and respiratory muscle dysfunction
      (Mdys) with exercise limitation. This characteristic feature might be generated, not only for
      a reduced lung function, but also by deconditioning as well as respiratory and peripheral
      muscle dysfunction. It remains unknown the potential benefits resulting from a specific
      training and its effects on plasmatic mediators.

      Chronic diseases are the leading cause of morbidity and mortality worldwide and is known that
      regular exercise has a beneficial effect on most of them. Many studies have shown the benefit
      of exercise in patients diagnosed with cancer, especially breast and colorectal cancer, even
      during active phases of specific treatment, however few studies refers to possible benefit of
      exercise in patients with lung cancer following surgical resection. Lung cancer is one of the
      most common cancers in Spain, the second in the general population and the first if we refer
      exclusively to the male population. Not only it is a common type of cancer, but also presents
      a high mortality with a survival rate at 5 years of approximately 12%. However, survival
      improves significantly in stage I (60-80% at 5 years) and progressively worse until stage IV
      (<5% at 5 years). Surgery is the treatment of choice for lung cancer in stages I and IIa.
      Despite the good results in terms of survival, it is not free of side effects. Depending on
      the extent of lung resection, it may result in functional limitations and impact on the
      patients' quality of life. Pulmonary lobectomy entails a significant reduction of the
      functional reserve: impaired lung function (FEV1 of 15%) and reduced exercise capacity (16%
      in the shuttle test). In contrast, in the pneumonectomy, reduced pulmonary function is
      disproportionately higher (FEV1 of 35%) in comparison with the exercise limitation (23%). To
      date we have no knowledge of studies that have specifically evaluated the effects of exercise
      training in these patients.

      Dysfunction of the diaphragm and other respiratory muscles, prevalent in COPD (chronic
      obstructive pulmonary disease) patients, has important clinical implications. It associates
      with susceptibility to hypercapnic ventilatory failure, ineffective cough, and even higher
      incidence of repeated hospital admissions and mortality. Therefore, respiratory muscle
      weakness described in some patients justifies the need to train respiratory muscles because
      there is no general exercise (bicycle, legs, arms) able to induce an overload enough to
      achieve training effect on respiratory muscles. Since a large proportion of lung cancer
      patients also suffer from COPD, endurance and strength of respiratory muscles are expected to
      be reduced. Moreover, after lobectomy patients have some degree of peripheral muscle
      deconditioning, which could be linked to the loss of reserve function, but also the relative
      rest. Although muscle training has been successfully used to restore function in patients
      with various chronic diseases and frailty, there is little evidence on the beneficial effects
      of muscle training in patients after lung cancer surgery.

      Many studies have related the insulin-like growth factor I (IGF-I) and its major regulatory
      proteins, Insulin-like growth factor binding protein (IGFBP-3) with various malignancies,
      including lung cancer. In healthy subjects with sedentary lifestyle, caloric diet leads to
      obesity and alterations of hormonal, metabolic and inflammatory modulate carcinogenesis.
      These disorders include chronic hyperinsulinemia, elevated plasma IGF-I, plasma enhanced
      bioavailability and increased steroid sex hormones of systemic inflammation markers. Physical
      exercise, in addition to its cardiovascular effects and/or muscular strength and endurance
      produces a response on plasmatic levels of IGF-I and IGFBP-3. This variability has been
      justified, in most cases, depending on type, intensity and/or duration of the exercise
      performed.
    

Intervention name(s): Aerobic and muscle resistance training
Intervention type(s): Behavioral
Intervention description(s): After having been allocated randomly to one of the two groups, patients of Intervention Group are encouraged to follow a training program (aerobic and endurance muscle training) during 8 weeks.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary purpose: Treatment
Keywords: Exercise; lung cancer; aerobic training, resistance training; respiratory muscle training