Home-based exercise, self-management program ‘beneficial’ after lung resection

Key takeaways:

• Patients who received a home-based exercise and self-management program after lung resection had more improved exercise capacity and self-efficacy.
• Quality of life and objective physical function also improved.

Following lung cancer resection, patients had more improved exercise outcomes and health-related quality of life with a home-based exercise and self-management program vs. usual care, according to results published in JAMA Network Open.

“Our findings suggest that a home-based exercise program for patients after lung cancer surgery is beneficial for patients,” Catherine L. Granger, PhD, FACP, professor of physiotherapy at The University of Melbourne and The Royal Melbourne Hospital, told Healio. “The program we tested was simple, low cost and will be relatively easy to implement for clinicians globally.”

In a randomized clinical trial, Granger and colleagues assessed 116 patients (mean age, 66.4 years; 58.6% women; 88.8% white) with non-small cell lung cancer who underwent lung resection surgery to determine the impact of a 3-month home-based exercise and self-management program (n = 58) vs. usual care (n = 58) on physical function, exercise capacity and quality of life up to 12 months following the procedure.

“[In the intervention group,] patients were supported at home by a physiotherapist (physical therapist) via weekly telephone calls, plus they were provided with some other inexpensive resources such as an education booklet and physical activity tracker (wrist worn),” Granger told Healio.

More than 80% of the study population completed assessments at three time points after lung resection surgery (3 months, 88.8%; 6 months, 81.9%; 12 months, 81.9%), according to researchers.

Based on average physical functioning domain scores of the 30-item European Organization for the Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30) capturing self-reported physical function at 3 months, researchers found that the two groups did not significantly differ from each other (intervention, 77.3 vs. usual care, 76.3).

In contrast, three measures did significantly differ between the two groups, with more favorable outcomes reported among those receiving the home-based exercise and self-management program. According to the study, these included:

• 6-minute walk distance/exercise capacity (mean difference, 39.7 m; 95% CI, 6.8 m-72.6 m);
• global health-related quality of life (mean difference, 7.1 points; 95% CI, 0.4-13.8 points); and
• exercise self-efficacy (mean difference, 16 points; 95% CI, 7-24.9 points).

At the 6-month mark, researchers observed a similar pattern as the intervention group continued to have more improvement in 6-minute walk distance (mean difference, 50.9 m; 95% CI, 6.7 m-95.1 m) and exercise self-efficacy (mean difference, 10.1 points; 95% CI, 1.9-18.2 points) vs. the usual care group.

The mean difference in Short Physical Performance Battery total score (0.8 points; 95% CI, 0.1-1.6 points), which captures an objective measure of physical function, also signalled more improvement among those receiving the home-based exercise and self-management program vs. usual care, according to the study.

In terms of safety, none of the patients experienced a serious adverse event. Among those receiving the intervention, one patient experienced new calf pain, deemed a minor adverse event. This event “resolved spontaneously,” according to researchers.

“This program is easy to replicate and may fit within existing staffing numbers at hospitals,” Granger told Healio. “We hope that clinicians elect to provide the program to their patients.”

Moving forward, Granger said this program should be evaluated against other types of exercise programs.

“We compared our program to a control of no exercise,” Granger told Healio. “Future studies should compare a home-based exercise program (like ours) to the more traditional programs of in-person center/hospital-based exercise programs to see if the benefits of a home-based program are just as great.

“If they are, home-based programs may be more appealing for some patients and clinicians,” Granger said.

A detailed program description can be found in a protocol paper published in BMJ Open Respiratory Research.

For more information:

Catherine L. Granger, PhD, FACP, can be reached at catherine.granger@unimelb.edu.au.