Cancer, Lung

Overview of Lung Cancer

This condition includes many different types of tumors, with non-small cell lung cancer the most common type. Lung cancer is a leading cause of preventable death in the United States because smoking and environmental exposure are the primary risk factors. The risk of metastasis is high with these tumors due to the rich supply of lymphatic and blood vessels in the lungs. Treatment is usually a bout of radiation or chemotherapy, followed by surgical excision of the tumor. Clients become deconditioned due to the disease process and treatment programs that produce persistent fatigue and decreased tolerance to physical activities.

Comorbidities to Consider

• There is a high rate of complication with lung cancer that can affect the musculoskeletal structures of the trunk and upper extremities.

• Clients with a history of smoking or environmental exposures may have an underlying emphysema condition.

Client Examination

Keys to Examination of Clients

• Determine clients' physiologic status and preparedness for engaging in physical activities by assessing blood tests for platelet, hemoglobin, and white blood cell levels.

• Assessment of lung function helps determine clients' status for performing exercise testing and clients' capacity to improve aerobic capacity.

• Assess overall mobility of clients who have undergone surgical excisions; slowed wound healing and fibrotic scar formations can restrict movements.

Recommended Baseline Testing of Fitness Levels

• Use a cycle ergometer to measure peak Vo₂ and maximum heart rate.¹ A 6-minute walk test can assess exercise tolerance in clients undergoing chemotherapy for lung cancer.²

• Examine the breathing patterns and rib-cage expansion to determine if pulmonary rehabilitation interventions are needed.³

• Quality-of-life measures and fatigue levels can be assessed with the Functional Assessment of Cancer Therapy for lung cancer.⁴

Exercise Prescription

Type: Walking, stationary cycling

Intensity: Start at 60% of maximum heart rate^1,5,6

Duration: 20–30 minutes

Frequency: 4 days per week, with a day of rest between each session

Getting Started

Alternate exercise days with chemotherapy days as fatigue will be a limiting factor for exercise activities. Progress the program over 4 weeks toward 70% of maximum Vo₂ or heart rate for 20 to 30 minutes 4 days per week. Exercise intensity is best assessed by a combination of heart rate measures and perceived exertion levels as fatigue levels may affect daily intensities of exercises. A low-intensity weight-training program can be added to an established aerobic fitness program. Clients undergoing chemotherapy will need to be managed for their level of fatigue and other side effects to maintain adherence to their exercise program.⁷ Although treatment of this condition involves removal of or damage to lung parenchyma ...