Lung Cancer Exercise Training Study

Inclusion criteria

• Signed informed consent prior to initiation of study-related procedures
• Age 21 - 80 years
• Weight < 205 kgs
• ECOG ≤ 1
• Diagnosed with histologically confirmed lung cancer, regardless of disease stage and receiving any prior line of any therapy in the context of metastatic disease
• An interval of at least three months following the completion of primary resection, if appropriate
• An interval of no longer than ten years following completion of primary therapy, if appropriate
• Life expectancy ≥ 4 months
• Performing less than 150 minutes of structured moderate-intensity or strenuous-intensity exercise per week
• Exercise intolerance (i.e., patients must have a VO2peak below that predicted for active age and sex-matched individuals)
• Willing to be randomized to one of the study arms
• Willing to commit to the study program and comply with all related protocol procedures
• Able to achieve an acceptable peak baseline CPET, as defined by any of the following criteria:

• achieving a plateau in oxygen consumption, concurrent with an increase in power output;
• a respiratory exchange ratio ≥ 1.10;
• attainment of maximal predicted heart rate (HRmax) (i.e., within 10 bpm of age-predicted HRmax [HRmax = 220-Age[years]);
• volitional exhaustion, as measured by a rating of perceived exertion (RPE) ≥ 18 on the BORG scale.
• Able to complete an acceptable baseline CPET in the absence of high risk ECG findings or other inappropriate response to exercise as determined by the PI.
• Ability to achieve and complete an acceptable baseline one-repetition maximum muscular strength test as defined by the effective execution of protocol-specific joint and muscle ranges of motion without remarkable signs or symptoms of pain, discomfort or distress.

Exclusion criteria

• Presence of a concurrent, actively treated other malignancy, or history of other malignancy treated within the past 3 years (other than non-melanoma skin cancer);
• Room air desaturation at rest ≤ 85%;
• Mental impairment leading to inability to cooperate.
• Any of the following absolute contraindications to cardiopulmonary exercise testing:

• Acute myocardial infarction (within 3-5 days of any planned study procedures);
• Unstable angina;
• Uncontrolled arrhythmia causing symptoms or hemodynamic compromise;
• Recurrent syncope;
• Active endocarditis;
• Acute myocarditis or pericarditis;
• Symptomatic severe aortic stenosis;
• Uncontrolled heart failure;
• Acute (within 3 months) pulmonary embolus or pulmonary infarction;
• Thrombosis of lower extremities;
• Suspected dissecting aneurysm;
• Uncontrolled asthma;
• Pulmonary edema;
• Respiratory failure;
• Acute non-cardiopulmonary disorders that may affect exercise performance or be aggravated by exercise (i.e., infection, renal failure, thyrotoxicosis)