In a significant stride towards enhancing pre-treatment care for lung cancer patients, researchers have unveiled a pioneering study focusing on the integration of a structured exercise regimen before initiating conventional cancer therapies. This innovative approach, detailed in the latest issue of BMC Cancer, explores how combining slow movement training with tonic force generation alongside aerobic exercise can potentially optimize patient outcomes during the critical waiting period preceding treatment.
Lung cancer, notorious for its high morbidity and mortality rates worldwide, often renders patients physically vulnerable even before therapy commencement. Traditional cancer treatment paradigms primarily emphasize the therapeutic interventions post-diagnosis, frequently overlooking the potential benefits of prehabilitation. This novel study addresses this gap by assessing the feasibility and safety of exercise interventions initiated from the first clinical visit for suspected advanced lung cancer.
The pilot feasibility trial enrolled seventeen patients, averaging 70 years in age, all suspected of harboring advanced-stage lung cancer. Researchers implemented a four-week pre-treatment exercise protocol that uniquely combined slow movement training emphasizing tonic force generation with steady aerobic exercises. This dual-modality regimen was meticulously designed to maintain and possibly enhance the patients’ muscular functional capacity and cardiovascular endurance in anticipation of forthcoming oncologic treatments.
Attendance and adherence to the exercise program emerged as particularly compelling outcomes. Despite the participants’ advanced age and cancer suspicion, the overall attendance rate impressively exceeded 150%, with the majority surpassing a 70.8% adherence threshold. Remarkably, none of the participants experienced adverse events attributable to the exercise intervention, underscoring both the safety and acceptability of this approach in a vulnerable patient population.
Functional performance metrics revealed statistically significant improvements post-intervention. Specifically, enhanced results were recorded in the five-time sit-to-stand test and the 30-second chair stand test. These tests, widely recognized as reliable indicators of lower limb strength and endurance, suggest that the combined exercise training effectively bolstered muscular functional capacities essential for daily activities. Such improvements could translate to better physical resilience during subsequent cancer treatments.
Contrarily, other parameters, including the six-minute walk distance, one-leg standing time, handgrip strength, knee extensor strength, skeletal muscle mass, and self-reported quality of life measures, did not manifest statistically significant changes. This could reflect the relatively short intervention period or the inherent challenges posed by the advanced disease state in modulating these complex physiological variables.
Patient-reported feedback provided valuable qualitative insights. Participants commonly expressed that engaging in the exercise program alleviated anxiety and helped maintain their physical condition during a period often characterized by psychological stress and uncertainty. This mental health benefit aligns with mounting evidence that supports exercise as a non-pharmacological intervention to mitigate cancer-related distress, potentially improving overall patient wellbeing.
The implications of initiating such structured exercise regimes extend beyond immediate physical benefits. Pre-treatment conditioning may enhance treatment tolerance, reduce therapy-associated complications, and possibly facilitate quicker recovery. The current findings set a foundational precedent, advocating for the incorporation of early rehabilitative strategies in comprehensive cancer care pathways.
Methodologically, the study’s strength lies in its prospective design and the detailed functional assessments that spanned objective performance tests and subjective quality of life evaluations. However, its pilot nature and single-center scope necessitate cautious interpretation. Larger randomized controlled trials are imperative to substantiate these preliminary findings and to elucidate the long-term impacts on clinical outcomes such as treatment efficacy, survival rates, and sustained quality of life improvements.
The physiological rationale underpinning the exercise regimen draws from established principles of muscle physiology and aerobic conditioning. Slow movement training focusing on tonic force generation aims to engage muscle fibers through sustained, low-velocity contractions, promoting neuromuscular activation and endurance without excessive strain. Coupled with aerobic exercise, which enhances cardiorespiratory fitness, this combination targets holistic physical rehabilitation conducive to patients with compromised health status.
This innovative approach harmonizes with emerging concepts in oncologic prehabilitation, which emphasizes optimizing patients’ physical and psychological fitness prior to therapeutic interventions. By potentially modulating systemic inflammation, improving metabolic profiles, and preserving muscular integrity, such exercise strategies could ultimately mitigate cancer treatment’s detrimental effects.
Moreover, this study’s findings contribute to the growing recognition of personalized medicine in oncology. Tailoring exercise protocols that accommodate individual functional capacities and disease status may revolutionize supportive care models, aligning with patients’ unique needs and clinical circumstances.
While the improvements in specific functional tests underscore the tangible benefits, the absence of significant changes in other measures prompts further exploration into optimizing exercise intensity, duration, and modalities. Future protocols may incorporate resistance training or more varied aerobic activities to elicit broader physiological adaptations.
Additionally, the psychological benefits spotlighted by participant feedback encourage integrating psychosocial support with physical training programs. Such holistic approaches could enhance patient engagement and adherence, fostering a more robust pre-treatment state.
The absence of adverse events reinforces the safety profile of initiating exercise interventions soon after diagnosis, debunking previous concerns regarding potential risks in a medically fragile population. These outcomes support recommendations endorsing early and supervised physical activity in cancer care.
Given the study’s timing—commencing from the very first clinical visit—this paradigm enables leveraging the often underutilized pre-treatment interval for therapeutic benefit. This proactive stance contrasts conventional reactive strategies, potentially shifting clinical practices towards earlier, integrative interventions.
In summary, the START-lung pilot trial illuminates new pathways in oncology supportive care, demonstrating that structured, combined slow movement and aerobic exercise begun at diagnosis is both feasible and beneficial for patients with suspected advanced lung cancer. The study encourages further research to validate these findings and to explore the precise mechanisms through which exercise modulates cancer trajectories and patient resilience.
As cancer treatment continues to evolve, the incorporation of comprehensive prehabilitation could emerge as a standard component of multidisciplinary care, fostering improved functional outcomes and quality of life. This study’s compelling data herald a new era where exercise is appropriately positioned not merely as an adjunct but as an integral element in lung cancer management.
Subject of Research: Exercise interventions during the pre-treatment phase in patients with advanced lung cancer.
Article Title: Combined effects of slow movement training with tonic force generation and aerobic exercise prior to cancer therapy in patients with lung cancer (START-lung): a pilot feasibility trial.
Article References: Katsushima, U., Fukushima, T., Nakano, J. et al. Combined effects of slow movement training with tonic force generation and aerobic exercise prior to cancer therapy in patients with lung cancer (START-lung): a pilot feasibility trial. BMC Cancer 25, 1438 (2025). https://doi.org/10.1186/s12885-025-14728-2
Image Credits: Scienmag.com
DOI: https://doi.org/10.1186/s12885-025-14728-2
