title: Improving muscle mass and function in cachexia:  non-drug approaches.
abstract: OBJECTIVE
  Therapeutic exercise may help maintain or slow down the rate of decline in muscle mass and physical function that occurs with cachexia. This review considers recent evidence in relation to patients with cachexia as regards the rationale for the use of exercise, the challenges in its clinical application and future developments.
  
  
  RESULTS
  Exercise may attenuate the effects of cachexia by modulating muscle metabolism, insulin sensitivity and levels of inflammation. Studies targeting cachectic patients have demonstrated that even in advanced disease peripheral muscle has the capacity to respond to exercise training. Nonetheless, there are challenges in implementing the use of exercise, particularly once cachexia is established in which tolerance to even low levels of exercise is poor. Strategies to make exercise a more accessible therapy are required and could include offering exercise earlier on in the course of the disease, at lower intensities and in various forms, including more novel approaches.
  
  
  CONCLUSIONS
  The use of therapeutic exercise has a sound rationale, even in patients with advanced disease and cachexia. Because of practical issues with its application, further study is required to examine if benefits achieved in small studies can be translated to a wider clinical population.
authors.affiliation: School Molecular Medical Sciences, University of Nottingham, Nottingham, UK. matthew.maddocks@nottingham.ac.uk
authors.forename: Matthew
authors.initials: M
authors.lastname: Maddocks
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Murton
authors.forename: Andrew
authors.initials: A
authors.lastname: Wilcock
mesh_terms: D002100:Cachexia / Q000378:metabolism / Q000517:prevention & control / Q000628:therapy*; D005081:Exercise Therapy / Q000379:methods*; D006801:Humans; D007249:Inflammation / Q000378:metabolism; D007333:Insulin Resistance; D009119:Muscle Contraction / Q000502:physiology; D018482:Muscle, Skeletal / Q000378:metabolism*; D009369:Neoplasms / Q000150:complications*