title: Deterioration in physical activity and function differs according to treatment type in non-small cell lung cancer - future directions for physiotherapy management.
abstract: OBJECTIVE
  To investigate in non-surgically and surgically treated non-small cell lung cancer (NSCLC): (1) changes in physical activity, function, health-related quality of life (HRQoL) and symptoms after diagnosis; and (2) the association between physical activity and outcomes.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Three acute tertiary hospitals.
  
  
  METHODS
  Sixty-nine individuals (43 male, median [IQR] age 68 [61 to 74] years) with stage I-IV NSCLC.
  
  
  METHODS
  The primary outcome (Physical Activity Scale for the Elderly) and secondary outcome (six-minute walk test and questionnaires assessing HRQoL, function, symptoms, mood) were measured at diagnosis (pre-treatment), and eight to ten weeks post-diagnosis (post-operative and/or during chemotherapy/radiotherapy).
  
  
  RESULTS
  Individuals treated surgically (n=27) experienced a deterioration in physical activity levels (baseline median [IQR]=74 [51 to 135]; follow-up median [IQR]=29 [24 to 73]; median difference=45, effect size=0.3). At follow-up physical activity was inversely related to depression, pain and appetite loss (rho>0.5, p<0.05). In contrast non-surgical individuals (n=42) did not experience a change in physical activity, however did experience deterioration in function, functional capacity, global HRQoL, fatigue and dyspnoea. Physical activity levels were low in this group and at follow-up the strongest relationships with physical activity levels were global HRQoL, function, fatigue and mood (inverse, rho>0.5, p<0.05).
  
  
  CONCLUSIONS
  Surgically treated individuals experienced a reduction in physical activity levels after diagnosis, which was not seen in the non-surgical group. Lower physical activity levels were associated with poorer outcomes, particularly in non-surgically treated individuals. Further research is required to establish the optimal intervention to improve physical activity levels in these cohorts.
authors.affiliation: Department of Physiotherapy, The University of Melbourne, 161 Barry Street, Parkville 3010, Victoria, Australia; Department of Physiotherapy, Royal Melbourne Hospital, Grattan Street, Parkville 3010, Victoria, Australia; Institute for Breathing and Sleep, Heidelberg Road, Heidelberg 3084, Victoria, Australia. Electronic address: catherine.granger@unimelb.edu.au.
authors.forename: C L
authors.initials: CL
authors.lastname: Granger
authors.affiliation: Department of Physiotherapy, The University of Melbourne, 161 Barry Street, Parkville 3010, Victoria, Australia. Electronic address: selina.parry@unimelb.edu.au.
authors.forename: S M
authors.initials: SM
authors.lastname: Parry
authors.affiliation: Department of Physiotherapy, The University of Melbourne, 161 Barry Street, Parkville 3010, Victoria, Australia. Electronic address: larae@unimelb.edu.au.
authors.forename: L
authors.initials: L
authors.lastname: Edbrooke
authors.affiliation: Department of Physiotherapy, The University of Melbourne, 161 Barry Street, Parkville 3010, Victoria, Australia; Institute for Breathing and Sleep, Heidelberg Road, Heidelberg 3084, Victoria, Australia. Electronic address: linda.denehy@unimelb.edu.au.
authors.forename: L
authors.initials: L
authors.lastname: Denehy
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000503:physiopathology* / Q000628:therapy*; D004185:Disability Evaluation; D015444:Exercise; D005080:Exercise Test; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000503:physiopathology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires
keywords: Function; Health-related quality of life; Lung neoplasms; Non-small cell lung cancer; Physical activity; Physiotherapy