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); or