The effectiveness of concurrent training in lung cancer survivors: a systematic review.

Abstract

Background: Lung cancer is associated with marked functional decline, symptom burden, and reduced quality of life across the cancer care continuum. Although exercise is increasingly supported in oncology, evidence specific to concurrent training in people with lung cancer remains limited and heterogeneous. This review synthesized the effects of concurrent training in adults with a confirmed lung cancer diagnosis who were undergoing or had completed oncological treatment, with pulmonary function as the prespecified primary outcome and physical fitness, functional capacity, and patient-reported outcomes as secondary outcomes. This review also describes exercise prescription characteristics according to the FITT-VP (frequency, intensity, time, type, weekly volume, and progression) framework.

Methods: Eligible studies were clinical trials that implemented concurrent training combining aerobic and resistance exercise within the same session. Searches were conducted in PubMed, Scopus, and Web of Science from inception to October 2025, completed by a supplementary CENTRAL research. Risk of bias was assessed using the Cochrane Risk of Bias tool for randomized trials and ROBINS-I V2 for non-randomized studies. Results were synthesized using a structured narrative approach, with relative differences calculated when pre-post data were available, but were interpreted only as descriptive indicators of within-group change and not as causal estimates of intervention effectiveness.

Results: Ten studies met the inclusion criteria. Pulmonary outcomes showed limited and inconsistent responsiveness, with favorable changes in spirometric indices reported in only a minority of studies (6.3-10.5%), whereas most trials reported stability or small descriptive changes (-1.7% to 11.4%). More consistent favorable descriptive changes were observed in cardiorespiratory fitness (6.1-19%), functional capacity (6.4-9.1%), and muscular strength (5.5-42.8%). Favorable changes were also reported in selected patient-reported outcomes, including emotional well-being (9.2-12.6%), anxiety (12.5-24.6%), and sleep quality (28.6%). However, comparative effects were inconsistent across outcomes, and the evidence is limited by small sample sizes, methodological heterogeneity, inconsistent reporting, and risk of bias.

Conclusions: Concurrent training may be associated with favorable changes in exercise capacity, functional performance, and muscular strength in people with lung cancer, whereas pulmonary function appears less responsive. Evidence remains limited by within-group findings, inconsistent between-group effects, heterogeneity, and risk of bias. Larger randomized trials with standardized FITT-VP reporting, adherence and safety monitoring, and longer follow-up are needed.