Exercise interventions
This pilot study consisted of a 12-week concurrent EIP and palliative chemotherapy. All patients were required to perform an EIP for 6 weeks, and patients who comply with this program were allowed to maintain the exercise for an additional 6 weeks. After screening, eligible patients began receiving palliative chemotherapy and started an EIP. Patients received fourth to sixth cycles of chemotherapy with the same regimen. Before starting palliative chemotherapy, patients consulted the Department of Rehabilitation Medicine to conduct a baseline assessment and to receive education on the EIP.The EIP consisted of three levels of exercise intensities: low, moderate, and high. Patients were asked to select the intensity according to their ability. Patients were recommended to start with the low intensity and to increase the intensity if tolerable. Each of the three levels of exercise intensity consisted of a total of 30–40 min. The low-intensity level recommended a total exercise time of 30 min with a warm-up exercise of 5 min, a main exercise of 20 min, and a cool-down exercise of 5 min. The moderate- to high-intensity level recommended a total exercise time of 40 min with a warm-up exercise of 5 min, a main exercise of 30 min, and a cool-down exercise of 5 min. The main exercise consisted of aerobic exercises such as walking on a treadmill, level walking or running for 15 min and resistant exercises using dumbbells, isotonic resistance bands or bicycle ergometer for 15 min. The low-intensity level was equivalent to 9–10 points on the Borg’s ratings of perceived exertion (PRE) and a heart rate reserve (HRR) of 30% during the main exercise. The moderate-intensity level was equivalent to 11–13 points on the PRE and an HRR of 40–50% during the main exercise. The high-intensity level was equivalent to 14–15 points on the PRE and an HRR of 70% during the main exercise.