Non-small cell lung cancer: physical capacity is associated with survival

Physical measures, mostly assessed before treatment

The researchers searched three bibliographic databases for available studies through May 2025. They included studies examining the link between at least one objective measure of physical functioning and survival in adults with this cancer.

Assessments were most often conducted before treatment. The authors separated surgical from non-surgical patients, then classified the measures according to body functions, activities and participation. This distinction matters: the indicators studied were not the same in the two groups.

An association observed across several dimensions

In surgical patients, the studies covered only activity-related measures. The meta-analysis of this group indicates that survivors had better exercise capacity, assessed using cardiopulmonary exercise testing or field tests.

In non-surgical patients, low grip strength, low exercise capacity and physical inactivity were each associated with higher mortality. The reported hazard ratios were 1.27, 2.11 and 2.86, respectively.

These values describe relative associations, not individual probabilities of death. The abstract provides neither absolute risks nor confidence intervals that would allow a precise assessment of the magnitude and uncertainty of these findings.

A prognostic indicator, not proof that exercise works

The central distinction is between prediction and intervention. Low physical capacity may signal a less favorable prognosis without this review establishing why. The abstract does not allow us to determine the extent to which cancer severity or other patient characteristics explain the associations.

The authors suggest that physical assessment could help better distinguish risk levels and personalize care. However, the studies used varying thresholds and showed heterogeneity. No study in surgical patients assessed the domains of body functions or participation.

These findings therefore support the prognostic value of physical measures. They do not allow us to choose a training program or promise a survival benefit from improving a score.

What we can take away

Physical capacity appears to provide useful information about the prognosis of this cancer. Demonstrating that an intervention aimed at improving it extends survival remains a separate question.