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)