Understanding the Feasibility of a Co-designed Pre-radiotherapy Exercise Programme - A Single-arm Study

Inclusion Criteria:

* Patients with clinically or histologically confirmed NSCLC stages 1-3.
* Planned to receive treatment with curative intention radiation as primary treatment.
* Eastern Cooperative Oncology Group (ECOG) performance status 0-2.
* At least 18 years of age.
* Can understand and communicate in English.
* Deemed safe to participate in moderate-intensity exercise and for ECG monitored maximal fitness test through the completion of a medical clearance form by their treating physician.
* Able to provide written and informed consent.

Exclusion Criteria:

* Unstable or new angina (diagnosed within the previous month).
* Unstable or acute heart failure, cardiomyopathy, or other uncontrolled cardiac disease (as evidenced by symptomatic fluid retention, excessive breathlessness, rapid weight gain, swollen ankles or pitting oedema) within the previous 3 months.
* Presence of new or uncontrolled cardiac arrhythmias.
* Confirmed or suspected spinal cord compression.
* Uncontrolled diabetes (e.g. medication changed within 1 month, has had episodes of hypoglycaemia during the previous 2 weeks, or hyperglycaemia which does not decrease with exercise during the previous 2 weeks).
* Is receiving combination treatment with chemotherapy or immunotherapy.
* Current active secondary malignancy other than non-melanoma skin cancer.
* Has had orthopaedic surgery within the previous 3 months on weight-bearing bones.
* Chest pain while undertaking exercise or physical activity.
* No \> Grade 2 peripheral neuropathy.
* Metastatic disease beyond localised metastatic involvement (e.g. bone or brain).
* Has discovered any abnormalities shown on the ECG monitored maximal fitness test which warrant early termination or contraindicate physical activity.
* People with living with a physical disability which would limit their ability to exercise safely on the stationary exercise bike used within this study.
* People who are non-English speakers.
* People who are pregnant.

  * Patient participation in other clinical research - As an additional consideration, patients will be excluded if they are currently enrolled in an alternative exercise or physical activity study, as this may impact outcomes in both studies. However, if they have been involved in research prior to this or are currently involved in research in an unrelated area we will not immediately exclude them from trial participation. Instead, the Doctor of Philosophy (PhD) candidate, Chief investigator, and Principal investigator will discuss their involvement to determine safe and appropriate enrolment.
  * Physical disability - it is with regret that we will be limited in our capacity to offer alternative exercises to accommodate people with a physical disability. To elaborate, the Belfast City Hospitals (BCH) main gym is willing to lend a stationary exercise bike to the research team in support of this study. However, due to limitations on equipment availability in the trust, and limited funding/resources to purchase equipment, people who have a physical disability which limits their capacity to exercise safely on the stationary bike will be excluded from this study. In an ideal scenario, we would also have a recumbent stationary bike to support more people with physical disability get involved within this research.