Low-intensity circuit exercise, psychological resilience, and quality of life in elderly lung cancer: A bibliometric review
Abstract
This review synthesizes evidence on Low-Intensity Circuit Exercise (LICE), psychological resilience, and quality of life (QOL) among elderly lung cancer populations using bibliometric and scoping methodologies. A search of the Web of Science Core Collection (2005–2025) identified 147 eligible studies after structured screening. Quantitative bibliometric mapping and qualitative thematic analysis were used to characterize publication trends, conceptual frameworks, and interdisciplinary linkages. Across the literature, low-intensity exercise modalities particularly circuit-based and combined aerobic-resistance formats were frequently associated with improvements in muscle strength, functional capacity, and selected cardiopulmonary indicators, while demonstrating favorable safety and adherence profiles in older adults. Psychological resilience emerged as a recurring construct linked to emotional well-being and QOL, with studies describing theoretical pathways involving stress regulation and self-efficacy. However, empirical evidence for resilience as a mediator remains limited and heterogeneous. Gaps identified through the review include a shortage of longitudinal designs, inconsistent reporting of exercise parameters, and variability in resilience measurement tools. Future research should prioritize standardized assessments, stratified analyses of older subgroups, and multidisciplinary approaches to better clarify how low-intensity exercise can be integrated into comprehensive rehabilitation strategies for elderly lung cancer patients. This review provides an updated evidence synthesis and highlights key directions for advancing exercise-based supportive care in psycho-oncology.
Copyright (c) 2025 Hengzhe Guo, Mengyu Hao, Ye Tao, Mei Gong
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
1. Siegel RL, Miller KD, Wagle NS, et al. Cancer statistics, 2023. CA: A Cancer Journal for Clinicians. 2023; 73(1): 17-48. doi: 10.3322/caac.21763
2. Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA: A Cancer Journal for Clinicians. 2021; 71(3): 209–249. doi: 10.3322/caac.21660
3. Giacalone A, Quitadamo D, Zanet E, et al. Cancer-related fatigue in the elderly. Supportive Care in Cancer. 2013; 21(10): 2899-2911. doi: 10.1007/s00520-013-1897-1
4. Bower JE. Cancer-related fatigue—mechanisms, risk factors, and treatments. Nature Reviews Clinical Oncology. 2014; 11(10): 597-609. doi: 10.1038/nrclinonc.2014.127
5. Baracos VE, Martin L, Korc M, et al. Cancer-associated cachexia. Nature Reviews Disease Primers. 2018; 4(1). doi: 10.1038/nrdp.2017.105
6. Stout NL, Baima J, Swisher AK, et al. A Systematic Review of Exercise Systematic Reviews in the Cancer Literature (2005‐2017). PM&R. 2017; 9(9S2). doi: 10.1016/j.pmrj.2017.07.074
7. Mustian KM, Alfano CM, Heckler C, et al. Comparison of Pharmaceutical, Psychological, and Exercise Treatments for Cancer-Related Fatigue: A Meta-analysis. JAMA Oncology. 2017; 3(7): 961-968. doi:10.1001/jamaoncol.2016.6914
8. Zhu R, Liu Z, Jiao R, et al. Updates on the pathogenesis of advanced lung cancer‐induced cachexia. Thoracic Cancer. 2018; 10(1): 8-16. doi: 10.1111/1759-7714.12910
9. Avancini A, Cavallo A, Trestini I, et al. Exercise prehabilitation in lung cancer: Getting stronger to recover faster. European Journal of Surgical Oncology. 2021; 47(8): 1847-1855. doi: 10.1016/j.ejso.2021.03.231
10. Hu Y, Gu S, Bu Z, et al. Effect of exercise for patients with advanced lung cancer and cancer-related fatigue: A systematic review and meta-analysis. Journal of Sport and Health Science. 2025; 14: 101017. doi: 10.1016/j.jshs.2024.101017
11. Venuta F, Diso D, Onorati I, et al. Lung cancer in elderly patients. Journal of Thoracic Disease. 2016; 8(S11): S908-S914. doi: 10.21037/jtd.2016.05.20
12. Clifford BK, Jones MD, Simar D, et al. The effect of exercise intensity on exercise‐induced hypoalgesia in cancer survivors: A randomized crossover trial. Physiological Reports. 2021; 9(19). doi: 10.14814/phy2.15047
13. Mavropalias G, Calapre L, Morici M, et al. Changes in plasma hydroxyproline and plasma cell-free DNA concentrations after higher- versus lower-intensity eccentric cycling. European Journal of Applied Physiology. 2021; 121(4): 1087-1097. doi: 10.1007/s00421-020-04593-1
14. Kocamaz D, Fidancioğlu NA, Yilmaz RC, et al. The effect of low-intensity resistance exercise training on Serum tumor biomarkers and quality of life in women with breast cancer: A randomized controlled trial. Cancer Biomarkers. 2025; 42(3). doi: 10.1177/18758592251329201
15. Tanaka M, Sugimoto K, Fujimoto T, et al. Preventive effects of low‐intensity exercise on cancer cachexia–induced muscle atrophy. The FASEB Journal. 2019; 33(7): 7852-7862. doi: 10.1096/fj.201802430r
16. Tomlinson D, Diorio C, Beyene J, et al. Effect of Exercise on Cancer-Related Fatigue. American Journal of Physical Medicine & Rehabilitation. 2014; 93(8): 675-686. doi: 10.1097/phm.0000000000000083
17. Giallauria F, Testa C, Cuomo G, et al. Exercise Training in Elderly Cancer Patients: A Systematic Review. Cancers. 2023; 15(6): 1671. doi: 10.3390/cancers15061671
18. Mikkelsen MK, Lund CM, Vinther A, et al. Effects of a 12-Week Multimodal Exercise Intervention Among Older Patients with Advanced Cancer: Results from a Randomized Controlled Trial. The Oncologist. 2022; 27(1): 67-78. doi: 10.1002/onco.13970
19. Adamsen L, Quist M, Andersen C, et al. Effect of a multimodal high intensity exercise intervention in cancer patients undergoing chemotherapy: randomised controlled trial. BMJ. 2009; 339(oct13 1): b3410-b3410. doi: 10.1136/bmj.b3410
20. Cheung DST, Takemura N, Chau PH, et al. Exercise levels and preferences on exercise counselling and programming among older cancer survivors: A mixed-methods study. Journal of Geriatric Oncology. 2021; 12(8): 1173-1180. doi: 10.1016/j.jgo.2021.05.002
21. Matta Mello Portugal E, Cevada T, Sobral Monteiro-Junior R, et al. Neuroscience of Exercise: From Neurobiology Mechanisms to Mental Health. Neuropsychobiology. 2013; 68(1): 1-14. doi: 10.1159/000350946
22. Courneya KS, McKenzie DC, Gelmon K, et al. A Multicenter Randomized Trial of the Effects of Exercise Dose and Type on Psychosocial Distress in Breast Cancer Patients Undergoing Chemotherapy. Cancer Epidemiology, Biomarkers & Prevention. 2014; 23(5): 857-864. doi: 10.1158/1055-9965.epi-13-1163
23. Serra MC, Ryan AS, Ortmeyer HK, et al. Resistance training reduces inflammation and fatigue and improves physical function in older breast cancer survivors. Menopause. 2018; 25(2): 211-216. doi:10.1097/GME.0000000000000969
24. Metcalfe JW, Orange ST, Madden LA, et al. Effects of resistance training on quality of life, fatigue, physical function, and muscular strength during chemotherapy treatment: a systematic review and meta-analysis. Supportive Care in Cancer. 2024; 32(9). doi: 10.1007/s00520-024-08766-y
25. Fukushima T, Nakano J, Ishii S, et al. Low-intensity exercise therapy with high frequency improves physical function and mental and physical symptoms in patients with haematological malignancies undergoing chemotherapy. European Journal of Cancer Care. 2018; 27(6): e12922. doi: 10.1111/ecc.12922
26. Chen HM, Tsai CM, Wu YC, et al. Randomised controlled trial on the effectiveness of home-based walking exercise on anxiety, depression and cancer-related symptoms in patients with lung cancer. British Journal of Cancer. 2014; 112(3): 438-445. doi: 10.1038/bjc.2014.612
27. Quist M, Adamsen L, Rørth M, et al. The Impact of a Multidimensional Exercise Intervention on Physical and Functional Capacity, Anxiety, and Depression in Patients With Advanced-Stage Lung Cancer Undergoing Chemotherapy. Integrative Cancer Therapies. 2015; 14(4): 341-349. doi: 10.1177/1534735415572887
28. Cheng D, Wang X, Hu J, et al. Effect of Tai Chi and Resistance Training on Cancer-Related Fatigue and Quality of Life in Middle-Aged and Elderly Cancer Patients. Chinese Journal of Integrative Medicine. 2021; 27(4): 265-272. doi: 10.1007/s11655-021-3278-9
29. van Waart H, Stuiver MM, van Harten WH, et al. Effect of Low-Intensity Physical Activity and Moderate- to High-Intensity Physical Exercise During Adjuvant Chemotherapy on Physical Fitness, Fatigue, and Chemotherapy Completion Rates: Results of the PACES Randomized Clinical Trial. Journal of Clinical Oncology. 2015; 33(17): 1918-1927. doi: 10.1200/jco.2014.59.1081
30. Wasley D, Gale N, Roberts S, et al. Patients with established cancer cachexia lack the motivation and self‐efficacy to undertake regular structured exercise. Psycho-Oncology. 2017; 27(2): 458-464. doi: 10.1002/pon.4512
31. Sullivan DR, Medysky ME, Tyzik AL, et al. Feasibility and potential benefits of partner‐supported yoga on psychosocial and physical function among lung cancer patients. Psycho-Oncology. 2021; 30(5): 789-793. doi: 10.1002/pon.5628
32. Han S, Zhang L, Li Q, et al. The Effects of Laughter Yoga on Perceived Stress, Positive Psychological Capital, and Exercise Capacity in Lung Cancer Chemotherapy Patients: A Pilot Randomized Trial. Integrative Cancer Therapies. 2023; 22. doi: 10.1177/15347354231218271
33. Takemura N, Cheung DST, Fong DYT, et al. Comparative effect of Tai Chi and aerobic exercise on cognitive function in advanced lung cancer survivors with perceived cognitive impairment: a three-arm randomized controlled trial with mediation analysis. Journal of Cancer Survivorship. 2024. doi:10.1007/s11764-024-01607-1
34. Denckla CA, Cicchetti D, Kubzansky LD, et al. Psychological resilience: an update on definitions, a critical appraisal, and research recommendations. European Journal of Psychotraumatology. 2020; 11(1). doi: 10.1080/20008198.2020.1822064
35. Li X, Chen S, Zhang J, et al. Resilience process and its protective factors in long-term survivors after lung cancer surgery: a qualitative study. Supportive Care in Cancer. 2020; 29(3): 1455-1463. doi: 10.1007/s00520-020-05633-4
36. Yin Y, Lyu M, Chen Y, et al. Self-efficacy and positive coping mediate the relationship between social support and resilience in patients undergoing lung cancer treatment: A cross-sectional study. Frontiers in Psychology. 2022; 13. doi: 10.3389/fpsyg.2022.953491
37. Hu T, Xiao J, Peng J, et al. Relationship between resilience, social support as well as anxiety/depression of lung cancer patients: A cross-sectional observation study. Journal of Cancer Research and Therapeutics. 2018; 14(1): 72-77. doi: 10.4103/jcrt.JCRT_849_17
38. Chen S, Mei R, Tan C, et al. Psychological resilience and related influencing factors in postoperative non‐small cell lung cancer patients: A cross‐sectional study. Psycho-Oncology. 2020; 29(11): 1815-1822. doi: 10.1002/pon.5485
39. Zhang C, Wang F, Kang Z, et al. Effect of Symptom Burden on Demoralization in Chinese Lung Cancer Patients: The Mediating Roles of Family Function, Resilience, and Coping Behaviors. Psycho-Oncology. 2025; 34(2). doi: 10.1002/pon.70102
40. Cho S, Ryu E. The mediating effect of resilience on happiness of advanced lung cancer patients. Supportive Care in Cancer. 2021; 29(11): 6217-6223. doi: 10.1007/s00520-021-06201-0
41. Ke J, Lin J, Lin X, et al. Dyadic effects of family resilience on quality of life in patients with lung cancer and spousal caregivers: The mediating role of dyadic coping. European Journal of Oncology Nursing. 2023; 66: 102400. doi: 10.1016/j.ejon.2023.102400
42. Yang Y, Qian X, Tang X, et al. The links between symptom burden, illness perception, psychological resilience, social support, coping modes, and cancer-related worry in Chinese early-stage lung cancer patients after surgery: a cross-sectional study. BMC Psychology. 2024; 12(1). doi: 10.1186/s40359-024-01946-9
43. Ye ZJ, Qiu HZ, Li PF, et al. Predicting changes in quality of life and emotional distress in Chinese patients with lung, gastric, and colon-rectal cancer diagnoses: the role of psychological resilience. Psycho-Oncology. 2016; 26(6): 829-835. doi: 10.1002/pon.4237
44. Xu J, Gao Z, Ji P, et al. Relationship between psychological resilience and quality of life in cancer patients and the multiple mediating roles of stigma and self perceived burden. Scientific Reports. 2025; 15(1). doi: 10.1038/s41598-025-96460-2
45. Huang J, Shi Y, Chen Y, et al. How social support influences learned helplessness in lung cancer patients: the chain mediation role of individual resilience and self-efficacy. Frontiers in Psychology. 2024; 15. doi: 10.3389/fpsyg.2024.1436495
46. Yang X, Li Y, Lin J, et al. Fear of recurrence in postoperative lung cancer patients: Trajectories, influencing factors and impacts on quality of life. Journal of Clinical Nursing. 2023; 33(4): 1409-1420. doi: 10.1111/jocn.16922
47. Hong YT, Ye BQ, Lin JL, et al. Characteristics and influencing factors of demoralization in patients with lung cancer: A latent class analysis. Psycho-Oncology. 2024; 33(3). doi: 10.1002/pon.6312
48. Seol KH, Bong SH, Kang DH, et al. Factors Associated with the Quality of Life of Patients with Cancer Undergoing Radiotherapy. Psychiatry Investigation. 2021; 18(1): 80-87. doi: 10.30773/pi.2020.0286
49. Mejia C, Wu M, Zhang Y, et al. Exploring Topics in Bibliometric Research Through Citation Networks and Semantic Analysis. Frontiers in Research Metrics and Analytics. 2021; 6: 742311. doi: 10.3389/frma.2021.742311
50. Arksey H, O’Malley L. Scoping studies: towards a methodological framework. International Journal of Social Research Methodology. 2005; 8(1): 19-32. doi: 10.1080/1364557032000119616
51. Donthu N, Kumar S, Mukherjee D, et al. How to conduct a bibliometric analysis: An overview and guidelines. Journal of Business Research. 2021; 133: 285-296. doi: 10.1016/j.jbusres.2021.04.070
52. Lyu P, Liu X, Yao T. A bibliometric analysis of literature on bibliometrics in recent half-century. Journal of Information Science. Published online August 21, 2023. doi: 10.1177/01655515231191233
53. Friedenreich CM, Neilson HK, Lynch BM. State of the epidemiological evidence on physical activity and cancer prevention. European Journal of Cancer. 2010; 46(14): 2593-2604. doi: 10.1016/j.ejca.2010.07.028
54. Brown JC, Winters‐Stone K, Lee A, et al. Cancer, Physical Activity, and Exercise. Comprehensive Physiology. Published online October 2012: 2775-2809. doi: 10.1002/cphy.c120005
55. Jacobsen PB, Donovan KA, Vadaparampil ST, et al. Systematic review and meta-analysis of psychological and activity-based interventions for cancer-related fatigue. Health Psychology. 2007; 26(6): 660-667. doi: 10.1037/0278-6133.26.6.660
56. Zhang Z, Chen W. A Systematic Review of the Relationship Between Physical Activity and Happiness. Journal of Happiness Studies. 2018; 20(4): 1305-1322. doi: 10.1007/s10902-018-9976-0
57. An HY, Chen W, Wang CW, et al. The Relationships between Physical Activity and Life Satisfaction and Happiness among Young, Middle-Aged, and Older Adults. International Journal of Environmental Research and Public Health. 2020; 17(13): 4817. doi: 10.3390/ijerph17134817
58. Chambers SK, Dunn J, Occhipinti S, et al. A systematic review of the impact of stigma and nihilism on lung cancer outcomes. BMC Cancer. 2012; 12: 184. doi:10.1186/1471-2407-12-184
59. Marker AM, Steele RG, Noser AE. Physical activity and health-related quality of life in children and adolescents: A systematic review and meta-analysis. Health Psychology. 2018; 37(10): 893-903. doi: 10.1037/hea0000653
60. Granger CL, McDonald CF, Irving L, et al. Low physical activity levels and functional decline in individuals with lung cancer. Lung Cancer. 2014; 83(2): 292-299. doi: 10.1016/j.lungcan.2013.11.014
61. Treanor C, Kyaw T, Donnelly M. An international review and meta-analysis of prehabilitation compared to usual care for cancer patients. Journal of Cancer Survivorship. 2017; 12(1): 64-73. doi: 10.1007/s11764-017-0645-9
62. Milne HM, Wallman KE, Guilfoyle A, et al. Self-determination theory and physical activity among breast cancer survivors. Journal of Sport and Exercise Psychology. 2008; 30(1): 23-38. doi:10.1123/jsep.30.1.23
63. Bade BC, Thomas DD, Scott JB, et al. Increasing Physical Activity and Exercise in Lung Cancer. Journal of Thoracic Oncology. 2015; 10(12): 1712. doi: 10.1097/jto.0000000000000681
64. Peddle CJ, Au HJ, Courneya KS. Associations Between Exercise, Quality of Life, and Fatigue in Colorectal Cancer Survivors. Diseases of the Colon & Rectum. 2008; 51(8): 1242-1248. doi: 10.1007/s10350-008-9324-2
65. Dhillon HM, Bell ML, van der Ploeg HP, et al. Impact of physical activity on fatigue and quality of life in people with advanced lung cancer: a randomized controlled trial. Annals of Oncology. 2017; 28(8): 1889-1897. doi: 10.1093/annonc/mdx205
66. Bradt J, Shim M, Goodill SW. Dance/movement therapy for improving psychological and physical outcomes in cancer patients. Cochrane Database of Systematic Reviews. 2015; 1(1): CD007103. doi: 10.1002/14651858
67. Nakano J, Hashizume K, Fukushima T, et al. Effects of Aerobic and Resistance Exercises on Physical Symptoms in Cancer Patients: A Meta-analysis. Integrative Cancer Therapies. 2018; 17(4): 1048-1058. doi: 10.1177/1534735418807555
68. Pinto BM, Stein K, Dunsiger S. Peers promoting physical activity among breast cancer survivors: A randomized controlled trial. Health Psychology. 2015; 34(5): 463-472. doi: 10.1037/hea0000120
69. Lynch J, Goodhart F, Saunders Y, et al. Screening for psychological distress in patients with lung cancer: results of a clinical audit evaluating the use of the patient Distress Thermometer. Supportive Care in Cancer. 2010; 19(2): 193-202. doi: 10.1007/s00520-009-0799-8
70. Rueda JR, Solà I, Pascual A, et al. Non-invasive interventions for improving well-being and quality of life in patients with lung cancer. Cochrane Database of Systematic Reviews. 2011; 2011(9): CD004282. doi: 10.1002/14651858.CD004282.pub3
71. Jones LW, Courneya KS, Fairey AS, et al. Does the Theory of Planned Behavior Mediate the Effects of an Oncologist’s Recommendation to Exercise in Newly Diagnosed Breast Cancer Survivors? Results From a Randomized Controlled Trial. Health Psychology. 2005; 24(2): 189-197. doi: 10.1037/0278-6133.24.2.189
72. Park CL, Edmondson D, Fenster JR, et al. Positive and Negative Health Behavior Changes in Cancer Survivors. Journal of Health Psychology. 2008; 13(8): 1198-1206. doi: 10.1177/1359105308095978
73. Clark MM, Novotny PJ, Patten CA, et al. Motivational readiness for physical activity and quality of life in long-term lung cancer survivors. Lung Cancer. 2008; 61(1): 117-122. doi: 10.1016/j.lungcan.2007.12.012
74. Huang Y, Huang Y, Bao M, et al. Psychological resilience of women after breast cancer surgery: a cross-sectional study of associated influencing factors. Psychology, Health & Medicine. 2019; 24(7): 866-878. doi: 10.1080/13548506.2019.1574353
75. Basen-Engquist K, Carmack CL, Li Y, et al. Social-cognitive theory predictors of exercise behavior in endometrial cancer survivors. Health Psychology. 2013; 32(11): 1137-1148. doi: 10.1037/a0031712
76. Gosain R, Gage-Bouchard E, Ambrosone C, et al. Stress reduction strategies in breast cancer: review of pharmacologic and non-pharmacologic based strategies. Seminars in Immunopathology. 2020; 42(6): 719-734. doi: 10.1007/s00281-020-00815-y
77. Bade BC, Brooks MC, Nietert SB, et al. Assessing the Correlation Between Physical Activity and Quality of Life in Advanced Lung Cancer. Integrative Cancer Therapies. 2016; 17(1): 73-79. doi: 10.1177/1534735416684016
78. Ungar N, Wiskemann J, Sieverding M. Physical Activity Enjoyment and Self-Efficacy As Predictors of Cancer Patients’ Physical Activity Level. Frontiers in Psychology. 2016; 7. doi: 10.3389/fpsyg.2016.00898
79. Granger CL, McDonald CF, Parry SM, et al. Functional capacity, physical activity and muscle strength assessment of individuals with non-small cell lung cancer: a systematic review of instruments and their measurement properties. BMC Cancer. 2013; 13(1). doi: 10.1186/1471-2407-13-135
80. Sun JY, Shi L, Gao XD, et al. Physical Activity and Risk of Lung Cancer: A Meta-Analysis of Prospective Cohort Studies. Asian Pacific Journal of Cancer Prevention. 2012; 13(7): 3143-3147. doi: 10.7314/apjcp.2012.13.7.3143
81. Granger CL, Parry SM, Edbrooke L, et al. Deterioration in physical activity and function differs according to treatment type in non-small cell lung cancer – future directions for physiotherapy management. Physiotherapy. 2016; 102(3): 256-263. doi: 10.1016/j.physio.2015.10.007
82. Dhillon HM, van der Ploeg HP, Bell ML, et al. The impact of physical activity on fatigue and quality of life in lung cancer patients: a randomised controlled trial protocol. BMC Cancer. 2012; 12(1). doi: 10.1186/1471-2407-12-572
