Objective: To characterize heterogeneity in physical activity (PA) trajectories among patients with lung cancer during early chemotherapy and examine associated demographic, clinical, and psychosocial factors.Methods: This longitudinal study enrolled 155 patients initiating chemotherapy at the First Affiliated Hospital of Anhui Medical University in Anhui Province, China.PA were assessed using the International Physical Activity Questionnaire-Short Form at baseline and before the second, third, and fourth cycles.Symptom burden, exercise self-efficacy, outcome expectations for exercise, and social support were assessed exclusively at baseline.Latent class growth analysis was utilized to identify PA trajectories.Factors associated with trajectory membership were analyzed using a two-stage strategy combining least absolute shrinkage and selection operator J o u r n a l P r e -p r o o f regression and Firth's penalized logistic regression.Results: Among 122 completers, two distinct trajectories were identified.The majority (77.9%) followed a "Moderate-Sustained Decline" trajectory, showing a significant drop at cycle 2 with persistently low activity.Conversely, 22.1% exhibited a "High-Decline-Partial Recovery" trajectory, characterized by a behavioral rebound after the initial decline.Multivariate analysis revealed that higher symptom burden (OR = 1.105,P = 0.028) and more pessimistic outcome expectations (OR = 1.723,P = 0.005) increased the likelihood of sustained decline.Higher exercise self-efficacy (OR = 0.855, P = 0.003) was significantly associated with the partial recovery profile. Conclusion:PA patterns are heterogeneous, though a decline prior to the second cycle is universal.Lower symptom burden and robust cognitive resources facilitate resilience.Proactive nursing interventions integrating symptom management with cognitive-behavioral empowerment targeting the critical window before the second cycle are recommended to prevent functional decline.
Cao et al. (2026) studied this question.