The effects of a six-week supervised multimodal exercise intervention during chemotherapy on cancer-related fatigue

Published:October 18, 2012DOI:https://doi.org/10.1016/j.ejon.2012.09.003

      Abstract

      Purpose

      Cancer related fatigue (CRF) is a common problem for cancer patients across diagnoses during chemotherapy and is associated with physical inactivity, lower functional level and lack of energy. Few RCT exercise intervention studies have included cancer patients undergoing chemotherapy. The objective of this study is to evaluate whether a six-week supervised multimodal exercise intervention, adjunct to chemotherapy and standard care, can reduce the patient's CRF level.

      Methods

      Data is based on analyses of a prospective randomised controlled trial ‘The Body & Cancer Trial’. 213 cancer patients with different diagnoses were randomised into an intervention group or wait-list control group. The primary outcome, Fatigue score (CRF), was evaluated by the Functional Assessment of Cancer Therapy-Anaemia Questionnaire (FACT-An-) (FACT-G score & FACT-An Anemia subscale). Intervention: Supervised exercise, comprising high-intensity cardiovascular and heavy resistance training, relaxation- and body awareness training and massage, 9 h weekly for 6 weeks.

      Results

      CRF was significantly reduced in the intervention group, corresponding to a Fatigue score reduction of 3.04 (effect size of 0.44, 95% CI 0.17–0.72) (P = .002), the FACT-An score by 5.40 (P = .015), the FACT-An Toi score by 5.22 (P = .009) and the Anaemia-ANS by 3.76 (P = .002). There was no statistically significant effect on the General Quality of Life score (FACT-G) or on any of the individual wellbeing scores; Physical (P = .13), Emotional (P = .87), Social (P = .83) and Functional (P = .26).

      Conclusion

      In summary, this six-week supervised multimodal exercise intervention can lead to significant reduction in self-reported CRF in cancer patients undergoing chemotherapy.

      Keywords

      To read this article in full you will need to make a payment

      Subscribe:

      Subscribe to European Journal of Oncology Nursing
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Adamsen L.
        • Midtgaard J.
        • Andersen C.
        • Quist M.
        • Moeller T.
        • Roerth M.
        Transforming the nature of fatigue through exercise: qualitative findings from a multidimensional exercise programme in cancer patients undergoing chemotherapy.
        European Journal of Cancer Care. 2004; 13: 362-370
        • Adamsen L.
        • Quist M.
        • Midtgaard J.
        • Andersen C.
        • Moller T.
        • Knutsen L.
        • et al.
        The effect of a multidimensional exercise intervention on physical capacity, well-being and quality of life in cancer patients undergoing chemotherapy.
        Supportive Care in Cancer. 2006; 14: 116-127
        • Adamsen L.
        • Andersen C.
        • Midtgaard J.
        • Moller T.
        • Quist M.
        • Rorth M.
        Struggling with cancer and treatment: young athletes recapture body control and identity through exercise: qualitative findings from a supervised group exercise program in cancer patients of mixed gender undergoing chemotherapy.
        Scandinavian Journal of Medicine & Science in Sports. 2009; 19: 55-66
        • Adamsen L.
        • Quist M.
        • Andersen C.
        • Moller T.
        • Herrstedt J.
        • Kronborg D.
        • et al.
        Effect of a multimodal high intensity exercise intervention in cancer patients undergoing chemotherapy: randomised controlled trial.
        British Medical Journal. 2009; 339: b3410
        • Ahlberg K.
        • Ekman T.
        • Gaston-Johansson F.
        • Mock V.
        Assessment and management of cancer-related fatigue in adults.
        Lancet. 2003; 362: 640-650
        • Ainsworth B.E.
        • Haskell W.L.
        • Herrmann S.D.
        • Meckes N.
        • Bassett Jr., D.R.
        • Tudor-Locke C.
        • et al.
        2011 Compendium of physical activities: a Second update of codes and MET values.
        Medicine and Science in Sports and Exercise. 2011; 43: 1575-1581
        • Andersen C.
        • Adamsen L.
        • Moeller T.
        • Midtgaard J.
        • Quist M.
        • Tveteraas A.
        • et al.
        The effect of a multidimensional exercise programme on symptoms and side-effects in cancer patients undergoing chemotherapy–the use of semi-structured diaries.
        European Journal of Oncology Nursing. 2006; 10: 247-262
        • Battaglini C.L.
        • Hackney A.C.
        • Garcia R.
        • Groff D.
        • Evans E.
        • Shea T.
        The effects of an exercise program in leukemia patients.
        Integrative Cancer Therapies. 2009; 8: 130-138
        • Berger A.M.
        • VonEssen S.
        • Khun B.R.
        • Piper B.F.
        • Farr L.
        • Agrawal S.
        • et al.
        Feasibilty of a sleep intervention during adjuvant breast cancer chemotherapy.
        Oncology Nursing Forum. 2002; 29: 1431-1441
        • Bower J.E.
        • Woolery A.
        • Sternlieb B.
        • Garet D.
        Yoga for cancer patients and survivors.
        Cancer Control. 2005; 12: 165-171
        • Brucker P.S.
        • Yost K.
        • Cashy J.
        • Webster K.
        • Cella D.
        General population and cancer patient norms for the functional assessment of cancer therapy-general (FACT-G).
        Evaluation & the Health Professions. 2005; 28: 192-211
        • Campos M.P.
        • Hassan B.J.
        • Riechelmann R.
        • Del G.A.
        Cancer-related fatigue: a review.
        Revista da Associação Médica Brasileira. 2011; 57: 211-219
        • Cella D.
        • Webster K.
        Linking outcomes management to quality-of-life measurement.
        Oncology (Williston.Park). 1997; 11: 232-235
        • Cella D.
        Factors influencing quality of life in cancer patients: anemia and fatigue.
        Seminars in Oncology. 1998; 25: 43-46
        • Cella D.
        • Eton D.T.
        • Lai J.S.
        • Peterman A.H.
        • Merkel D.E.
        Combining anchor and distribution-based methods to derive minimal clinically important differences on the Functional Assessment of Cancer Therapy (FACT) anemia and fatigue scales.
        Journal of Pain and Symptom Management. 2002; 24: 547-561
        • Chang P.H.
        • Lai Y.H.
        • Shun S.C.
        • Lin L.Y.
        • Chen M.L.
        • Yang Y.
        • et al.
        Effects of a walking intervention on fatigue-related experiences of hospitalized acute myelogenous leukemia patients undergoing chemotherapy: a randomized controlled trial.
        Journal of Pain and Symptom Management. 2008; 35: 524-534
        • Cohen J.
        Statistical Power Analysis for the Behavioral Sciences.
        second ed. Lawrence Erlbaum Associates, Hillsdale, NJ1988
        • Coleman E.A.
        • Coon S.
        • Hall-Barrow J.
        • Richards K.
        • Gaylor D.
        • Stewart B.
        Feasibility of exercise during treatment for multiple myeloma.
        Cancer Nursing. 2003; 26: 410-419
        • Courneya K.S.
        • Friedenreich C.M.
        • Quinney H.A.
        • Fields A.L.
        • Jones L.W.
        • Fairey A.S.
        A randomized trial of exercise and quality of life in colorectal cancer survivors.
        European Journal of Cancer Care. 2003; 12: 347-357
        • Courneya K.S.
        • Segal R.J.
        • Gelmon K.
        • Reid R.D.
        • Mackey J.R.
        • Friedenreich C.M.
        • et al.
        Six-month follow-up of patient-rated outcomes in a randomized controlled trial of exercise training during breast cancer chemotherapy.
        Cancer Epidemiology, Biomarkers & Prevention. 2007; 16: 2572-2578
        • Courneya K.S.
        • Sellar C.M.
        • Stevinson C.
        • McNeely M.L.
        • Peddle C.J.
        • Friedenreich C.M.
        • et al.
        Randomized controlled trial of the effects of aerobic exercise on physical functioning and quality of life in lymphoma patients.
        Journal of Clinical Oncology. 2009; 27: 4605-4612
        • Cramp F.
        • Daniel J.
        Exercise for the management of cancer-related fatigue in adults.
        Cochrane Database of Systematic Reviews. 2008; (CD006145)
        • da Costa B.R.
        • Vieira E.R.
        Stretching to reduce work-related musculoskeletal disorders: a systematic review.
        Journal of Rehabilitation Medicine. 2008; 40: 321-328
        • Demiralp M.
        • Oflaz F.
        • Komurcu S.
        Effects of relaxation training on sleep quality and fatigue in patients with breast cancer undergoing adjuvant chemotherapy.
        Journal of Clinical Nursing. 2010; 19: 1073-1083
        • Dimeo F.
        • Fetscher S.
        • Lange W.
        • Mertelsmann R.
        • Keul J.
        Effects of aerobic exercise on the physical performance and incidence of treatment-related complications after high-dose chemotherapy.
        Blood. 1997; 90: 3390-3394
        • Dimeo F.C.
        • Stieglitz R.D.
        • Novelli-Fischer U.
        • Fetscher S.
        • Keul J.
        Effects of physical activity on the fatigue and psychologic status of cancer patients during chemotherapy.
        Cancer. 1999; 85: 2273-2277
        • Dodd M.J.
        • Cho M.H.
        • Miaskowski C.
        • Painter P.L.
        • Paul S.M.
        • Cooper B.A.
        • et al.
        A randomized controlled trial of home-based exercise for cancer-related fatigue in women during and after chemotherapy with or without radiation therapy.
        Cancer Nursing. 2010; 33: 245-257
        • Ferrell-Torry A.T.
        • Glick O.J.
        The use of therapeutic massage as a nursing intervention to modify anxiety and the perception of cancer pain.
        Cancer Nursing. 1993; 16: 93-101
        • Hartvig P.
        • Aulin J.
        • Hugerth M.
        • Wallenberg S.
        • Wagenius G.
        Fatigue in cancer patients treated with cytotoxic drugs.
        Journal of Oncology Pharmacy Practice. 2006; 12: 155-164
        • Headley J.A.
        • Ownby K.K.
        • John L.D.
        The effect of seated exercise on fatigue and quality of life in women with advanced breast cancer.
        Oncology Nursing Forum. 2004; 31: 977-983
        • Henry D.H.
        • Viswanathan H.N.
        • Elkin E.P.
        • Traina S.
        • Wade S.
        • Cella D.
        Symptoms and treatment burden associated with cancer treatment: results from a cross-sectional national survey in the U.S.
        Supportive Care in Cancer. 2008; 16: 791-801
        • Hofman M.
        • Ryan J.L.
        • Figueroa-Moseley C.D.
        • Jean-Pierre P.
        • Morrow G.R.
        Cancer-related fatigue: the scale of the problem.
        The Oncologist. 2007; 12: 4-10
        • Jacobsen P.B.
        • Donovan K.A.
        • Vadaparampil S.T.
        • Small B.J.
        Systematic review and meta-analysis of psychological and activity-based interventions for cancer-related fatigue.
        Health Psychology. 2007; 26: 660-667
        • Jarden M.
        • Baadsgaard M.T.
        • Hovgaard D.J.
        • Boesen E.
        • Adamsen L.
        A randomized trial on the effect of a multimodal intervention on physical capacity, functional performance and quality of life in adult patients undergoing allogeneic SCT.
        Bone Marrow Transplantation. 2009; 43: 725-737
        • Kangas M.
        • Bovbjerg D.H.
        • Montgomery G.H.
        Cancer-related fatigue: a systematic and meta-analytic review of non-pharmacological therapies for cancer patients.
        Psychological Bulletin. 2008; 134: 700-741
        • Lerman C.
        • Rimer B.
        • Blumberg B.
        • Cristinzio S.
        • Engstrom P.F.
        • MacElwee N.
        • et al.
        Effects of coping style and relaxation on cancer chemotherapy side effects and emotional responses.
        Cancer Nursing. 1990; 13: 308-315
        • Lucia A.
        • Earnest C.
        • Perez M.
        Cancer-related fatigue: can exercise physiology assist oncologists?.
        The Lancet Oncology. 2003; 4: 616-625
        • Lyles J.N.
        • Burish T.G.
        • Krozely M.G.
        • Oldham R.K.
        Efficacy of relaxation training and guided imagery in reducing the aversiveness of cancer chemotherapy.
        Journal of Consulting and Clinical Psychology. 1982; 50: 509-524
        • MacVicar M.G.
        • Winningham M.L.
        • Nickel J.L.
        Effects of aerobic interval training on cancer patients' functional capacity.
        Nursing Research. 1989; 38: 348-351
        • Markes M.
        • Brockow T.
        • Resch K.L.
        Exercise for women receiving adjuvant therapy for breast cancer.
        Cochrane Database of Systematic Reviews. 2006; (CD005001)
        • McNeely M.L.
        • Campbell K.L.
        • Rowe B.H.
        • Klassen T.P.
        • Mackey J.R.
        • Courneya K.S.
        Effects of exercise on breast cancer patients and survivors: a systematic review and meta-analysis.
        Canadian Medical Association Journal. 2006; 175: 34-41
        • Midtgaard J.
        • Rorth M.
        • Stelter R.
        • Tveteras A.
        • Andersen C.
        • Quist M.
        • et al.
        The impact of a multidimensional exercise program on self-reported anxiety and depression in cancer patients undergoing chemotherapy: a phase II study.
        Palliative & Supportive Care. 2005; 3: 197-208
        • Midtgaard J.
        • Stage M.
        • Moller T.
        • Andersen C.
        • Quist M.
        • Rorth M.
        • et al.
        Exercise may reduce depression but not anxiety in self-referred cancer patients undergoing chemotherapy. Post-hoc analysis of data from the ‘Body & Cancer’ trial.
        Acta Oncologica. 2011; 50: 660-669
        • Minton O.
        • Richardson A.
        • Sharpe M.
        • Hotopf M.
        • Stone P.
        Drug therapy for the management of cancer-related fatigue.
        Cochrane Database of Systematic Reviews. 2010; (CD006704)
        • Mock V.
        • Burke M.B.
        • Sheehan P.
        • Creaton E.M.
        • Winningham M.L.
        • Kenney-Tedder S.
        • et al.
        A nursing rehabilitation program for women with breast cancer receiving adjuvant chemotherapy.
        Oncology Nursing Forum. 1994; 21: 899-907
        • Mock V.
        • Atkinson A.
        • Barsevick A.
        • Cella D.
        • Cimprich B.
        • Cleeland C.
        • et al.
        NCCN Practice guidelines for cancer-related fatigue.
        Oncology (Williston Park). 2000; 14: 151-161
        • Morrow G.R.
        • Andrews P.L.
        • Hickok J.T.
        • Roscoe J.A.
        • Matteson S.
        Fatigue associated with cancer and its treatment.
        Supportive Care in Cancer. 2002; 10: 389-398
        • Mutrie N.
        • Campbell A.M.
        • Whyte F.
        • McConnachie A.
        • Emslie C.
        • Lee L.
        • et al.
        Benefits of supervised group exercise programme for women being treated for early stage breast cancer: pragmatic randomised controlled trial.
        British Medical Journal. 2007; 334: 517
        • Nakagawa S.
        • Cuthill I.C.
        Effect size, confidence interval and statistical significance: a practical guide for biologists.
        Biological Reviews of the Cambridge Philosophical Society. 2007; 82: 591-605
        • Post-White J.
        • Kinney M.E.
        • Savik K.
        • Gau J.B.
        • Wilcox C.
        • Lerner I.
        Therapeutic massage and healing touch improve symptoms in cancer.
        Integrative Cancer Therapies. 2003; 2: 332-344
        • Quist M.
        • Rorth M.
        • Zacho M.
        • Andersen C.
        • Moeller T.
        • Midtgaard J.
        • et al.
        High-intensity resistance and cardiovascular training improve physical capacity in cancer patients undergoing chemotherapy.
        Scandinavian Journal of Medicine & Science in Sports. 2006; 16: 349-357
        • Quist M.
        • Rørth M.
        • Langer S.
        • Jones L.W.
        • Laursen J.H.
        • Pappot H.
        • et al.
        Safety and feasibility of a combined exercise intervention for inoperable lung cancer patients undergoing chemotherapy: a pilot study.
        Lung Cancer. 2011; 75: 203-208
        • Saltin B.
        • Gollnick P.D.
        Skeletal muscle adaptability: significance for metabolism and performance.
        in: Pearcey L.D. Adrain P.H. Geiger S.R. Handbook of Physiology, Sektion 10: Skeletal Muscle. American Physiological Society, Washington DC1983: 555-631
        • Sawada N.O.
        • Zago M.M.
        • Galvao C.M.
        • Cardozo F.M.
        • Zandonai A.P.
        • Okino L.
        • et al.
        The outcomes of visualization and acupuncture on the quality of life of adult cancer patients receiving chemotherapy.
        Cancer Nursing. 2010; 33: E21-E28
        • Schwartz A.L.
        • Winters-Stone K.
        • Gallucci B.
        Exercise effects on bone mineral density in women with breast cancer receiving adjuvant chemotherapy.
        Oncology Nursing Forum. 2007; 34: 627-633
        • Schwartz A.L.
        Fatigue mediates the effects of exercise on quality of life.
        Quality of Life Research. 1999; 8: 529-538
        • Schwartz A.L.
        • Mori M.
        • Gao R.
        • Nail L.M.
        • King M.E.
        Exercise reduces daily fatigue in women with breast cancer receiving chemotherapy.
        Medicine and Science in Sports and Exercise. 2001; 33: 718-723
        • Segal R.
        • Evans W.
        • Johnson D.
        • Smith J.
        • Colletta S.
        • Gayton J.
        • et al.
        Structured exercise improves physical functioning in women with stages I and II breast cancer: results of a randomized controlled trial.
        Journal of Clinical Oncology. 2001; 19: 657-665
        • Speck R.M.
        • Courneya K.S.
        • Masse L.C.
        • Duval S.
        • Schmitz K.H.
        An update of controlled physical activity trials in cancer survivors: a systematic review and meta-analysis.
        Journal of Cancer Survivorship. 2010; 4: 87-100
        • Stasi R.
        • Abriani L.
        • Beccaglia P.
        • Terzoli E.
        • Amadori S.
        Cancer-related fatigue: evolving concepts in evaluation and treatment.
        Cancer. 2003; 98: 1786-1801
        • Velthuis M.J.
        • Agasi-Idenburg S.C.
        • Aufdemkampe G.
        • Wittink H.M.
        The effect of physical exercise on cancer-related fatigue during cancer treatment: a meta-analysis of randomised controlled trials.
        Clinical Oncology (Royal College of Radiologists). 2010; 22: 208-221
        • Wagner L.I.
        • Cella D.
        Fatigue and cancer: causes, prevalence and treatment approaches.
        British Journal of Cancer. 2004; 91: 822-828
        • Yang C.Y.
        • Tsai J.C.
        • Huang Y.C.
        • Lin C.C.
        Effects of a home-based walking program on perceived symptom and mood status in postoperative breast cancer women receiving adjuvant chemotherapy.
        Journal of Advanced Nursing. 2011; 67: 158-168
        • Yellen S.B.
        • Cella D.F.
        • Webster K.
        • Blendowski C.
        • Kaplan E.
        Measuring fatigue and other anemia-related symptoms with the Functional Assessment of Cancer Therapy (FACT) measurement system.
        Journal of Pain and Symptom Management. 1997; 13: 63-74