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Schmitz KH, Speck RM. Risks and benefits of physical activity among breast cancer survivors who have completed treatment. ACTA ACUST UNITED AC 2010; 6:221-38. [PMID: 20187728 DOI: 10.2217/whe.10.1] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Worldwide, over 1 million cases of breast cancer are diagnosed each year. In the USA, approximately 185,000 women are newly diagnosed annually. Nearly 90% of newly diagnosed cancer patients in the USA will live for 5 years beyond diagnosis and there are estimated to be 2.4 million breast cancer survivors currently living in the USA. There are unique challenges in meeting the medical needs of these survivors. Persistent impairment and increased medical risks can occur as a result of treatment, including changes to the cardiovascular, pulmonary, endocrine, immune, musculoskeletal, neurological and lymphatic systems. Physical activity can cause positive changes in each of these body systems. However, physiologic impairments and altered risks for cardiopulmonary, bone health, neurosensory and other outcomes among breast cancer survivors can cause confusion regarding the safety of returning to exercise after treatment. In this article, we review the adverse effects of cancer treatments on the body systems affected by and used to perform exercise, the risks of exercise among breast cancer survivors, the effects of exercise on persistent treatment toxicities, whether exercise may prevent recurrence or mortality, as well as providing guidance for exercise testing and prescription among breast cancer survivors.
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Affiliation(s)
- Kathryn H Schmitz
- University of Pennsylvania School of Medicine, Division of Clinical Epidemiology, Philadelphia, PA 19104-6021, USA.
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152
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Sprod LK, Hsieh CC, Hayward R, Schneider CM. Three versus six months of exercise training in breast cancer survivors. Breast Cancer Res Treat 2010; 121:413-9. [PMID: 20443054 DOI: 10.1007/s10549-010-0913-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Accepted: 04/21/2010] [Indexed: 01/22/2023]
Abstract
Breast cancer is the most prevalent type of cancer in American women. Exercise appears to diminish many of the side effects resulting from breast cancer and its treatment. Very little research, however, has compared the outcomes of varying lengths of combined aerobic and resistance training exercise interventions on physiological and psychological parameters in breast cancer survivors. The purpose of this study was to compare the physiological and psychological outcomes following 3 and 6 months of exercise in breast cancer survivors. Breast cancer survivors (N = 114) participated in either 3 months of prescriptive, individualized exercise (3M; n = 29), 6 months of prescriptive, individualized exercise (6M; n = 68), or served as sedentary controls (C; n = 17). Cancer survivors completed a medical evaluation and assessment at baseline followed by a predetermined 3- or 6-month exercise intervention. Cancer survivors in the control group performed no exercise between the initial assessment and 6-month reassessment. Cardiovascular endurance, pulmonary function, muscular endurance, fatigue, and symptoms of depression were assessed at baseline and post intervention. Repeated measures ANCOVA revealed improvements (P < 0.05) in cardiovascular endurance, fatigue, and symptoms of depression in breast cancer survivors undergoing 3- and 6-month individualized exercise interventions. Breast cancer survivors exercising for 6 months showed additional improvements (P < 0.05) in pulmonary function and muscular endurance. Cancer survivors in the control group did not improve in cardiovascular endurance, pulmonary function, muscular endurance, or fatigue. Three months of individualized, prescriptive exercise leads to improved cardiovascular endurance, fatigue, and symptoms of depression in breast cancer survivors. Additional benefits are seen if exercise is continued for a total of 6 months.
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Affiliation(s)
- Lisa K Sprod
- Rocky Mountain Cancer Rehabilitation Institute, University of Northern Colorado, Campus Box 6, Greeley, CO 80639, USA
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153
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Swenson KK, Nissen MJ, Henly SJ. Physical activity in women receiving chemotherapy for breast cancer: adherence to a walking intervention. Oncol Nurs Forum 2010; 37:321-30. [PMID: 20439216 DOI: 10.1188/10.onf.321-330] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To describe and predict adherence to a physical activity protocol for patients with breast cancer receiving chemotherapy. DESIGN Longitudinal, observational study. SETTING Cancer center in the upper Midwestern region of the United States. SAMPLE 36 patients with breast cancer aged 40-55 years who were receiving adjuvant treatment. METHODS A longitudinal study was conducted within a randomized clinical trial comparing the effects of physical activity versus bisphosphonates on bone mineral density. Participants randomized to physical activity were advised to walk 10,000 steps per day and received initial physical therapy consultation and ongoing motivational interviewing. Multilevel modeling was used to identify variables that predict adherence. MAIN RESEARCH VARIABLES Adherence to the 10,000-step protocol was estimated with total steps and mean steps per day. FINDINGS Thirty-six women were enrolled in the physical activity group; 29 provided step data. The mean total steps per participant for the first six weeks was 280,571 (SD = 111,992), which is 67% of the prescribed steps. Excluding days when no steps were recorded, the mean steps per day for the initial six-week period was 7,363 (SD = 2,421), a 74% adherence rate. A significant linear increase occurred in steps per day after chemotherapy in a treatment cycle (p < 0.0001). Baseline inactivity predicted adherence. CONCLUSIONS Adherence to the walking program was compromised during chemotherapy but improved after chemotherapy completion. IMPLICATIONS FOR NURSING Knowing that chemotherapy predicts adherence to a walking protocol is useful for selecting the type, timing, and intensity of physical activity interventions.
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Affiliation(s)
- Karen K Swenson
- Oncology Research Department, Park Nicollet Institute, Minneapolis, MN, USA.
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154
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Velthuis MJ, Agasi-Idenburg SC, Aufdemkampe G, Wittink HM. The effect of physical exercise on cancer-related fatigue during cancer treatment: a meta-analysis of randomised controlled trials. Clin Oncol (R Coll Radiol) 2010; 22:208-21. [PMID: 20110159 DOI: 10.1016/j.clon.2009.12.005] [Citation(s) in RCA: 181] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2009] [Revised: 12/03/2009] [Accepted: 12/08/2009] [Indexed: 12/28/2022]
Abstract
The aim of this meta-analysis was to evaluate the effects of different exercise prescription parameters during cancer treatment on cancer-related fatigue (CRF). We also aimed to gain insight into the safety and feasibility of exercise during adjuvant cancer treatment. A systematic search of CINAHL, Cochrane Library, Embase, Medline, Scopus and PEDro was carried out. Randomised controlled trials studying the effects of exercise during cancer treatment on CRF were included. In total, 18 studies (12 in breast, four in prostate and two in other cancer patients) met all the inclusion criteria. During breast cancer treatment, home-based exercise lead to a small, non-significant reduction (standardised mean difference 0.10, 95% confidence interval -0.25 to 0.45), whereas supervised aerobic exercise showed a medium, significant reduction in CRF (standardised mean difference 0.30, 95% confidence interval 0.09 to 0.51) compared with no exercise. A subgroup analysis of home-based (n=65) and supervised aerobic (n=98) and resistance exercise programmes (n=208) in prostate cancer patients showed no significant reduction in CRF in favour of the exercise group. Adherence ranged from 39% of the patients who visited at least 70% of the supervised exercise sessions to 100% completion of a home-based walking programme. In more than half the studies (12 of 18; 67%) adverse events were reported. Eight events in total (0.72%) occurred in these studies.
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Affiliation(s)
- M J Velthuis
- Comprehensive Cancer Center Middle Netherlands, Utrecht, the Netherlands.
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155
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Maryam A, Fazlollah A, Eesa M, Ebrahim H, Abbas VF. The effect of designed exercise programme on quality of life in women with breast cancer receiving chemotherapy. Scand J Caring Sci 2010; 24:251-8. [PMID: 20230515 DOI: 10.1111/j.1471-6712.2009.00714.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
AIM AND OBJECTIVE The researchers sought to investigate the effect of a designed exercise programme on the quality of life (QOL) in women with breast cancer receiving chemotherapy. BACKGROUND Regarding the destructive effects of breast cancer and chemotherapy on women's lifestyle and well-being, health-care providers have the responsibility of searching for effective and safe programmes in order to bring an improvement to the patients' QOL. METHODS In a quasi-experimental design, 56 women with breast cancer receiving chemotherapy in an Iranian cancer institution were chosen; and then divided into two control and experiment groups consisting of 28 participants each. The patients in the experiment group followed a designed exercise programme characterized with daily physical exercises, 3-5 days per week, which lasted for 9 weeks. The Quality of Life-Breast Cancer (QOL-BC) questionnaire was employed to measure the participants' QOL in physical, emotional and social dimensions before and after the intervention. Descriptive and inferential statistics were utilized for data analysis. RESULTS No significant differences were found in the QOL dimensions between two groups before the manipulation; but significant differences in physical (p = 0.004), emotional (p = 0.01), social (p = 0.02) and spiritual (p = 0.45) dimensions as well as the total QOL (p = 0.003) after the intervention, were indicative of the effectiveness of the programme. CONCLUSION Based on the study findings, it is recommended that this programme can be employed as an effective means of improving the QOL among patients with breast cancer.
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156
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Siefert ML. Fatigue, Pain, and Functional Status During Outpatient Chemotherapy. Oncol Nurs Forum 2010; 37:E114-23. [DOI: 10.1188/10.onf.114-123] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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157
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Barton DL, Soori GS, Bauer BA, Sloan JA, Johnson PA, Figueras C, Duane S, Mattar B, Liu H, Atherton PJ, Christensen B, Loprinzi CL. Pilot study of Panax quinquefolius (American ginseng) to improve cancer-related fatigue: a randomized, double-blind, dose-finding evaluation: NCCTG trial N03CA. Support Care Cancer 2010; 18:179-87. [PMID: 19415341 PMCID: PMC3911883 DOI: 10.1007/s00520-009-0642-2] [Citation(s) in RCA: 164] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Accepted: 04/03/2009] [Indexed: 11/28/2022]
Abstract
PURPOSE This pilot trial sought to investigate whether any of three doses of American ginseng (Panax quinquefolius) might help cancer-related fatigue. A secondary aim was to evaluate toxicity. METHODS Eligible adults with cancer were randomized in a double-blind manner, to receive American ginseng in doses of 750, 1,000, or 2,000 mg/day or placebo given in twice daily dosing over 8 weeks. Outcome measures included the Brief Fatigue Inventory, vitality subscale of the Medical Outcome Scale Short Form-36 (SF-36), and the Global Impression of Benefit Scale at 4 and 8 weeks. RESULTS Two hundred ninety patients were accrued to this trial. Nonsignificant trends for all outcomes were seen in favor of the 1,000- and 2,000-mg/day doses of American ginseng. Area under the curve analysis of activity interference from the Brief Fatigue Inventory was 460-467 in the placebo group and 750 mg/day group versus 480-551 in the 1,000- and 2,000-mg/day arms, respectively. Change from baseline in the vitality subscale of the SF-36 was 7.3-7.8 in the placebo and the 750-mg/day arm, versus 10.5-14.6 in the 1,000- and 2,000-mg/day arms. Over twice as many patients on ginseng perceived a benefit and were satisfied with treatment over those on placebo. There were no significant differences in any measured toxicities between any of the arms. CONCLUSION There appears to be some activity and tolerable toxicity at 1,000-2,000 mg/day doses of American ginseng with regard to cancer-related fatigue. Thus, further study of American ginseng is warranted.
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Affiliation(s)
- Debra L Barton
- Mayo Clinic and Mayo Foundation, 200 First Street, SW, Rochester, MN 55905, USA.
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158
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Rørth M, Madsen KR, Burmølle SH, Midtgaard J, Andersen C, Nielsen B, Stage M, Adamsen L. Effects of Darbepoetin Alfa with exercise in cancer patients undergoing chemotherapy: an explorative study. Scand J Med Sci Sports 2010; 21:369-77. [PMID: 20136754 DOI: 10.1111/j.1600-0838.2009.01066.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Fatigue is frequent in cancer patients undergoing chemotherapy. Erythropoietins (EPO) have shown well-documented effects on these patients, and administered in pharmacological doses, may reduce the need for transfusion of blood cells and improve quality of life (QoL). An explorative, descriptive, non-randomised intervention study using semi-structured interviews was conducted with the aim to gain an insight into the effects and experiences associated with EPO treatment in combination with a structured 6-week physical exercise intervention. Sixteen cancer patients with evidence of disease, who had received at least one cycle chemotherapy, participated. Participants received 500 μg Darbepoetin Alfa (DA) every 3 weeks during the intervention. Four typologies of patients were identified with regard to DA effects. The interviews revealed that eleven patients experienced some kind of immediate improvement in cognitive and emotional functioning, and subjective daily well-being. Furthermore physical improvement and changes in QoL outcomes showed no significant differences between the study group and a reference group. A significant increase in the hemoglobin concentration (7.14-7.87 mmol/L, P<0.05) was found in the study group. The future use of EPO in cancer patients is hampered by the reported negative influence of EPO on the prognosis in some diagnoses and should be based on randomized studies.
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Affiliation(s)
- M Rørth
- Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark.
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159
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Mustian KM, Sprod LK, Palesh OG, Peppone LJ, Janelsins MC, Mohile SG, Carroll J. Exercise for the management of side effects and quality of life among cancer survivors. Curr Sports Med Rep 2010; 8:325-30. [PMID: 19904073 DOI: 10.1249/jsr.0b013e3181c22324] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Physical activity may play an important role in the rehabilitation of cancer survivors during and after treatment. Current research suggests that numerous beneficial outcomes are experienced in cancer survivors undergoing exercise interventions during or after cancer treatment. Exercise not only plays a role in managing side effects but also improves functional capacity and quality of life. The purpose of this article is to provide an overview of the oncology literature supporting the use of exercise as an effective intervention for improving cancer-related fatigue, other side effects, functional capacity, and quality of life among cancer survivors.
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Affiliation(s)
- Karen M Mustian
- University of Rochester School of Medicine and Dentistry, James P. Wilmot Cancer Center, Department of Radiation Oncology, Rochester, NY, USA.
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160
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Retrospective trial of complete decongestive physical therapy for lower extremity secondary lymphedema in melanoma patients. Support Care Cancer 2010; 19:141-7. [DOI: 10.1007/s00520-009-0803-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Accepted: 12/15/2009] [Indexed: 10/20/2022]
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161
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An update of controlled physical activity trials in cancer survivors: a systematic review and meta-analysis. J Cancer Surviv 2010; 4:87-100. [PMID: 20052559 DOI: 10.1007/s11764-009-0110-5] [Citation(s) in RCA: 860] [Impact Index Per Article: 61.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Accepted: 11/26/2009] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Approximately 11.1 million cancer survivors are alive in the United States. Activity prescriptions for cancer survivors rely on evidence as to whether exercise during or after treatment results in improved health outcomes. This systematic review and meta-analysis evaluates the extent to which physical activity during and post treatment is appropriate and effective across the cancer control continuum. METHODS A systematic quantitative review of the English language scientific literature searched controlled trials of physical activity interventions in cancer survivors during and post treatment. Data from 82 studies were abstracted, weighted mean effect sizes (WMES) were calculated from 66 high quality studies, and a systematic level of evidence criteria was applied to evaluate 60 outcomes. Reports of adverse events were abstracted from all studies. RESULTS Quantitative evidence shows a large effect of physical activity interventions post treatment on upper and lower body strength (WMES = 0.99 & 0.90, p < 0.0001 & 0.024, respectively) and moderate effects on fatigue and breast cancer-specific concerns (WMES = -0.54 & 0.62, p = 0.003 & 0.003, respectively). A small to moderate positive effect of physical activity during treatment was seen for physical activity level, aerobic fitness, muscular strength, functional quality of life, anxiety, and self-esteem. With few exceptions, exercise was well tolerated during and post treatment without adverse events. CONCLUSIONS Current evidence suggests many health benefits from physical activity during and post cancer treatments. Additional studies are needed in cancer diagnoses other than breast and with a focus on survivors in greatest need of improvements for the health outcomes of interest.
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162
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Griffith K, Wenzel J, Shang J, Thompson C, Stewart K, Mock V. Impact of a walking intervention on cardiorespiratory fitness, self-reported physical function, and pain in patients undergoing treatment for solid tumors. Cancer 2009; 115:4874-84. [PMID: 19637345 DOI: 10.1002/cncr.24551] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Cancer treatment is associated with decline in measured and self-reported physical function and increased pain. In the current study, the authors evaluated the impact of a walking intervention on these outcomes during chemotherapy/radiation. METHODS Patients with breast, prostate, and other cancers (N=126) were randomized to a home-based walking intervention (exercise) or usual care (control). Exercise dose during the intervention was assessed using a 5-item Physical Activity Questionnaire. Outcome measures were cardiorespiratory fitness, expressed as peak oxygen uptake (VO2) measured during treadmill testing (n=85) or estimated by 12-minute walk (n=27), and self-reported physical function, role limitations, and pain derived from Medical Outcomes Study Short Form 36. Linear regression was used to evaluate pre-to-post intervention change outcomes between groups. RESULTS The mean (standard deviation) age of the patients was 60.2 (10.6) years. Diagnoses included prostate (55.6%) and breast (32.5%) cancer. Treatment included external beam radiotherapy (52.3%) and chemotherapy (34.9%). Exercise patients reported worsening Medical Outcomes Study physical function role limitations by the end of cancer treatment (P=.037). Younger age was associated with improved Medical Outcomes Study physical function (P=.048). In all patients, increased exercise dose was associated with decreased Medical Outcomes Study pain (P=.046), regardless of diagnosis. The percent change of VO2 between prostate and nonprostate cancer patients when adjusted for baseline VO2 and Physical Activity Questionnaire values was 17.45% (P=.008), with better VO2 maintenance in the prostate group. CONCLUSIONS Exercise during cancer treatment improves cardiorespiratory fitness and self-reported physical function in prostate cancer patients and in younger patients, regardless of diagnosis, and may attenuate loss of those capacities in patients undergoing chemotherapy. Exercise also reduces the pain experience.
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Affiliation(s)
- Kathleen Griffith
- Center for Nursing Research, Johns Hopkins University School of Nursing, Baltimore, Maryland 21201, USA.
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163
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Halle M, Schoenberg MH. Physical activity in the prevention and treatment of colorectal carcinoma. DEUTSCHES ARZTEBLATT INTERNATIONAL 2009; 106:722-7. [PMID: 19997551 DOI: 10.3238/arztebl.2009.0722] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2008] [Accepted: 04/06/2009] [Indexed: 12/14/2022]
Abstract
BACKGROUND Colorectal carcinoma is the most common type of tumor in Western countries. The risk of developing colorectal carcinoma depends both on genetic factors (familial predisposition) and on lifestyle-related factors such as body-mass index, level of physical activity, and nutritional behavior. Regular physical activity is important in primary prevention, and there is also evidence that the prognosis after treatment of a colorectal carcinoma can be improved by exercise. METHODS The PubMed database was searched for relevant articles that appeared in the last 10 years, and selected articles were evaluated. RESULTS Cross-sectional studies have shown that regular physical activity (ca. 7 hours of brisk walking per week) lowers the risk of colon carcinoma by 40%. Physical activity also improves the outcome of patients already diagnosed with colorectal carcinoma: for example, patients with advanced disease (UICC stage II or III) have been found to survive significantly longer if they perform 4 hours of brisk walking per week, or the equivalent degree of physical exercise. CONCLUSIONS Cross-sectional studies show that physically active persons are less likely to develop colorectal carcinoma than physically inactive persons, and that they have better outcomes in the event that they do develop the disease. The positive findings with respect to secondary prevention still need to be confirmed in interventional trials, but in primary prevention, at least, physical activity should be actively promoted, along with other beneficial lifestyle habits and screening measures.
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Affiliation(s)
- Martin Halle
- Preventive and Rehabilitative Sports Medicine, Hospital rechts der Isar, Technische Universität München, Munich, Germany.
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164
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Abstract
Zusammenfassung. Die tumorbedingte Fatigue ist ein verbreitetes und den Patienten sehr belastendes Syndrom im Rahmen der Krebserkrankung und -therapie. Tumorbedingte Fatigue (im angloamerikanischen Sprachraum als cancer-related fatigue, CRF, bezeichnet) geht einher mit dem subjektiven Gefühl von physischer und mentaler Müdigkeit, Erschöpfung, Energieverlust und wenig Möglichkeiten der Erholung. Es geht weit über das „normale” Maß an Erschöpfung hinaus, was gesunde Personen erleben. Tumorbedingte Fatigue kommt als Folge der Krebserkrankung selbst und als Nebeneffekt der Krebstherapie vor. Das genaue Ursachengefüge ist jedoch bislang nicht genau geklärt. Zum Diagnosezeitpunkt leiden bis zu 40%, im weiteren Verlauf der Krebsbehandlung mehr als 90% der Patienten unter tumorbedingter Fatigue. Unter der Strahlentherapie tritt die tumorbedingte Fatigue bei über 90%, während der Chemotherapie bei bis zu 80% der Betroffenen auf. Tumorbedingte Fatigue neigt zur Chronifizierung auch nach Abschluss der Therapie und ist dann umso belastender für die Patienten, da eine Ursachenzuschreibung erschwert ist. Die Beeinträchtigungen durch die tumorbedingte Fatigue sind beträchtlich, die Lebensqualität, das psychische Wohlbefinden so wie die Teilhabe am Alltagsleben und die berufliche Leistungsfähigkeit sind in aller Regel massiv eingeschränkt. Trotz dieser hohen Relevanz für Patienten und Behandler hat sich die Forschung über tumorbedingte Fatigue, im Vergleich zu anderen Begleitsymptomen der Krebserkrankung und -therapie, erst in den letzten Jahren intensiviert. Die vorliegende Arbeit gibt einen systematischen Überblick über epidemiologische Grundlagen, krankheitsbegleitende Aspekte sowie evaluierte nicht-medikamentöse Interventionen und ihren Stellenwert innerhalb der Behandlung tumorbedingter Fatigue.
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Affiliation(s)
- Ulrike de Vries
- Zentrum für Klinische Psychologie und Rehabilitation, Universität Bremen
| | - Karl Reif
- Institut für Public Health und Pflegeforschung, Abt. Interdisziplinäre Alterns- und Pflegeforschung, Universität Bremen
| | - Nina Stuhldreher
- Institut für Public Health und Pflegeforschung, Abt. Interdisziplinäre Alterns- und Pflegeforschung, Universität Bremen
| | - Franz Petermann
- Zentrum für Klinische Psychologie und Rehabilitation, Universität Bremen
| | - Stefan Görres
- Institut für Public Health und Pflegeforschung, Abt. Interdisziplinäre Alterns- und Pflegeforschung, Universität Bremen
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165
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Abstract
Exercise improves quality of life (QOL) in people with cancer. Most oncology healthcare providers recognize the statement to be true because the research literature provides strong support for the physical and psychological benefits of exercise. Because the terms exercise, QOL, and people with cancer have different meanings, the contextual connections in which they are used are important to understanding the relationship between exercise and QOL in people with cancer. This article explores the links between exercise and QOL in people with cancer and examines issues that impact the development, implementation, and evaluation of exercise programs for people with cancer. Issues related to exercise goal development, exercise prescription, exercise testing, exercise adherence, and methods to evaluate the efficacy of exercise in relation to QOL are discussed.
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Affiliation(s)
- Eileen Hacker
- Department of Biobehavioral Health Sciences in the College of Nursing, The University of Illinois, Chicago, USA.
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166
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Changes in the Body Image and Relationship Scale following a one-year strength training trial for breast cancer survivors with or at risk for lymphedema. Breast Cancer Res Treat 2009; 121:421-30. [DOI: 10.1007/s10549-009-0550-7] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2009] [Accepted: 09/09/2009] [Indexed: 10/20/2022]
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167
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Physiotherapy management of cancer-related fatigue: a survey of UK current practice. Support Care Cancer 2009; 18:817-25. [DOI: 10.1007/s00520-009-0715-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2009] [Accepted: 07/27/2009] [Indexed: 11/26/2022]
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168
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Buss T, de Walden-Gałuszko K, Modlińska A, Osowicka M, Lichodziejewska-Niemierko M, Janiszewska J. Kinesitherapy alleviates fatigue in terminal hospice cancer patients—an experimental, controlled study. Support Care Cancer 2009; 18:743-9. [DOI: 10.1007/s00520-009-0709-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2009] [Accepted: 07/20/2009] [Indexed: 12/01/2022]
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169
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Wiggins MS, Simonavice EM. Quality of life benefits in cancer survivorship with supervised exercise. Psychol Rep 2009; 104:421-4. [PMID: 19610471 DOI: 10.2466/pr0.104.2.421-424] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
To assess whether a supervised exercise program would benefit cancer survivors' perceived psychological well-being over the course of a 6-mo. program, 8 female and 2 male cancer survivors, ages 45 to 69 (M = 56.2, SD = 8.1) were recruited into the program from a presentation given to a breast-cancer support group and by word of mouth. Activity sessions were two times per week and typically involved treadmill and bicycle ergometer time, plus eight to ten weight-training stations. A quality of life measure was taken at baseline, 3, and 6 mo. Analyses showed a significant increase in quality of life from baseline to 3 mo. and from baseline to 6 mo. Being physically active in a supervised exercise program provided increased perceived benefits in quality of life for these cancer survivors over 6 mo.
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Affiliation(s)
- Matthew S Wiggins
- University of Wisconsin-Eau Claire, Department of Kinesiology, 105 Garfield Avenue, Eau Claire, WI 54702, USA.
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170
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Is bra discomfort a barrier to exercise for breast cancer patients? Support Care Cancer 2009; 18:735-41. [PMID: 19669168 DOI: 10.1007/s00520-009-0707-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2009] [Accepted: 07/16/2009] [Indexed: 10/20/2022]
Abstract
GOALS OF WORK Although exercise can provide a range of benefits for women living with a breast cancer diagnosis, many impediments to exercise exist. Several psychosocial and physical capacity impediments to exercise have been investigated, but no study has systematically investigated whether bras impede breast cancer patients from exercising. This study aimed to assess the extent to which exercise-induced breast pain and bra discomfort were reported by women living with breast cancer and whether this breast pain and bra discomfort impeded these women from participating in physical activity. PATIENTS AND METHODS Seventy-four women living with a breast cancer diagnosis completed a custom-designed questionnaire. Frequency data were analyzed to identify the most common barriers to exercise, and features in current bra designs causing discomfort during exercise were established. MAIN RESULTS When analyzed according to mean score, "bra discomfort" ranked as the fourth highest barrier to exercise behind a lack of self-discipline, procrastination, and fatigued by exercise. A significant 70.3% of the sample (p < 0.001) reported experiencing bra discomfort during exercise. Over half (57.7%) of these respondents reported the band as the most uncomfortable part of the bra. CONCLUSIONS This study has clearly established that bra discomfort, particularly bra band tightness, is a barrier to participating in physical activity for women living with a breast cancer diagnosis. To further encourage exercise in women living with a diagnosis of breast cancer, potential barriers to exercise, such as inadequate bra design, need to be modified to enable these women to enjoy the health benefits of exercising in comfort.
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Jarden M, Nelausen K, Hovgaard D, Boesen E, Adamsen L. The effect of a multimodal intervention on treatment-related symptoms in patients undergoing hematopoietic stem cell transplantation: a randomized controlled trial. J Pain Symptom Manage 2009; 38:174-90. [PMID: 19345060 DOI: 10.1016/j.jpainsymman.2008.09.005] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Revised: 08/29/2008] [Accepted: 09/17/2008] [Indexed: 11/30/2022]
Abstract
Studies applying exercise, relaxation training, and psychoeducation have each indicated a positive impact on physical performance and/or psychological factors in patients diagnosed with cancer. We explored the longitudinal effect of a combination of these interventions on treatment-related symptoms in patients undergoing myeloablative allogeneic hematopoietic stem cell transplantation (allo-HSCT). Forty-two patients (18-65 years) were randomized either to an intervention or a control group. The intervention group received standard treatment and care, and a supervised four- to six-week structured exercise program, progressive relaxation, and psychoeducation during hospitalization, one hour per day for five days per week. The control group received standard treatment, care, and physiotherapy. A 24-item symptom assessment questionnaire was completed weekly during hospitalization, and at three and six months after allo-HCST. Through principal component analysis with varimax rotation, individual symptoms were grouped into five symptom clusters: mucositis, cognitive, gastrointestinal, affective, and functional symptom clusters. Then, a subsequent general estimate equation analysis revealed similar longitudinal patterns of intensity in all symptom clusters for intervention and control groups, but in the intervention group, there was an overall significant reduction (P<0.05) in symptom intensity over time for all clusters except the affective symptom cluster. This study provides beginning evidence for the efficacy of an exercise-based multimodal intervention in reducing the intensity of a spectrum of symptoms in this small sample of patients undergoing allo-HSCT.
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Affiliation(s)
- Mary Jarden
- Department of Hematology, The University Hospitals Center for Nursing and Care Research, Copenhagen, Denmark.
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172
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Windsor P, Potter J, McAdam K, McCowan C. Evaluation of a Fatigue Initiative: Information on Exercise for Patients Receiving Cancer Treatment. Clin Oncol (R Coll Radiol) 2009; 21:473-82. [DOI: 10.1016/j.clon.2009.01.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2007] [Revised: 01/02/2009] [Accepted: 01/22/2009] [Indexed: 11/27/2022]
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173
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Spathis A, Dhillan R, Booden D, Forbes K, Vrotsou K, Fife K. Modafinil for the treatment of fatigue in lung cancer: a pilot study. Palliat Med 2009; 23:325-31. [PMID: 19270033 DOI: 10.1177/0269216309102614] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cancer-related fatigue is the most prevalent and distressing symptom experienced by patients with advanced cancer. Central nervous system stimulants have been shown to relieve fatigue in nonmalignant disease. Modafinil is a stimulant with a selective site of action in the brain that is better tolerated than traditional stimulants, such as methylphenidate. The aim of this study was to determine the feasibility of conducting a randomised controlled trial to assess the efficacy and safety of modafinil for the treatment of fatigue in patients with lung cancer. Twenty patients with non-small cell lung cancer were recruited to this open-label study. Modafinil was taken in a fixed dose-titration schedule of 100 mg daily for 7 days followed by 200 mg daily for 7 days. Fifteen patients completed the study. During the study period, there was a rapid and statistically significant reduction in the primary outcome, fatigue (P = 0.001) and the secondary outcomes of daytime sleepiness and depression/anxiety. This improvement in fatigue was also clinically significant. Ten patients chose to continue modafinil after the study and the drug was well-tolerated. It would be both feasible and worthwhile to conduct a definitive randomised controlled trial to determine the role of modafinil in the treatment of cancer-related fatigue.
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Affiliation(s)
- A Spathis
- Addenbrookes Hospital, Cambridge, UK.
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174
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Hoving JL, Broekhuizen MLA, Frings-Dresen MHW. Return to work of breast cancer survivors: a systematic review of intervention studies. BMC Cancer 2009; 9:117. [PMID: 19383123 PMCID: PMC2678275 DOI: 10.1186/1471-2407-9-117] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2008] [Accepted: 04/21/2009] [Indexed: 11/10/2022] Open
Abstract
Background Breast cancer management has improved dramatically in the past three decades and as a result, a population of working age women is breast cancer survivor. Interventions for breast cancer survivors have shown improvements in quality of life and in physical and psychological states. In contrast, efforts aimed at stimulating re-employment and return-to-work interventions for breast cancer survivors have not kept pace. The objective of this review was to study the effects and characteristics of intervention studies on breast cancer survivors in which the outcome was return to work. Methods The Cochrane Controlled Trials Register (The Cochrane Library, Issue 4, 2006), Medline, Ovid, EMBASE and PsychInfo were systematically searched for studies conducted between 1970 to February 2007. Intervention studies for female breast cancer survivors that were focused on return to work were included. Results Our search strategy identified 5219 studies. Four studies out of 100 potentially relevant abstracts were selected and included 46–317 employed women who had had mastectomy, adjuvant therapy and rehabilitation, with the outcome return to work. The intervention programs focused on improvement of physical, psychological and social recovery. Although a substantial percentage (between 75% to 85%) of patients included in these studies returned to work after rehabilitation, it is not clear whether this proportion would have been lower for patients without counseling or exercise, or any other interventions, as three out of four studies did not include a comparison group. Conclusion The most important finding of this review is the lack of methodologically sound intervention studies on breast cancer survivors with the outcome return to work. Using evidence from qualitative and observational studies on cancer and the good results of intervention studies on return to work programs and vocational rehabilitation, return to work interventions for breast cancer survivors should be further developed and evaluated.
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Affiliation(s)
- J L Hoving
- Coronel Institute of Occupational Health and Research Center for Insurance Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
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175
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Abstract
Physical exercise has attracted increased interest in rehabilitation of oncological patients. The purpose of this paper is to review the literature and summarize the evidence of physical exercise in preventing cancer, its ability in attenuating the effect of cancer and its treatments and to provide guidelines for exercise prescription Review of recent literature by electronic search of MEDline (Pub Med), Cancer lit, Cochrane libraries, CINAHL were done using Keywords and the variables were identified and systematically evaluated. There is strong evidence for reduced risk of colorectal and breast cancer with possible association for prostate, endometrial and lung cancer with increasing physical activity. Exercise helps cancer survivors cope with and recover from treatment; exercise may improve the health of long term cancer survivors and extend survival. Physical exercise will benefit throughout the spectrum of cancer. However, an understanding of the amount, type and intensity of exercise needed has not been fully elucidated. There is sufficient evidence to promote exercise in cancer survivors following careful assessment and tailoring on exercise prescription.
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Affiliation(s)
- P. Rajarajeswaran
- College of Physiotherapy, Mother Theresa Post Graduate and Research Institute of Health Sciences, Puducherry – 6, India
| | - R. Vishnupriya
- College of Physiotherapy, Mother Theresa Post Graduate and Research Institute of Health Sciences, Puducherry – 6, India
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176
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WIGGINS MATTHEWS, SIMONAVICE EMILYM. QUALITY OF LIFE BENEFITS IN CANCER SURVIVORSHIP WITH SUPERVISED EXERCISE 1. Psychol Rep 2009. [DOI: 10.2466/pr0.104.2.420-424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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177
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Pinto BM, Rabin C, Dunsiger S. Home-based exercise among cancer survivors: adherence and its predictors. Psychooncology 2009; 18:369-76. [PMID: 19242921 PMCID: PMC2958525 DOI: 10.1002/pon.1465] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Evidence of the benefits of exercise for those treated for cancer has led to exercise interventions for this population. Some have questioned whether cancer patients offered a home-based intervention adhere to the exercise prescribed. METHOD We examined exercise adherence in a randomized controlled trial of a 12-week, home-based exercise trial for breast cancer patients. Three adherence outcomes were examined: minutes of exercise participation/week, number of steps taken during planned exercise/week, and whether the participant met her weekly exercise goal. Predictors of adherence (e.g. demographic and medical variables, Transtheoretical Model variables, history of exercise) were examined. RESULTS Findings indicate that participants significantly increased their minutes of exercise and steps taken during planned exercise from Week 1 to 12. The percentage of participants achieving exercise goals was highest in the first few weeks. Exercise self-efficacy significantly predicted each adherence outcome. Baseline PA predicted mean exercise session steps over the 12 weeks. CONCLUSION Adherence to a home-based exercise intervention for breast cancer patients changes over time and may be related to baseline levels of exercise self-efficacy.
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Affiliation(s)
- Bernardine M Pinto
- Miriam Hospital and Warren Alpert Medical School of Brown University, Providence, RI 02903, USA.
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178
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White SM, McAuley E, Estabrooks PA, Courneya KS. Translating physical activity interventions for breast cancer survivors into practice: an evaluation of randomized controlled trials. Ann Behav Med 2009; 37:10-9. [PMID: 19255819 DOI: 10.1007/s12160-009-9084-9] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2008] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Although physical activity (PA) interventions have been effective for improving health outcomes in breast cancer survivors, little is known relative to their potential for translation into practice. PURPOSE This review was designed to provide a quantitative estimate of the reporting of both internal and external validity in recent studies of PA in breast cancer survivors (BCS). METHODS The Reach, Efficacy/Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was utilized to assess the reporting of internal and external validity in 25 randomized controlled trials (RCTs) of PA and BCS published between 1998 and 2008. Each trial was evaluated relative to the degree it met criteria for each of the above dimensions. RESULTS The majority of studies in this review reported dimensions reflecting internal validity. The overall level of detail relative to external validity of PA interventions was rarely reported, limiting the generalizability of study findings. CONCLUSIONS As with many RCTs of health behavior change, detail relative to contextual elements of published PA interventions in BCS is limited. It is recommended that future physical activity interventions in BCS be designed to facilitate scalable and sustainable interventions for improving health outcomes in this population.
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Affiliation(s)
- Siobhan M White
- Department of Kinesiology and Community Health, University of Illinois, 336 Freer Hall, 906 S. Goodwin Ave, Urbana, IL 61801, USA.
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180
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Hsieh CC, Sprod LK, Hydock DS, Carter SD, Hayward R, Schneider CM. Effects of a supervised exercise intervention on recovery from treatment regimens in breast cancer survivors. Oncol Nurs Forum 2009; 35:909-15. [PMID: 18980921 DOI: 10.1188/08.onf.909-915] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE/OBJECTIVES To investigate the effects of supervised exercise training on cardiopulmonary function and fatigue in cancer survivors undergoing various clinical treatments. DESIGN Pretest and post-test quasiexperimental. SETTING Outpatient oncology rehabilitation center. SAMPLE 96 breast cancer survivors undergoing various clinical treatments. METHODS Subjects were divided into four groups based on the specific type of clinical treatment: surgery alone (n = 22); surgery and chemotherapy (n = 30); surgery and radiation (n = 17); and surgery, chemotherapy, and radiation (n = 27). Following a comprehensive screening and medical examination, cardiovascular endurance, pulmonary function, and fatigue were assessed, leading to the development of an individualized exercise prescription and a six-month exercise intervention. Repeated-measures analysis of variance and covariance were used to compare the effectiveness of the intervention and differences among treatment groups. MAIN RESEARCH VARIABLES Systolic and diastolic blood pressure, resting heart rate, forced vital capacity, forced expiratory volume, predicted oxygen consumption, time on treadmill, and fatigue. FINDINGS Cardiopulmonary function (predicted maximal oxygen consumption and time on treadmill) significantly increased in all groups after exercise training. In addition, resting heart rate and forced vital capacity significantly improved in those receiving surgery, chemotherapy, and radiation. Psychologically, the exercise intervention resulted in significant reductions in behavioral, affective, sensory, cognitive and mood, and total fatigue scale scores in all three groups who received treatment with surgery. The breast cancer survivors in the surgery-alone group showed significant reductions in behavioral, affective, and total fatigue scale scores but not in sensory and cognitive and mood fatigue scale scores. CONCLUSIONS The results suggest that moderate intensity, individualized, prescriptive exercise maintains or improves cardiopulmonary function with concomitant reductions in fatigue regardless of treatment type. Moreover, cancer survivors receiving combination chemotherapy and radiotherapy following surgery appear to benefit to a greater extent as a result of an individualized exercise intervention. IMPLICATIONS FOR NURSING Clinicians need to be aware of adjuvant therapies such as moderate exercise that attenuate negative side effects of cancer treatments. Symptom management recommendations should be given to cancer survivors concerning the effectiveness of exercise throughout the cancer continuum and the importance of participating in a cancer rehabilitation exercise program.
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Affiliation(s)
- City C Hsieh
- Department of Physical Education, The National HsinChu University of Education, Taiwan
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181
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Wonders KY, Reigle BS. Trastuzumab and Doxorubicin-Related Cardiotoxicity and the Cardioprotective Role of Exercise. Integr Cancer Ther 2009; 8:17-21. [DOI: 10.1177/1534735408330717] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Women diagnosed with breast cancer typically undergo a multimodal approach to treating their disease. The treatments used often result in sequelae such as fatigue, hair loss, nausea and vomiting, and functional impairment. Many of these sequelae can be controlled or eliminated with pharmacological, physical, or social interventions. However, 2 effective cytotoxic agents, doxorubicin and trastuzumab, are associated with a potentially life-threatening sequela, cardiotoxicity. Currently, these agents are dosage and duration limited to circumvent cardiac damage. Exercise prior to and during the administration of these agents is emerging as a possible cardioprotective intervention based on the findings of animal model studies. Incorporating exercise into the breast cancer treatment trajectory may eliminate the dosage and duration restrictions of these antineoplastic agents and ultimately affect survival and quality of life. The authors present the pharmacological mechanism for each agent and the exciting results of animal model studies that lay the groundwork for future clinical trials.
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Affiliation(s)
- Karen Y. Wonders
- Department of Health, Physical Education and Recreation, Wright State University, Dayton,
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182
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Kim CJ, Kang DH, Park JW. A meta-analysis of aerobic exercise interventions for women with breast cancer. West J Nurs Res 2009; 31:437-61. [PMID: 19176403 DOI: 10.1177/0193945908328473] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The purpose of this meta-analysis was to examine the effectiveness of aerobic exercise interventions on cardiopulmonary function and body composition in women with breast cancer. Of 24 relevant studies reviewed, 10 studies (N = 588) met the inclusion criteria. The findings indicated that aerobic exercise significantly improved cardiopulmonary function as assessed by absolute VO2 peak (standardized mean difference [SMD] .916, p < .001), relative VO2 peak (SMD .424, p < .05), and 12-minute walk test ( SMD .502, p < .001). Similarly, aerobic exercise significantly improved body composition as assessed by percentage body fat (SMD -.890, p < .001), but body weight and lean body mass did not change significantly. Aerobic exercise during or after cancer adjuvant therapy seems to be an effective means of improving cardiopulmonary function and decreasing percentage body fat in women with breast cancer. Further studies are needed to examine the long-term benefits of aerobic exercise.
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183
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Abstract
Cancer of the breast is a significant health problem for women from the time of diagnosis through the treatment and survivorship trajectory. The disease and treatments are an assault to a woman's body, resulting in sequelae that can be debilitating. Although women diagnosed with breast cancer are living longer, concerns about functional limitations, recurrence, and survival remain paramount. Physical activity and exercise are preventative and rehabilitative measures that can be employed at various points along the breast cancer trajectory. Current research supports the beneficial role that physical activity and exercise play in reducing the risk for developing breast cancer and preventing or attenuating disease and treatment-related impairments.
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Affiliation(s)
- Beverly S Reigle
- College of Nursing, University of Cincinnati, Cincinnati, OH, USA
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184
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Is exercise an acceptable and practical therapy for people with or cured of cancer? A systematic review. Cancer Treat Rev 2009; 35:383-90. [PMID: 19131171 DOI: 10.1016/j.ctrv.2008.11.008] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2008] [Revised: 11/19/2008] [Accepted: 11/27/2008] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Therapeutic exercise, although potentially beneficial, does not appear acceptable to many cancer patients. A greater understanding of the reasons for this is required. We have systematically reviewed the use of exercise in this group, identifying rates of uptake, adherence and completion along with factors influencing acceptability. METHODS Searches were completed using relevant key words. Data on study design, patient group, exercise intervention, patient flow data and reasons for declining or withdrawing from a programme were independently extracted by two researchers. Rates of study uptake, completion and adherence were compared according to dichotomised patient or programme characteristics using Mann Whitney U test (p=0.05). Reasons provided when declining or withdrawing from a study were categorised. RESULTS Sixty five studies were included. The majority contained groups made up entirely or predominantly of patients with breast cancer offered an aerobic or resistance exercise programme. The median [IQR] rates of uptake, adherence and completion were 63 [33-80]%, 84 [72-93]% and 87 [80-96]%, respectively. No characteristic influenced the proportion of patients taking up or completing a programme. The main reasons for refusal were disinterest or the impracticality of undertaking the programme and for withdrawal, medical complication or deterioration. CONCLUSIONS The invitation to undertake a programme of therapeutic exercise is accepted by about two-thirds of patients. Rates of adherence and completion are relatively high, but overall, only about half of patients offered a programme complete one. There is a need to modify exercise programmes if they are to be acceptable for the majority of patients.
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185
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Al-Majid S, Gray DP. A biobehavioral model for the study of exercise interventions in cancer-related fatigue. Biol Res Nurs 2008; 10:381-91. [PMID: 19114410 DOI: 10.1177/1099800408324431] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Cancer-related fatigue (CRF) is a multifactorial, biobehavioral phenomenon experienced by the majority of persons with cancer. It has negative consequences on the individual's physical functioning and quality of life. An array of biological, psychobehavioral, and functional mechanisms contributes to its occurrence. A relatively large number of studies have examined the effect of physical exercise on CRF over the past few decades. Most of these studies did not specifically examine the effect of physical exercise on the biobehavioral mechanisms underlying CRF. For the most part, these studies have not been guided by a consistent theoretical model. Consequently, the mechanisms by which exercise may ameliorate CRF are not fully elucidated. A theoretical model incorporating fatigue-related biobehavioral variables that could be affected by physical exercise will allow for effective knowledge development in this area and could lead to the development and refinement of exercise protocols that specifically target these mechanisms. Thus, the purpose of this paper is to present a comprehensive theoretical model to guide future research on the effectiveness of exercise interventions in CRF. The proposed model incorporates the biological, psychobehavioral, and functional variables implicated in the induction of CRF.
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Affiliation(s)
- Sadeeka Al-Majid
- Department of Nursing, California State University, Fullerton, California 92834, USA.
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186
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187
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Abstract
OBJECTIVES To review the theories that have been the basis for randomized controlled trials (RCTs) promoting health behavior change among adults diagnosed and treated for cancer. DATA SOURCES Electronic databases and recent review papers. CONCLUSION Several theories have been used in intervention development: Transtheoretical Model, Motivational Interviewing, Social Learning and Social Cognitive Theory, Theory of Planned Behavior, and Cognitive Behavioral Theory. There is support for the efficacy of some of these interventions. However, there has been limited assessment of theory-based constructs and examination of the mediational role of theoretical constructs in intervention efficacy. IMPLICATIONS FOR NURSING PRACTICE There is a need to apply theory in the development of interventions to assess the effects of the intervention on the constructs and to conduct mediational tests of these constructs.
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188
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Abstract
Cancer-related fatigue (CRF) is influenced and modulated by a number of critical factors, and the mechanism that is both necessary and sufficient to induce development of severe fatigue in patients with cancer has not yet been identified. Specific research efforts to understand the factors that may contribute to CRF development have been made, including studies of the direct effects of tumor burden, the effects of cancer treatment, and other pathophysiologic and psychosocial conditions. Compelling new hypotheses regarding CRF pathophysiology have been proposed, such as the pro-inflammatory hypothesis, the serotonin hypothesis, the vagal-afferent-activation hypothesis, the anemia hypothesis, and the adenosine triphosphate hypothesis; some of these have been tested in both animal models and humans and some in animals only. Gaining an understanding of the specific mechanisms related to the development of fatigue in patients with cancer and survivors requires further investigation. Pathophysiologic research in CRF could be applied in the clinic to improve CRF diagnosis and to enable administration of mechanism-driven interventions. A targeted intervention study with CRF as a primary end point also would be useful.
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Affiliation(s)
- Xin Shelley Wang
- Department of Symptom Research, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA.
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189
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Kowal J, Overduin LY, Balfour L, Tasca GA, Corace K, Cameron DW. The role of psychological and behavioral variables in quality of life and the experience of bodily pain among persons living with HIV. J Pain Symptom Manage 2008; 36:247-58. [PMID: 18411016 DOI: 10.1016/j.jpainsymman.2007.10.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2007] [Revised: 10/03/2007] [Accepted: 11/01/2007] [Indexed: 01/22/2023]
Abstract
With increased life expectancy of individuals living with HIV, quality of life (QOL) has become a focus of treatment. More research is needed to address pain-related QOL and modifiable variables, such as health behaviors, depressive symptoms, and coping styles, which could be included in treatment protocols to improve QOL among individuals with HIV. Objectives of this study were to (1) examine relationships among health behaviors, psychological variables, and QOL, particularly pain-specific QOL, (2) examine the relationships among coping, depressive symptoms, and QOL, and (3) compare QOL scores of individuals with HIV and population-based normative data. HIV positive men and women not currently on highly active antiretroviral therapy were recruited during regular visits to an HIV outpatient clinic. They completed the Medical Outcome Study Health Survey SF-36 scale, which includes a physical components scale, a mental components scale, and a bodily pain subscale. They also completed questionnaires assessing health behaviors, depressive symptoms, and coping styles. Participants (n=97) scored significantly lower on most aspects of QOL than age-matched Canadian and U.S. norms. Hierarchical multiple regressions revealed that physical activity and CD4 cell count were independently related to lower physical components scale scores; smoking and depressive symptoms were independently associated with lower mental components scale scores; and education, physical activity, and depressive symptoms were independently associated with lower pain-related QOL. Depressive symptoms mediated the relationship between coping styles and the mental components scale and pain-related QOL. Results suggest that targeting depressive symptoms, physical activity, and coping strategies as part of comprehensive treatment protocols could help improve pain-specific QOL and overall QOL among individuals with HIV.
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Affiliation(s)
- John Kowal
- Department of Psychology, The Ottawa Hospital Rehabilitation Centre, Ottawa, Canada.
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190
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Battaglini C, Mihalik J, Bottaro M, Dennehy C, Petschauer M, Hairston L, Shields E. Effect of exercise on the caloric intake of breast cancer patients undergoing treatment. Braz J Med Biol Res 2008; 41:709-15. [DOI: 10.1590/s0100-879x2008000800012] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2007] [Accepted: 08/15/2008] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - J.P. Mihalik
- University of North Carolina at Chapel Hill, USA
| | | | - C. Dennehy
- Navitas Cancer Rehabilitation Centers of America, Inc., USA
| | | | | | - E.W. Shields
- University of North Carolina at Chapel Hill, USA
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191
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Stuhldreher N, Reif K, de Vries U, Görres S, Petermann F. Development and evaluation of a cancer-related fatigue patient education program: protocol of a randomized controlled trial. BMC Nurs 2008; 7:12. [PMID: 18651943 PMCID: PMC2491613 DOI: 10.1186/1472-6955-7-12] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2008] [Accepted: 07/23/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cancer-related fatigue (CRF) and its impact on patients' quality of life has been an increasing subject of research. However, in Germany there is a lack of evidence-based interventions consistent with the multidimensional character of fatigue. The objective of this study is to develop and evaluate a self-management program for disease-free cancer patients to cope with CRF. METHODS Based on evidence extracted from a literature review, a curriculum for the self-management program was elaborated. The curriculum was reviewed and validated by an interdisciplinary expert group and the training-modules will be pretested with a small number of participants and discussed in terms of feasibility and acceptance.To determine the efficacy of the program a randomised controlled trial will be carried out: 300 patients will be recruited from oncological practices in Bremen, Germany, and will be allocated to intervention or control group. The intervention group participates in the program, whereas the control group receives standard care and the opportunity to take part in the program after the end of the follow-up (waiting control group). Primary outcome measure is the level of fatigue, secondary outcome measures are quality of life, depression, anxiety, self-efficacy and physical activity. Data will be collected before randomisation, after intervention, and after a follow-up of 6 months. DISCUSSION Because there are no comparable self-management programs for cancer survivors with fatigue, the development of the curriculum has been complex; therefore, the critical appraisal by the experts was an important step to validate the program and their contributions have been integrated into the curriculum. The experts appreciated the program as filling a gap in outpatient cancer care.If the results of the evaluation prove to be satisfactory, the outpatient care of cancer patients can be broadened and supplemented. TRIAL REGISTRATION ClinicalTrials NCT00552552.
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Affiliation(s)
- Nina Stuhldreher
- University of Bremen, Institute of Public Health and Nursing Research IPP, Department of Research on Interdisciplinary Ageing and Nursing, Grazer Str. 4, 28359 Bremen, Germany
| | - Karl Reif
- University of Bremen, Institute of Public Health and Nursing Research IPP, Department of Research on Interdisciplinary Ageing and Nursing, Grazer Str. 4, 28359 Bremen, Germany
| | - Ulrike de Vries
- University of Bremen, Centre for Clinical Psychology and Rehabilitation, Grazer Str. 6, 28359 Bremen, Germany
| | - Stefan Görres
- University of Bremen, Institute of Public Health and Nursing Research IPP, Department of Research on Interdisciplinary Ageing and Nursing, Grazer Str. 4, 28359 Bremen, Germany
| | - Franz Petermann
- University of Bremen, Centre for Clinical Psychology and Rehabilitation, Grazer Str. 6, 28359 Bremen, Germany
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192
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Abstract
This Review discusses physiological, emotional, behavioural, and cognitive aspects of psychological adjustment to chronic illness. Reviewing the reports of the past decade, we identify four innovative and promising themes that are relevant for understanding and explaining psychological adjustment. In particular, the emphasis on the reasons why people fail to achieve a healthy adjustment has shifted to the identification of factors that help patients make that adjustment. To promote psychological adjustment, patients should remain as active as is reasonably possible, acknowledge and express their emotions in a way that allows them to take control of their lives, engage in self-management, and try to focus on potential positive outcomes of their illness. Patients who can use these strategies have the best chance of successfully adjusting to the challenges posed by a chronic illness.
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Affiliation(s)
- Denise de Ridder
- Department of Clinical & Health Psychology, Utrecht University, The Netherlands Research Institute for Psychology & Health, Utrecht, Netherlands.
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193
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Hwang JH, Chang HJ, Shim YH, Park WH, Park W, Huh SJ, Yang JH. Effects of supervised exercise therapy in patients receiving radiotherapy for breast cancer. Yonsei Med J 2008; 49:443-50. [PMID: 18581595 PMCID: PMC2615347 DOI: 10.3349/ymj.2008.49.3.443] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Postoperative radiotherapy for breast cancer has a number of associated complications. This study examined whether supervised moderate-intensity exercise could mitigate the complications that occur during radiotherapy. PATIENTS AND METHODS Forty women were randomized before radiotherapy after various operations for breast cancer. Seventeen patients who were assigned to the exercise group performed supervised moderate-intensity exercise therapy for 50 min 3 times per week for 5 weeks. Twenty-three patients in the control group were asked to perform self-shoulder stretching exercise. The World Health Organization Quality of Life-BREF (WHOQOL-BREF), brief fatigue inventory (BFI), range of motion (ROM) of the shoulder, and pain score were assessed before and after radiotherapy. RESULTS There were no significant differences noted at baseline between groups. In the exercise group, there was an increase in the WHOQOL-BREF and shoulder ROM and decrease in BFI and pain score after radiotherapy. On the other hand, patients in the control group showed decrease in the WHOQOL-BREF and shoulder ROM and increase in BFI and pain score after radiotherapy. There were statistically significant differences in the changes in the WHOQOL, BFI, shoulder ROM, and pain score between the groups. CONCLUSION Patients receiving radiotherapy for breast cancer may benefit in physical and psychological aspects from supervised moderate-intensity exercise therapy.
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Affiliation(s)
- Ji Hye Hwang
- Department of Physical Medicine and Rehabilitation, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Jung Chang
- Department of Physical Medicine and Rehabilitation, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Hun Shim
- Division of Sports Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Hah Park
- Division of Sports Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Jae Huh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung-Hyun Yang
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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194
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Abstract
Cancer-related fatigue (CRF) is a common symptom in patients treated for cancer. For patients receiving chemotherapy, the prevalence is 75% to 90%; in those receiving radiation, 65%. The management of CRF is difficult because its nature is not yet fully explained and it has a variety of causes. The purpose of the review is to identify interventions that can be used by nurses successfully to reduce fatigue during cancer treatment. A search of the medical (PubMed) and nursing (CINAHL) literature (1995 to February 2005) produced 18 studies. In two-thirds of the studies, the populations were breast cancer patients. Half of the studies had a sample size of less then 30 patients. The studies included dealt with sleep promotion (1), instruction and education (5), exercise (10), and distraction and relaxation (2). Significant effects were found in studies promoting exercise. For interventions on sleep promotion and on education and counseling, a positive result was found, but this was not significant. For distraction and relaxation, only an effect until a few hours after the intervention was found. Given the multidimensional nature of CRF, a combination of interventions is most likely to be effective. Thus far, such an approach by nurses during cancer treatment has not been tested.
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195
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Abstract
The purpose of this randomized control trial was to verify the effectiveness of a brief group intervention that combines stress management psycho-education and physical activity (ie, independent variable) intervention in reducing fatigue and improving energy level, quality of life (mental and physical), fitness (VO 2submax), and emotional distress (ie, dependent variables) in breast cancer survivors. This study applied Lazarus and Folkman stress-coping theoretical framework, as well as Salmon's unifying theory of physical activity. Eighty-seven French-speaking women who had completed their treatments for nonmetastatic breast cancer at a university hospital in Quebec City, Canada, were randomly assigned to either the group intervention (experimental) or the usual-care (control) condition. Data were collected at baseline, postintervention, and at 3-month follow-up. The 4-week group intervention was cofacilitated by 2 nurses. Results showed that participants in the intervention group showed greater improvement in fatigue, energy level, and emotional distress at 3-month follow-up, and physical quality of life at postintervention, compared with the participants in the control group. These results suggest that a brief psycho-educational group intervention focusing on active coping strategies and physical activity is beneficial to cancer survivors after breast cancer treatments.
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196
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Chang PH, Lai YH, Shun SC, Lin LY, Chen ML, Yang Y, Tsai JC, Huang GS, Cheng SY. Effects of a walking intervention on fatigue-related experiences of hospitalized acute myelogenous leukemia patients undergoing chemotherapy: a randomized controlled trial. J Pain Symptom Manage 2008; 35:524-34. [PMID: 18280104 DOI: 10.1016/j.jpainsymman.2007.06.013] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2007] [Revised: 06/21/2007] [Accepted: 06/29/2007] [Indexed: 11/25/2022]
Abstract
The purpose of this randomized, controlled clinical trial was to preliminarily examine the effects of a three-week walking exercise program (WEP) on fatigue-related experiences of acute myelogenous leukemia (AML) patients receiving chemotherapy. Eligible AML patients were randomly assigned to either an experimental group (n=11), which received 12 minutes of WEP per day, five days per week for three consecutive weeks, or to a control group (n=11), which received standard ward care. Effects of the WEP were assessed by seven indicators: worst and average fatigue intensities, fatigue interference with patients' daily life, 12-minute walking distance, overall symptom distress, anxiety, and depressive status. All patients were evaluated four times: before chemotherapy (baseline or Day 1), Day 7, Day 14, and Day 21 of chemotherapy. Data were analyzed by Generalized Estimating Equation and revealed that AML patients in the three-week WEP group had a significantly greater increase in 12-minute walking distance than the control group. Patients in the WEP also had lower levels of fatigue intensity and interference, symptom distress, anxiety, and depressive status than the control group. Although preliminary, our results strongly suggest that three weeks of systematic walking exercise is clinically feasible for AML patients undergoing chemotherapy and can effectively improve their fatigue-related experiences.
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Affiliation(s)
- Pi-Hua Chang
- Department of Nursing, Taichung Veterans General Hospital, Taichung, Republic of China
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197
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van Weert E, Hoekstra-Weebers JEHM, May AM, Korstjens I, Ros WJG, van der Schans CP. The development of an evidence-based physical self-management rehabilitation programme for cancer survivors. PATIENT EDUCATION AND COUNSELING 2008; 71:169-190. [PMID: 18255249 DOI: 10.1016/j.pec.2007.11.027] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2007] [Revised: 11/28/2007] [Accepted: 11/28/2007] [Indexed: 05/25/2023]
Abstract
OBJECTIVE This paper describes the development of a physical training programme for cancer patients. Four related but conceptually and empirically distinct physical problems are described: decreased aerobic capacity, decreased muscle strength, fatigue and impaired role physical functioning. The study aimed to identify the optimal content for an exercise programme that addresses these four physical problems, based on the highest level of evidence available. The study further aimed to review the evidence available on the delivery of the programmes. The final goal was to develop a programme in which content and delivery are based on the best available evidence. METHODS Literature searches (PUBMED and MEDLINE, to July 2006) on content looked for evidence about the efficacy of exercise on aerobic capacity, muscle strength, fatigue and impaired role physical functioning. Literature searches on delivery looked for self-management and/or self-efficacy enhancing techniques in relation to outcome, adherence to and/or adoption of a physically active lifestyle. RESULTS Evidence on the effectiveness of exercise in cancer patients varies and increases when moving from muscle strength (RCT level), fatigue and physical role functioning to aerobic capacity (all at the meta-analysis level). Effect sizes for aerobic capacity were moderate, while effect sizes for fatigue and physical role functioning were zero and/or small. Many of the studies have significant methodological shortcomings. There was some evidence (meta-analyses) that self-management programmes and self-efficacy enhancing programmes have beneficial effects on health outcomes in a variety of chronic diseases, on the quality of life in cancer patients, and on exercise adherence and later exercise behaviour. CONCLUSION Limited data are available on the effectiveness of exercise for cancer patients. Although evidence supports the positive effects of exercise on exercise capacity during and after completion of cancer treatment, the effects for fatigue and role functioning are ambiguous. Evidence on the effectiveness of progressive exercise training on muscle strength is promising. In addition, some evidence supports the positive effects of self-management programmes and self-efficacy enhancing programmes on health outcomes, exercise adherence and later exercise behaviour. PRACTICE IMPLICATIONS The resulting programme was developed on the basis of the highest quality of evidence available regarding content and delivery. The content is based on information obtained from the present review, and on the recommendations of the American College of Sports Medicine. Potential advantages of the programme include: (a) tailored physical training towards focusing on the patient's established problems and (b) delivery of the training as a self-management programme that might have beneficial effects on health outcome, exercise adherence and a long-term physically active lifestyle.
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Affiliation(s)
- Ellen van Weert
- Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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198
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Abstract
BACKGROUND Cancer-related fatigue is now recognised as an important symptom associated with cancer and its treatment. A number of studies have investigated the effects of physical activity in reducing cancer-related fatigue with no definitive conclusions regarding its effectiveness. OBJECTIVES To evaluate the effect of exercise on cancer-related fatigue both during and after cancer treatment. SEARCH STRATEGY The Cochrane Controlled Trials Register (CENTRAL/CCTR), MEDLINE (1966 to July 2007), EMBASE (1980 to July 2007), CINAHL (1982 to July 2007), British Nursing Index (January 1984 to July 2007), AMED (1985 to July 2007), SIGLE (1980 to July 2007), and Dissertation Abstracts International (1861 to July 2007) were all searched using key words. Reference lists off all studies identified for inclusion and relevant reviews were also searched. In addition, relevant journals were hand searched and experts in the field of cancer-related fatigue were contacted. SELECTION CRITERIA Randomised controlled trials (RCTs) that investigated the effect of exercise on cancer-related fatigue in adults were included. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the methodological quality of studies and extracted data based upon predefined criteria. Where data were available meta-analyses were performed for fatigue using a random-effects model. MAIN RESULTS Twenty-eight studies were identified for inclusion (n = 2083 participants), with the majority carried out on participants with breast cancer (n = 16 studies; n = 1172 participants). A meta-analysis of all fatigue data, incorporating 22 comparisons provided data for 920 participants who received an exercise intervention and 742 control participants. At the end of the intervention period exercise was statistically more effective than the control intervention (SMD -0.23, 95% Confidence Interval (CIs) -0.33 to -0.13). AUTHORS' CONCLUSIONS Exercise can be regarded as beneficial for individuals with cancer-related fatigue during and post cancer therapy. Further research is required to determine the optimal type, intensity and timing of an exercise intervention.
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Affiliation(s)
- F Cramp
- University of the West of England, School of Allied Health Professions, Glenside Campus, Blackberry Hill, Bristol, UK, BS16 1DD.
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199
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Ingram C, Visovsky C. Exercise intervention to modify physiologic risk factors in cancer survivors. Semin Oncol Nurs 2008; 23:275-84. [PMID: 18022055 DOI: 10.1016/j.soncn.2007.08.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To review the best current evidence regarding the effects of exercise on modifiable risk factors for adverse physiologic outcomes of cancer and its treatment. DATA SOURCES Clinical practice guidelines, systematic reviews, meta-analyses, and single studies. CONCLUSION There is mounting evidence that exercise improves fatigue, physical functioning, and cardio-respiratory fitness. Preliminary evidence suggests that exercise also contributes to improvements in body weight and composition, metabolic risk factors, and immune function. It may also influence disease-free and overall survival in selected populations. IMPLICATIONS FOR NURSING PRACTICE Exercise appears to be a safe and well-tolerated intervention that may minimize or prevent adverse physiologic outcomes of cancer and cancer treatment.
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Affiliation(s)
- Carolyn Ingram
- School of Nursing, Faculty of Health Sciences, McMaster University, 1200 Main St West, HSC - 2J32, Hamilton, Ontario L8N 3Z5, Canada.
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200
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Knobf MT, Musanti R, Dorward J. Exercise and quality of life outcomes in patients with cancer. Semin Oncol Nurs 2008; 23:285-96. [PMID: 18022056 DOI: 10.1016/j.soncn.2007.08.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To review the evidence of the effects of exercise interventions in patients with cancer in each of four quality-of-life domains: physical, psychological, social, and spiritual. DATA SOURCES Research articles, abstracts, literature review. CONCLUSION There is strong evidence to support positive effects of exercise on physical and psychological well-being. Exercise improves physical function, muscle strength, emotional well-being, self esteem, decreases fatigue, anxiety, and depression, and helps maintain weight. Data suggest exercise fosters social functioning and more research is needed on the relationship of exercise and spiritual well-being. IMPLICATIONS FOR NURSING PRACTICE There is sufficient evidence to support exercise as an intervention to enhance a cancer patient's physical functioning and psychological well-being. Nurses should be encouraged to integrate physical activity recommendations into practice, tailored to the individual's health condition and mutual goal setting.
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Affiliation(s)
- M Tish Knobf
- Yale University School of Nursing, 100 Church St South, New Haven, CT 06536-0740, USA.
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