Effect of a multimodal high intensity exercise intervention in cancer patients undergoing chemotherapy: randomised controlled trial

Lis Adamsen, Morten Quist, Christina Andersen, Tom Møller, Jørn Herrstedt, Dorte Kronborg, Marie T Baadsgaard, Kirsten Vistisen, Julie Midtgaard, Birgitte Christiansen, Maria Stage, Morten T Kronborg, Mikael Rørth, Lis Adamsen, Morten Quist, Christina Andersen, Tom Møller, Jørn Herrstedt, Dorte Kronborg, Marie T Baadsgaard, Kirsten Vistisen, Julie Midtgaard, Birgitte Christiansen, Maria Stage, Morten T Kronborg, Mikael Rørth

Abstract

Objective: To assess the effect of a multimodal group exercise intervention, as an adjunct to conventional care, on fatigue, physical capacity, general wellbeing, physical activity, and quality of life in patients with cancer who were undergoing adjuvant chemotherapy or treatment for advanced disease.

Design: Randomised controlled trial.

Setting: Two university hospitals in Copenhagen, Denmark.

Participants: 269 patients with cancer; 73 men, 196 women, mean age 47 years (range 20-65) representing 21 diagnoses. Main exclusion criteria were brain or bone metastases. 235 patients completed follow-up.

Intervention: Supervised exercise comprising high intensity cardiovascular and resistance training, relaxation and body awareness training, massage, nine hours weekly for six weeks in addition to conventional care, compared with conventional care.

Main outcome measures: European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), Medical Outcomes Study Short Form (MOS SF-36), Leisure Time Physical Activity Questionnaire, muscular strength (one repetition maximum), maximum oxygen consumption (Vo(2)max). Statistical methods The general linear model was used for continuous outcome while analysis of associates between categorical outcomes was performed as analysis of marginal homogeneity in contingency tables.

Results: Adjusted for baseline score, disease, and demographic covariates, the intervention group showed an estimated improvement at six weeks for the primary outcome, fatigue, of -6.6 points (95% confidence interval -12.3 to -0.9, P=0.02; effect size=0.33, 0.04 to 0.61). Significant effects were seen on vitality (effect size 0.55, 95% CI 0.27 to 0.82), physical functioning (0.37, 0.09 to 0.65), role physical (0.37, 0.10 to 0.64), role emotional (0.32, 0.05 to 0.59), and mental health (0.28, 0.02 to 0.56) scores. Improvement was noted in physical capacity: estimated mean difference between groups for maximum oxygen consumption was 0.16 l/min (95% CI 0.1 to 0.2, P<0.0001) and for muscular strength (leg press) was 29.7 kg (23.4 to 34.9, P<0.0001). No significant effect was seen on global health status/quality of life.

Conclusion: A supervised multimodal exercise intervention including high and low intensity components was feasible and could safely be used in patients with various cancers who were receiving adjuvant chemotherapy or treatment for advanced disease. The intervention reduced fatigue and improved vitality, aerobic capacity, muscular strength, and physical and functional activity, and emotional wellbeing, but not quality of life.

Trial registration: Current Controlled trials ISRCTN05322922.

Conflict of interest statement

Competing interests: None declared.

Figures

https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4787458/bin/adal632786.f1_default.jpg
Fig 1 Trial profile

References

    1. Smets EM, Garssen B, Schuster-Uitterhoeve AL, de Haes JC. Fatigue in cancer patients. Br J Cancer 1993;68:220-4.
    1. Henry DH, Viswanathan HN, Elkin EP, Traina S, Wade S, Cella D. Symptoms and treatment burden associated with cancer treatment: results from a cross-sectional national survey in the US. Support Care Cancer 2008;16:791-801.
    1. Baum A, Andersen BL. Introduction. In: Baum A, Andersen BL, eds. Psychosocial interventions for cancer. American Psychological Association, 2001:3-15.
    1. Pinto BM, Eakin E, Maruyama NC. Health behavior changes after a cancer diagnosis: what do we know and where do we go from here? Ann Behav Med 2000;22:38-52.
    1. Fentem PH. ABC of sports medicine: benefits of exercise in health and disease. BMJ 1994;308:1291-5.
    1. Lucía A, Earnest C, Pérez M. Cancer-related fatigue: can exercise physiology assist oncologists? Lancet Oncol 2003;4:616-25.
    1. Schmitz KH, Holtzman J, Courneya KS, Mâsse LC, Duval S, Kane R. Controlled physical activity trials in cancer survivors: a systematic review and meta-analysis. Cancer Epidemiol Biomarkers Prev 2005;14:1588-95.
    1. McNeely ML, Campbell KL, Rowe BH, Klassen TP, Mackey JR, Courneya KS. Effects of exercise on breast cancer patients and survivors: a systematic review and meta-analysis. CMAJ 2006;175:34-41.
    1. Markes M, Brockow T, Resch KL. Exercise for women receiving adjuvant therapy for breast cancer. Cochrane Database Syst Rev 2006;(4):CD005001.
    1. Kraemer WJ, Adams K, Cafarelli E, Dudley GA, Dooly C, Feigenbaum MS, et al. American College of Sports Medicine position stand: progression models in resistance training for healthy adults. Med Sci Sports Exerc 2002;34:364-80.
    1. Kangas M, Bovbjerg DH, Montgomery GH. Cancer-related fatigue: a systematic and meta-analytic review of non-pharmacological therapies for cancer patients. Psychol Bull 2008;134:700-41.
    1. Kwekkeboom KL, Hau H, Wanta B, Bumpus M. Patients’ perceptions of the effectiveness of guided imagery and progressive muscle relaxation interventions used for cancer pain. Complement Ther Clin Pract 2008;14:185-94.
    1. Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ, et al. Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc 2000;32(9 Suppl):S498-504.
    1. Saltin B, Gollnick PD. Skeletal muscle adaptability: significance for metabolism and performance. In: Peachey LD, Adrian PH, Geiger SR, eds. Handbook of physiology, sektion 10: skeletal muscle. American Physiological Society, 1983:555-631.
    1. McCaffery M, Beebe A. Pain: clinical manual for nursing practice. Mosby, 1989.
    1. da Costa BR, Vieira ER. Stretching to reduce work-related musculoskeletal disorders: a systematic review. J Rehabil Med 2008;40:321-8.
    1. Bower JE, Woolery A, Sternlieb B, Garet D. Yoga for cancer patients and survivors. Cancer Control 2005;12:165-71.
    1. Anderson BD, Spector AH. Introduction to pilates-based rehabilitation. Orthop Phys Ther Clin N Am 2000;9:395-400.
    1. Ferrell-Torry AT, Glick OJ. The use of therapeutic massage as a nursing intervention to modify anxiety and the perception of cancer pain. Cancer Nurs 1993;16:93-101.
    1. Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 1993;85:365-76.
    1. Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 1992;30:473-83.
    1. Saltin B, Grimby G. Physiological analysis of middle-aged and old former athletes. Comparison with still active athletes of the same ages. Circulation 1968;38:1104-15.
    1. de Bruin A, Picavet HSJ, Nossikov A, eds. Health interview surveys: towards international harmonization of methods and instruments. World Health Organization, 1996.
    1. Aadahl M, Jørgensen T. Validation of a new self-report instrument for measuring physical activity. Med Sci Sports Exerc 2003;35:1196-202.
    1. Brzycki M. Strength testing: predicting a one-rep max from reps to fatigue. J Phys Educ Recreation Dance 1993;64:88-90.
    1. Andersen LB. A maximal cycle exercise protocol to predict maximal oxygen uptake. Scand J Med Sci Sports 1995;5:143-6.
    1. Quist M, Rorth M, Zacho M, Andersen C, Moeller T, Midtgaard J, Adamsen L. High-intensity resistance and cardiovascular training improve physical capacity in cancer patients undergoing chemotherapy. Scand J Med Sci Sports 2006;16:349-57.
    1. Adamsen L, Quist M, Midtgaard J, Andersen C, Møller 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. Support Care Cancer 2006;14:116-27.
    1. Cohen J. Statistical power analysis for the behavioral sciences. 2nd rev ed. Lawrence Erlbaum Associates, 1988.
    1. Nakagawa S, Cuthill IC. Effect size, confidence interval and statistical significance: a practical guide for biologists. Biol Rev Camb Philos Soc 2007;82:591-605.
    1. Klee M, Groenvold M, Machin D. Quality of life of Danish women: population-based norms of the EORTC QLQ-C30. Qual Life Res 1997;6:27-34.
    1. King MT. The interpretation of scores from the EORTC quality of life questionnaire QLQ-C30. Qual Life Res 1996;5:555-67.
    1. Mutrie N, Campbell AM, 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. BMJ 2007;334:517-20.
    1. Courneya KS, Segal RJ, Mackey JR, Gelmon K, Reid RD, Friedenreich CM, et al. Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomized controlled trial. J Clin Oncol 2007;25:4396-404.
    1. Lucía A, Earnest C, Pérez M. Cancer-related fatigue: can exercise physiology assist oncologists? Lancet Oncol 2003;4:616-25.
    1. Adamsen L, Midtgaard J, Roerth M, Andersen C, Quist M, Moeller T. Transforming the nature of fatigue through exercise: qualitative findings from a multidimensional exercise programme in cancer patients undergoing chemotherapy. Eur J Cancer Care 2004;13:362-70.
    1. Uitterhoeve RJ, Vernooy M, Litjens M, Potting K, Bensing J, De Mulder P, et al. Psychosocial interventions for patients with advanced cancer: a systematic review of the literature. Br J Cancer 2004;91:1050-62.
    1. van Emmerik AA, Kamphuis JH, Hulsbosch AM, Emmelkamp PM. Single session debriefing after psychological trauma: a meta-analysis. Lancet 2002;360:766-71.
    1. Roila F, Hesketh PJ, Herrstedt J; Antiemetic Subcommittee of the Multinational Association of Supportive Care in Cancer. Prevention of chemotherapy- and radiotherapy-induced emesis: results of the 2004 Perugia International Antiemetic Consensus Conference. Ann Oncol 2006;17:20-8.
    1. 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. J Clin Oncol 2001;19:657-65.
    1. Bjørner JB, Damsgaard MT, Watt T, Bech P, Rasmussen NK, Kristensen TS, et al. Dansk manual til SF-36: et spørgeskema om helbredsstatus [SF-36 (Danish manual): health-related quality of life questionnaire]. Danish Association of the Pharmaceutical Industry, 1997.
    1. Nader GA. Concurrent strength and endurance training: from molecules to man. Med Sci Sports Exerc 2006;38:1965-70.
    1. Gayda M, Choquet D, Ahmaidi S. Effects of exercise training modality on skeletal muscle fatigue in men with coronary heart disease. J Electromyogr Kinesiol 2009;19:e32-9.
    1. Moinuddin I, Leehey DJ. A comparison of aerobic exercise and resistance training in patients with and without chronic kidney disease. Adv Chronic Kidney Dis 2008;15:83-96.
    1. Thomas DE, Elliott EJ, Naughton GA. Exercise for type 2 diabetes mellitus. Cochrane Database Syst Rev 2006;(3):CD002968.
    1. Milne HM, Wallman KE, Gordon S, Courneya KS. Effects of a combined aerobic and resistance exercise program in breast cancer survivors: a randomized controlled trial. Breast Cancer Res Treat 2008;108:279-88.
    1. Galvão DA, Newton RU. Review of exercise intervention studies in cancer patients. J Clin Oncol 2005;23:899-909.
    1. O’Connor PJ, Puetz TW. Chronic physical activity and feelings of energy and fatigue. Med Sci Sports Exerc 2005;37:299-305.
    1. Luebbert K, Dahme B, Hasenbring M. The effectiveness of relaxation training in reducing treatment-related symptoms and improving emotional adjustment in acute non-surgical cancer treatment: a meta-analytical review. Psychooncology 2001;10:490-502.
    1. Dimeo F, Schwartz S, Fietz T, Wanjura T, Böning D, Thiel E. Effects of endurance training on the physical performance of patients with hematological malignancies during chemotherapy. Support Care Cancer 2003;11:623-8.
    1. Jarden M, Hovgaard D, Boesen E, Quist M, Adamsen L. Pilot study of a multimodal intervention: mixed-type exercise and psychoeducation in patients undergoing allogeneic stem cell transplantation. Bone Marrow Transplant 2007;40:793-800.
    1. Cancer Research UK. UK cancer incidence statistics by country: table 8.2: females—number of new cases of cancer diagnosed, by site, UK, 2005. .
    1. Cancer Research UK. UK cancer incidence statistics by country: table 8.1: males—number of new cases of cancer diagnosed, by site, UK, 2005. .
    1. Espey DK, Wu XC, Swan J, Wiggins C, Jim MA, Ward E, et al. Annual report to the nation on the status of cancer, 1975-2004, featuring cancer in American Indians and Alaska Natives. Cancer 2007;110:2119-52.
    1. Canadian Cancer Society. Canadian cancer statistics 2008. Toronto: National Cancer Institute of Canada, 2008.
    1. Clemmensen IH, Nedergaard KH, Storm HH. Kræft i Danmark: en opslagsbog[Prevalence of cancer in Denmark: a reference book]. Danish Cancer Society, 2006.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel