Energy Conservation and Activity Management

Energy Conservation and Activity Management

PEP Topic 
Fatigue
Description 

Energy conservation is the deliberate and planned management of one’s personal energy resources to prevent their depletion. Energy conservation strategies include planning, delegating, setting priorities, pacing, resting, and scheduling activities that require high-energy use at times of peak energy. Balancing rest and activity during times of high fatigue allows for maintaining adequate energy to perform valued activities and reach important goals.

Likely to Be Effective

Research Evidence Summaries

Barsevick, A. M., Whitmer, K., Sweeney, C., & Nail, L. M. (2002). A pilot study examining energy conservation for cancer treatment-related fatigue. Cancer Nursing, 25, 333–341.

doi: 10.1097/00002820-200210000-00001
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Intervention Characteristics/Basic Study Process:

The energy conservation and activity management (ECAM) intervention included completing a journal to monitor fatigue, sleep, rest, activity, and other symptoms; listing and prioritizing usual activities; and creating a tailored energy conservation plan. The intervention was delivered by nurse counselors in three telephone sessions of 15 to 30 minutes in length.

Sample Characteristics:

  • The study sample included 38 adults in two groups:  radiotherapy (n = 18; mean age = 59.4 years; 70% female; 84% Caucasian) and chemotherapy (n = 20; mean age = 57.4 years; 91% female; 95% Caucasian).
  • The control group included 182 adults (mean age = 55.1 years; 58% female; 95% Caucasian).

Setting:

  • Experimental participants were outpatients in a National Cancer Institute–designated cancer center.
  • Patients in the control group were from a multi-site study on fatigue measurement.

Phase of Care and Clinical Applications:

Patients were undergoing the active treatment phase of care.

Study Design:

  • The study used a single group pre-/posttest design.
  • A nonequivalent control group from another study was used for posttest comparisons.

Measurement Instruments/Methods:

Profile of Mood States (POMS) Fatigue scale

Results:

  • The intervention was well tolerated and acceptable to patients.
  • Results showed a trend for the two groups to differ at both points in time, with the control group exhibiting higher fatigue scores than the ECAM group.

Limitations:

  • The study had a small sample size.
  • The control group was a nonequivalent.
  • The population was vulnerable, with many medical problems that can effect adherence.

Nursing Implications:

Minimal training with the intervention materials is needed.

Barsevick, A. M., Dudley, W., Beck, S., Sweeney, C., Whitmer, K., & Nail, L. (2004). A randomized clinical trial of energy conservation for patients with cancer-related fatigue. Cancer, 100, 1302–1310.

doi: 10.1002/cncr.20111
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Intervention Characteristics/Basic Study Process:

The energy conservation and activity management (ECAM) intervention consisted of information provision, guidance in formulating and implementing a plan for energy conservation and activity management, and support in appraising the effectiveness of symptom management efforts. The intervention included completing a journal to monitor fatigue, sleep, rest, activity, and other symptoms; listing and prioritizing usual activities; and creating a tailored energy conservation plan. The intervention was delivered by nurse counselors in three telephone sessions that were 15 to 30 minutes in length.

Sample Characteristics:

  • The study included 396 adults (age range 18–83 years); 85% were women, and most were Caucasian.
  • Multiple diagnoses were included, but 71% of participants had breast cancer.
  • All participants were initiating treatment with chemotherapy (47%), radiotherapy (44%), or concurrent chemoradiotherapy (9%).

Setting:

Outpatient services of two large university cancer centers

Phase of Care and Clinical Applications:

Patients were undergoing the active treatment phase of care.

Study Design:

The study was a randomized, clinical trial with a repeated-measures design and an attentional control group.

Measurement Instruments/Methods:

  • Profile of Mood States (POMS)
  • Schwartz Cancer Fatigue Scale (SCFS)
  • General Fatigue Scale (GFS)

Results:

  • The ECAM intervention had a statistically significant effect in reducing fatigue, but the clinical effect was modest.
  • The intervention group experienced significantly less disruption of usual activities compared with the control group, although the intervention was not associated with changes in overall functional status.

Conclusions:

Efficacy findings were not confounded by the inability of patients who were in poorer health to complete the data collection process.

Limitations:

  • Overrepresentation of women and a breast cancer diagnosis limits the generalizability to men, patients with other diagnoses, and those in poorer health.
  • The amount of missing data was substantial. 
  • Costs were not addressed.

Nursing Implications:

Minimal training with the intervention materials is needed.


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