Exercise

Exercise

PEP Topic 
Chemotherapy-Induced Nausea and Vomiting
Description 

Exercise is physical activity that involves repetitive bodily movement done to improve or maintain one or more of the components of physical fitness—cardiorespiratory endurance (aerobic fitness), muscular strength, muscular endurance, flexibility, and body composition. Exercise interventions in patients with cancer have been provided as home-based, patient-managed, supervised and unsupervised, individual or group exercise sessions of varying duration and frequency. They can include combinations of aerobic and resistance activities. Exercise has been studied in patients with cancer for anxiety, chemotherapy-induced nausea and vomiting (CINV), depression, lymphedema, sleep/wake disturbance, pain, and fatigue. Users of this information are encouraged to review intervention details in study summaries because exercise interventions studied and their timings in the trajectory of cancer care vary and these differences can influence effectiveness.

Effectiveness Not Established

Research Evidence Summaries

Andersen, C., Adamsen, L., Moeller, T., Midtgaard, J., Quist, M., Tveteraas, A., & Rorth, M. (2006). The effect of a multidimensional exercise programme on symptoms and side-effects in cancer patients undergoing chemotherapy—The use of semi-structured diaries. European Journal of Oncology Nursing, 10(4), 247-262.

doi: 10.1016%2Fj.ejon.2005.12.007
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Study Purpose:

To evaluate the effect of a multidimensional exercise program on managing symptoms in patients with cancer undergoing chemotherapy

Intervention Characteristics/Basic Study Process:

Patients receiving chemotherapy participated in a structured, supervised exercise program, consisting of resistance-fitness training, massage, relaxation, and body-awareness training held in a workout room within the hospital, two to three times per week for a six-week period. Participants trained in mixed groups of seven to nine. Physiotherapists and a specially trained nurse, who participated in the physical training, supervised the program. Participants selected a total package of high or low intensity physical activity. They were not able select one activity over another.

Sample Characteristics:

  • The study consisted of 54 patients with cancer.
  • Participant ages ranged from 18-65 years.
  • All patients had been diagnosed at least one month prior receiving chemotherapy for adjuvant or advanced disease and had World Health Organization (WHO) performance statuses of 0-1 (0-5 scale).
  • Patients were excluded from the study if they had documented brain metastases, had received anticoagulation treatment or treatment for arrhythmia or myocardial infarction within the past three months, had dementia and psychotic conditions, or were unable to read and write in Danish.

Setting:

The study was conducted at university outpatient and inpatient settings in Denmark.

Study Design:

This was a prospective, exploratory study.

Measurement Instruments/Methods:

Using semi-structured diaries, patients rated 12 symptoms, including lack of appetite, nausea and vomiting, diarrhea, paraesthesia, constipation, physical fatigue, treatment-related fatigue, muscle pain, arthralgia, and other pain, defined by Common Toxicity Criteria (CTC) daily using a 0-4 scale.

Results:

  • During the intervention, patients reported decreases in 10 of 12 symptoms.
  • Patients with evidence of disease scored symptoms higher than those without evidence of disease.
  • Both groups responded positively to the intervention based on sum of symptom scores.

Conclusions:

A six-week, multidimensional exercise intervention administered while patients were simultaneously receiving chemotherapy led to reductions in symptoms.

Limitations:

  • The use of daily diaries is time consuming for patients.
  • Some data was missing.
  • Because this continued over time, participants may have recorded the previous score just to fill it in.
  • An exercise program takes commitment. The length of time for classes varied between high- and low-intensity groups.
  • Providing space for workout rooms accessible to inpatients and outpatients may be an issue for some centers.
  • Each symptom was given equal weight whereas some symptoms may be perceived as more problematic for patients.
  • This intervention requires a high level of knowledge and specific skills on the part of the individual who trains and supervises patients.

Winningham, M.L., & MacVicar, M.G. (1988). The effect of aerobic exercise on patient reports of nausea. Oncology Nursing Forum, 15, 447-450.

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Study Purpose:

To evaluate the therapeutic value of exercise to control or reduce nausea in patients with breast cancer receiving chemotherapy

Intervention Characteristics/Basic Study Process:

Subjects were randomized to one of three groups.

  • The experimental exercise group participated in a 10-week supervised program with a cycle ergometer and aerobic and interval training three times per week.
  • In the placebo group, subjects met with exercise leaders on a weekly basis for conversational interaction and the mild stretching and flexibility exercises, which the experimental group also had performed during warm-up and cool down.
  • The control group received no treatment, but patients were instructed to continue normal activities and notify study personnel if they began exercising.

Sample Characteristics:

  • The study consisted of 42 women with breast cancer.
  • The mean age of patients was 46 years.
  • No race or ethnicity data were recorded.
  • All patients were receiving chemotherapy (no doxorubicin), had had surgical treatment (mastectomy or lumpectomy), did not have uncontrolled cardiac disease or hypertension, were within the first six months of chemotherapy, and had had three treatments before entering the program.
  • Functional capacity at baseline was 0-2 Zubrod score or Karnofsky Performance Status of 60%–100%.
  • No participants were in an exercise program, and all were medically cleared by an oncologist.

Setting:

  • Participants were from a large Midwestern city.
  • Patients were recruited from outpatient clinics, private practices, and a university medical center.

Study Design:

The design was randomized, with three groups and pre- and post-test measures.

Measurement Instruments/Methods:

Pretest to post-test nausea responses were coded as improved, no change, or worsened as reported on the Derogatis Symptom Checklist-90-Revised, a 5-point distress/somatization scale. This somatization scale has 12 items and includes a variety of symptoms common to medical patients.

Results:

The differences among the experimental, control, and placebo groups were statistically significant, with the experimental group showing marked improvement in nausea compared to the control and placebo groups. The experimental group showed significant improvements in the Somatization scale scores (i.e., perceptions of autonomically mediated symptoms) over the control and placebo groups.

Limitations:

  • The study was restricted to women with breast cancer who were on a specific aerobic exercise protocol; therefore, the study is not generalizable to other groups with cancer.
  • One cannot assume that other exercise techniques will generate the same results.
  • Patients with a history of hypertension or cardiac disease were excluded.
  • No patients receiving doxorubicin were admitted into the study.
  • Exercise testing was monitored by a physician.

Nursing Implications:

Moderate aerobic exercise may provide some benefit in reducing nausea. Researchers recommended that patients abstain from exercise several hours prior to blood testing and on days of treatment.


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