Exercise

Exercise

PEP Topic 
Cognitive Impairment
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 self-managed programs, and supervised and unsupervised individual or group exercise sessions of varying duration and frequency. These interventions can include combinations of aerobic and resistance activities.

Exercise has been studied in patients with cancer for anxiety, chemotherapy-induced nausea and vomiting, cognitive impairment, depression, lymphedema, sleep/wake disturbance, pain, and fatigue. Users of this information are encouraged to review exercise intervention details in study summaries; as the interventions and their timing in the trajectory of cancer care vary, these differences can influence effectiveness.

Effectiveness Not Established

Research Evidence Summaries

Baumann, F.T., Drosselmeyer, N., Leskaroski, A., Knicker, A., Krakowski-Roosen, H., Zopf, E.M., & Bloch, W. (2011). 12-week resistance training with breast cancer patients during chemotherapy: Effects on cognitive abilities. Breast Care, 6, 142–143.

10.1159/000327505
Print

Study Purpose:

 To evaluate the effectiveness of resistance training on cognitive abilities in patients with breast cancer undergoing neoadjuvant chemotherapy   

Intervention Characteristics/Basic Study Process:

The intervention group (IG) participated in 60 minutes of resistance training (three sets of 8–12 reps for 10 different exercises at 55%–75% maximum effort) twice a week for 12 weeks. The control group (CG) did not receive any information. Cognitive evaluations were performed in the IG prior to them receiving the intervention and at study conclusion (one to two weeks after end of chemotherapy) for both groups.

Sample Characteristics:

  • The total number of participants was 17 (9 in intervention group, and 8 in thecontrol group). 
  • The mean age for the IG was 46.6 years (+/- 6.9 years). The mean age for the CG was 52 years (+/- 5.5 years).
  • The percentage of males and females was not provided.
  • Participants had been diagnosed with stage I–III breast cancer and were receiving neo-adjuvant chemotherapy.

Setting:

  • Site was not specified.
  • Patients were recruited from the Breast Center of the University Hospital of Cologne, Germany.

Phase of Care and Clinical Applications:

Patients were undergoing active treatment.

Study Design:

Prospective, non-randomized controlled trial

Measurement Instruments/Methods:

  • Memo memory test (verbal memory)     
  • Wilde Intelligence subtest (working memory)
  • d2 Test of Attention (focused attention and concentration)

Results:

The IG's d2 Test of Attention scores improved (p = 0.049), but no significant differences were observed in comparison to the CG. The IG d2 error rate decreased from baseline by 1.12 points (p = 0.017) but was significantly different from the CG at baseline (p = 0.040) and post-intervention (p = 0.019). The IG short-term verbal memory was marginally improved from baseline (p = NS) but was significantly better than CG scores (p = 0.048). IG Wilde test scores for working memory showed significant improvement from baseline (p= 0.049), but no significant difference existed between IG and CG scores.

Conclusions:

Improvements were seen in focused attention and concentration, working memory, and verbal memory for the IG. Although no differences were observed in verbal memory and attention between the IG and CG, the CG did not have baseline evaluations performed for adequate group comparisons.  

Limitations:

  • The sample size was less than 30.
  • The sample was not randomized.
  • No pre-test was conducted for the CG.
  • No comparative demographics were collected (e.g., education, occupation, information on treatment, previous treatment modalities). 
  • No actual scores or data were presented in the research brief. 

Nursing Implications:

Benefits of physical activity, predominately aerobic exercise, have improved symptoms of fatigue, sleep disturbances, affect, and cognitive function. Using resistance training may improve short-term verbal memory, working memory, attention, and concentration. Further study is warranted.

Korstjens, I., Mesters, I., van der Peet, E., Gijsen, B., & van den Borne, B. (2006). Quality of life of cancer survivors after physical and psychosocial rehabiliation. European Journal of Cancer Prevention, 15(6), 541–547.

doi:10.1097/01.cej.0000220625.77857.95
Print

Study Purpose:

This 12-week physical fitness and psychoeducational rehabilitation program was conducted to enhance quality of life and recovery among cancer survivors of all types of cancer. Its physical fitness component was aimed at improving movement skills, strength, and endurance; helping participants cope with physical complaints (e.g., fatigue); and enhancing feelings of control and stress reduction. Its psychoeducational component was aimed at providing support in coping with cancer and enhancing self-confidence and autonomy.

Intervention Characteristics/Basic Study Process:

 The intervention had three components.  

1. A physical fitness program involving two hours of training twice weekly with guidance from two expert physiotherapists. Each session consisted of

  • One hour of individual training for endurance and strength or one hour of group sports and games
  • 30 minutes of aqua-aerobics in an indoor pool.

2. A psychoeducational program consisting of seven two-hour sessions aimed at providing support in coping with cancer and enhancing self-confidence and autonomy.

3. Information on cancer-related subjects.

Subjective measures were completed prior to the intervention, 6 weeks into the intervention, and at 12 weeks at the intervention's end. 

Sample Characteristics:

  • The number of enrolled participants was 665. Of the enrolled participants, 658 initiated the program, 634 completed 6 weeks of the program, and 579 completed the program's full 12 weeks. 
  • The average age of the participants was 50.6 ± 9.5 years, with a range of 18–75 years.
  • 54% of the participants had breast cancer. Other cancers included were lymphoma, digestive tract, gynecologic, and lung cancer.
  • 77.8% of the participants were female and 21% were male. Gender was unknown for 1.2% of the participants. 
  • The average time since diagnosis was 2.1 years, with a range of 0–25 years.
  • The average time since end of treatment was 1.3 years, with a range 0–14 years.

Setting:

This was a single-site study. 

Study Design:

This was a prospective trial. 

Measurement Instruments/Methods:

The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-30 (EORTC QLQ-C30) was used to measured global and functional quality of life using 6 subscales (global, physical, role, cognitive, emotional, social functioning) and one symptom scale on fatigue. Scores range from 0–100, with higher scores indicating higher quality of life for the global and functional scales. Higher symptom scores indicate greater fatigue.

The Tampa Kinesophobia Scale was used to measure excessive, irrational and debilitating fear of physical movement and activity resulting from a feeling of vulnerability to painful injury or re-injury. Two subscales were used to measure avoidance of activities (7 items) and pathologic somatic focus (4 items).

Results:

As measured by two items on the EORTC QLQ–C30, cognitive function improved at 12 weeks, but not at 6 weeks. There were significant improvements for all quality-of-life domains and fatigue for all cancer patients after 12 weeks (p < 0.05).

Conclusions:

The authors suggest that exercise may improve cognitive functioning as well as other quality-of-life domains.

Limitations:

  • Although subjective cognitive function improved over 12 weeks, this finding was not confirmed by objective cognitive-specific measures.
  • A wide range of ages was included in the sample, but no age breakdown was recorded for the two cohorts; ge-related changes in cognitive function may influence the results between the two cohorts.
  • The authors were unable to determine whether changes in quality of life were a result of the exercise versus the psychoeducational intervention or the combination of both.
  • There was no control group as a comparison. 

Reid-Arndt, S.A., Matsuda, S., & Cox, C.R. (2012). Tai chi effects on neuropsychological, emotional, and physical functioning following cancer treatment: A pilot study. Complementary Therapies in Clinical Practice, 18, 26–30.

10.1016/j.ctcp.2011.02.005
Print

Study Purpose:

To examine the effects of tai chi on neuropsychological, psychological, and physical health of female cancer survivors  

Intervention Characteristics/Basic Study Process:

Women participated in an hour-long, twice-weekly Yang-style tai chi course for 10 weeks. They underwent testing prior to the course and then one month following the test.

Sample Characteristics:

  • A total of 23 participants enrolled in the study.  
  • The women's average age was 62.3 years (SD = 10.8 years).
  • The sample was 100% female.
  • The women had been diagnosed with breast (n = 16), ovarian (n = 3), or endometrial (n = 1) cancer; NHL (n = 2); or CLL (n = 1).
  • All had received chemotherapy at least 12 months prior.
  • On average, the women had complete 16.4 years (SD = 2.1 years) of education.
     

Setting:

  • Mutli-site 
  • Mid-Western city
     

Phase of Care and Clinical Applications:

Patients were undergoing long-term follow-up.

Study Design:

Pilot study

Measurement Instruments/Methods:

  • Rey Auditory Verbal Learning Test (memory)    
  • Trail Making Test A
  • Trail Making Test B (executive functioning)
  • Stroop Test (executive functioning)
  • Oral Word Association Test
  • Wechsler Adult Intelligence Scale Third Edition (WAIS-III) Digit Span and Digit Symbol
  • Multiple Abilities Self-Report Questionnaire (MASQ)

Results:

Statistical significant changes were seen in the scores of immediate memory (Rey trial 1, Rey trials 1–5, Logical Memory), delayed memory (logical memory II), verbal fluency (COWAT), attention (Trails A, Digit Symbol) and executive functioning (Trails B, Stroop Test). The Reliable Change Index analyses did not meet the criteria for reliable change as a group. Self-reported cognitive functioning improved for verbal and visual memory in the MASQ (p < 0.05). No significant changes were seen in fatigue. Significant improvements were seen in multiple measures of balance (p < 0.002).

Conclusions:

Tai chi may promote gains in cognitive and physical functioning in cancer survivors.

Limitations:

  • The sample was small at less than 30 participants.
  • It was a well-educated group, all female, with a range of treatment and length from last treatment)
  • No control group was included.
  • Classes were taught in a group setting, so the group support and interaction may have influenced the findings, rather than the tai chi itself.

Nursing Implications:

This is a small pilot study, but it suggests that tai chi may be helpful in improving neurocognitive functioning. Tai chi is a relatively easy exercise to perform for most patients and is readily available in most areas. Further research is needed to verify the benefits of tai chi on cognitive dysfunction.

Schwartz, A.L., Thompson, J.A., & Masood, N. (2002). Interferon-induced fatigue in patients with melanoma: A pilot study of exercise and methylphenidate. Oncology Nursing Forum, 29(7), E85–E90.

doi:10.1188/02.ONF.E85-E90
Print

Study Purpose:

This study was conducted to examine the effect of exercise and methylphenidate (MPH) on fatigue, functional ability, and cognitive function in patients with melanoma. It also aimed to determine the percentage of patients who adhered to interferon-alfa, MPH, and exercise treatment.

Intervention Characteristics/Basic Study Process:

The intervention group was given 20 mg of long-acting MPH every morning for four months and took part in at least 15–20 minutes of aerobic exercise four days per week. The duration and intensity of exercise gradually increased over the study's four months.

Assessments were completed prior to the first dose of interferon-alfa. Subsequent assessments of functional ability and cognition function (using Trail Making Test forms) and quality of life were repeated at one and four months after baseline. Subsequent assessments of fatigue scale, body weight, daily activity, and medication logs were submitted monthly.

Sample Characteristics:

  • The total number of individuals involved in the study was 28.
  • There were 12 participants and 16 historic controls. 
  • The average age of the treatment group was 44, with a range of 20–64. Age information for the historic group was not provided.
  • Gender information was not provided.
  • 92% of the participants were Caucasian.
  • The treatment group tended to have completed more years of formal education.
  • Participants had newly diagnosed melanoma with surgical intervention, no prior treatment, and were actively undergoing treatment with interferon-alfa.

Setting:

The study took place at a university-based cancer center.

Study Design:

This was a longitudinal pilot study with descriptive/exploratory design. It made use of a historic control group for comparison.

Measurement Instruments/Methods:

  • The Trail Making Test (TMT) Parts A and B measured visual attention, motor speed, and cognitive flexibility.
  • The Schwartz Cancer Fatigue Scale measured fatigue with 6 items. Scores range from 6–36, with higher scores indicating greater fatigue.
  • The Medical Outcomes Study Short Form (SF-36) measured quality-of-life and global function with physical and mental health subscales. Scores range from 0–100, with higher scores indicating higher functioning.
  • Adherence was measured with daily activity and medication logs.
  • Body weight was measured to the nearest 0.1 kg and obtained monthly.

Results:

Functional ability increased an average of 6% for all participants and 9% for the treatment group. A percent change in a 12-minute walk was negatively related to TMT-A (p = 0.04) and TMT-B (p = 0.05), suggesting a relationship between higher exercise and improved cognitive functioning (indicated by lower scores on TMT). Taking MPH was correlated with improved TMT-B performance at 4 months (r = -0.85, p < 0.001). 

All participants' cognitive function scores were within normal ranges at baseline. Sixty-six percent of participants adhered to MPH at four months; all subjects continued to exercise at four months.

Conclusions:

The combination of exercise and MPH has positive effects on cognitive function, functional ability, and fatigue over time. The authors suggest that MPH may have contributed to better exercise adherence.

Limitations:

  • The study had a small sample size.
  • One-third of the participants stopped taking MPH within the first week; for one participant, this was due to significant side effects related to anxiety.
  • Two participants regularly exercised prior to enrollment, but the study did not address which group they were assigned to, potentially influencing outcomes.

Menu