Banzer, W., Bernhorster, M., Schmidt, K., Niederer, D., Lungwitz, A., Thiel, C., . . . Vogt, L. (2014). Changes in exercise capacity, quality of life and fatigue in cancer patients during an intervention. European Journal of Cancer Care, 23, 624–629. 

To explore the interdependence of changes in oxygen uptake, quality of life (QOL), and cancer-related fatigue (CRF) during a four-month exercise intervention

Aerobic exercise capacity was determined by a physician-supervised cardiopulmonary exercise test on an electrically braked cycle ergometer. An initial watt load of 0 watts was increased by 25 watts every three minutes until exhaustion. The results were used at an initial exercise counseling session to individualize exercise plans (i.e., frequency of three to five times per week, intensity, type of exercise, opportunity to participate in a Nordic walking training session once per week). Subjects attended a second counseling session four weeks into the intervention to adjust home-based exercises to fit their conditions. An exercise counselor was available by phone, via email, or in person at any time during the intervention. Assessments were repeated at the end of 16–20 weeks. Self-reported measures of adherence to exercise plans were obtained by diaries.

• N = 101  
• AGE RANGE = 32–85 years
• MALES: 40%, FEMALES: 60%
• KEY DISEASE CHARACTERISTICS: Confirmed cancer diagnosis (any site and stage) within the past three years; during adjuvant, palliative, or postadjuvant therapy (finished within the past 12 months); performance status of 0–II (as ranked by the Eastern Cooperative Oncology Group); exclusion criteria included brain or bone metastasis, uncontrolled hypertension, hemoglobin counts < 8 g/dl, and any condition precluding exercise

• SITE: Multi-site    
• SETTING TYPE: Multiple settings    
• LOCATION: Germany

• PHASE OF CARE: Multiple phases of care
• APPLICATIONS: Palliative care 

Repeated measures pre- and postintervention

• Aerobic exercise capacity measured by a cardiopulmonary exercise test (CPET) and the peak oxygen consumption (VO2PEAK) 
• QOL measured by the European Organisation for Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30 v.3.0)

Subjects were active (i.e., hiking, biking, walking, bicycling) three to six times per week for 60–300 minutes at 60%–100% of individual anaerobic thresholds. At baseline, the groups differed in QOL scores but not CRF or VO2PEAK scores. Subjects with complete data sets had a significant increase in VO2PEAK and QOL scores, and their fatigue decreased significantly over the course of the intervention. No significant effect for diagnosis or time since diagnoses occurred.

A relationship between exercise capacity enhancement, QOL improvement, and fatigue symptom reduction exists during and shortly after cancer treatment.

• Baseline sample/group differences of import
• Risk of bias (no control group)
• Risk of bias (no blinding)
• Risk of bias (no random assignment) 
• Risk of bias (no appropriate attentional control condition)
• Unintended interventions or applicable interventions not described that would influence results
• Key sample group differences that could influence results
• Findings not generalizable
• Questionable protocol fidelity

The data in this study support the role of individualized exercise planning based on baseline exercise capacity with respect to frequency, time, and intensity as well as the importance of patient choice in the type of exercise in which to participate.