Bourke, L., Thompson, G., Gibson, D. J., Daley, A., Crank, H., Adam, I., . . . Saxton, J. (2011). Pragmatic lifestyle intervention in patients recovering from colon cancer: a randomized controlled pilot study. Archives of Physical Medicine and Rehabilitation, 92, 749–755.

To investigate the feasibility of an intervention aimed at increasing exercise participation and improving dietary behavior in survivors of colon cancer and obtain preliminary data on the effect of the intervention on fatigue, exercise, and dietary outcomes.

Patients were randomly assigned to intervention or standard care control groups. The 12-week intervention included supervised and home-based exercise and dietary advice. During the first six weeks, the experimental group attended two group supervised exercise sessions of 30 minutes of aerobic exercise. Participants were asked to continue the same time of activities at home once a week during the same period and were asked to keep an exercise log. During the last six weeks, participants attended a supervised session once a week and were to perform two weekly home-based exercise sessions. Participants were given a dietary advice information pack and periodically attended healthy eating seminars encouraging reduction in saturated fat, increased fiber intake, reduction in refined carbohydrates, and limited alcohol intake.

• The sample was comprised of 18 survivors of colon cancer.
• Mean age was 69 years (range 52–80); 66.6% of patients were female and 33.3% were male.
• Of the patients, 83.3% had undergone surgery and one-third had received chemotherapy.
• Average time from the end of treatment was slightly greater than 16 months.

• Single site
• Outpatient
• United Kingdom

Patients were undergoing the transition phase after initial treatment.

This was a randomized, controlled trial that was single-blinded for some outcome measures.

• Godin Leisure Score Index for exercise behavior
• Functional Assessment of Cancer Treatment–Fatigue scale (FACT-F)
• Functional Assessment of Cancer Treatment–Colorectal scale (FACT-C) for quality of life
• Skeletal muscle fatigability assessed via electromyogram (EMG) signal analysis

There was an overall 90% attendance rate at supervised exercise sessions and a 77% attendance rate at dietary seminars. Of those in the intervention group, 66.6% returned exercise logs, and among these, there was a 94% rate of adherence to independent aerobic exercise for 25 to 30 minutes. There was no significant difference between groups in exercise behavior. Fatigue scores improved significantly in the intervention group (p = 0.005) compared to controls. There was a significant increase in dietary fiber intake (p = 0.044), with no other differences in dietary habits. Compared to controls, there were significant improvements in chair sit to stand performance (p = 0.003) and aerobic exercise tolerance (p = 0.01).

Combined supervised group and home-based individual exercise with dietary education was shown to be feasible and demonstrated preliminary positive effects on fatigue and dietary fiber intake.

• The study had a small sample size, with less than 30 participants.
• Standard care was not described.
• There is no information about other interventions or symptoms that might affect outcomes.
• The study design lacked an attentional control.
• There was a 6% dropout rate.
• There was a relatively limited time frame of follow-up.
• Given no difference between groups in exercise behavior overall, findings suggested that the group aspect with seminars and supervised exercise sessions may have been the important difference.

Findings suggested that an intervention combining some group supervised exercise and some home-based exercise is feasible and can be effective in reducing fatigue. Further research in this area is warranted as researchers attempt to determine the most effective ways to provide exercise interventions that patients will adhere to. The combination of some group periodic supervised sessions may improve patient motivations to adhere to a program, given the relatively low dropout rate seen here. This study was performed after completion of cancer treatment.