Coleman, E. A., Goodwin, J. A., Kennedy, R., Coon, S. K., Richards, K., Enderlin, C., . . . Anaissie, E. J. (2012). Effects of exercise on fatigue, sleep, and performance: a randomized trial. Oncology Nursing Forum, 39, 468–477.

To compare usual care with a home-based individualized exercise program (HBIEP) in patients receiving intensive treatment for multiple myeloma (MM) and epoetin alfa therapy.

This was a randomized trial with repeated measures of two groups (one experimental and one control) and an approximate 15-week experimental period for the HBIEP. The control group received a recommendation to walk 20 minutes three times per week. In the HBIEP, patients were given color-coded stretch bands and materials to illustrate exercises to be used, and they were to perform aerobic walking to reach 65% to 80% of the maximal heart rate. Patients mailed in weekly activity summaries. Assessments were performed at baseline, 10 to 12 weeks later prior to the second chemotherapy cycle, and three to four weeks later when finishing stem cell collection.

• The study was comprised of 187 patients (92 in usual care and 95 in the intervention).
• Age ranged from 35 to 76 years in the usual care group and 25 to 76 years in the intervention group.
• In the usual care group, 60% of patients were male and 40% were female.  In the intervention group, 57% of patients were male and 43% were female.
• Patients were newly diagnosed with MM and were eligible for treatment with an aggressive protocol that included stem cell transplant. 
• The majority of patients were well educated and had great motivation to exercise. The intent of the intervention was to determine whether specific exercises were more effective in improving sleep and decreasing fatigue.

• Single site
• Multiple settings
• Southern United States international referral center

• Patients were undergoing the active antitumor treatment phase of care.
• The study has clinical applicability for elder care. 

This was a randomized, controlled trial with repeated measures of two groups and a 15-week experimental period.

• Profile of Mood States (POMS) Fatigue Scale
• Functional Assessment of Cancer Therapy-Fatigue (FACT-F)
• Actigraph recordings
• Six-minute walk test
• Hemoglobin levels at baseline and before and after stem cell collection
• Descriptive statistics used to compare demographics
• Treatment effects and repeated measures ANOVA used to determine effects of HBIEP

No statistically significant differences existed among the experimental and control groups for fatigue, sleep, or performance (aerobic capacity). Statistically significant differences (p < 0.05) were found in each of the study outcomes for all patients as treatment progressed, and patients experienced more fatigue and poorer nighttime sleep and performance.

The effect of exercise seemed to be minimal on decreasing fatigue, improving sleep, and improving performance. Exercise is safe and has physiologic benefits for patients undergoing MM treatment and, when combined with epoetin alfa, helped to alleviate anemia.

• The study had a risk of bias (sample characteristics) because it consisted of mostly well-educated patients.
• A key sample group difference that could influence the results included the inclusion of mostly well-educated patients.
• Patients self-reported compliance with HBIEP. This was a home-based program, so no observation was performed. 
• Patients in the control group were not discouraged from exercising.
• No patient could perform the strength tests.
• Anemia was present at baseline in the majority of patients, and all participants would become anemic with treatment; therefore, all patients received treatment for anemia, which potentially limited the results.

Although the results might indicate no derived benefit, patients became more fatigued, slept less, and experienced a decline in performance with more treatment. The HBIEP group required fewer red blood cell transfusions to maintain a similar hemoglobin level, less platelet transfusions, and fewer days to collect stem cells. When combined with epoetin alfa therapy, exercise had an effect in decreasing cancer-related anemia and improving cell count recovery after high-dose chemotherapy. These are benefits to patients and the healthcare economy. Cancer rehabilitation exercises may result in improved performance. Having fatigue prior to treatment might predict having fatigue after treatment. Energy conservation measures should be considered with endurance and resistance exercises. Rehabiltation therapy might be needed for deconditioned patients. Exercise should be tailored individually based on the patient's disease stage, presence of bone lesions, and values. The HBIEP may have helped to alleviate anemia, but there is no evidence that HBIEP combining muscle strengthening and aerobic walking exercises decreases fatigue.