Courneya, K. S., Friedenreich, C. M., Sela, R. A., Quinney, H. A., Rhodes, R. E., & Handman, M. (2003). The group psychotherapy and home-based physical exercise (group-hope) trial in cancer survivors: physical fitness and quality of life outcomes. Psycho-Oncology, 12, 357–374.

Patients were randomized to receive either 10 weeks of group psychotherapy and exercise (home-based, moderate intensity, 20 to 30 minutes, three to five times per week, and tailored across the intervention to promote progression toward the goal of achieving a heart rate during exercise of 65% to 75% of the estimated heart rate maximum) or group psychotherapy only. The group psychotherapy intervention consisted of stress management and relaxation training or expressive supportive therapy. Both group psychotherapy interventions had a psychoeducational focus. Patients in the group psychotherapy only arm received a personalized exercise plan after study completion. To control for possible contamination between the experimental conditions, groups of patients who had registered for a group psychotherapy program at a large cancer center, rather than individual patients, were randomized.

• The study included 96 patients (group psychotherapy and exercise group, n = 51; group psychotherapy only, n = 45).
• Mean age was 51.55 years (range 25–74).
• Of the patients, 84% were female, 50% had stage I or II disease, and 50% had stage III or IV disease.
• Most patients were Caucasian and had an annual income of $40,000 per year.
• All patients were screened for participation restrictions for a moderate exercise program using the revised Physical Activity Readiness Questionnaire (PAR-Q) and a submaximal fitness assessment.
• Diagnoses included breast cancer (40.9%), colon cancer (9.4%), lymphoma (6.2%), ovarian cancer (5.2%), gastric cancer (4.2%), melanoma, and mixed solid tumors (21.8%).

• Single site
• Outpatient comprehensive cancer center

Patients were undergoing the active treatment and long-term follow-up phases of care.

This was a randomized, controlled trial with a crossover for the control group receiving group psychotherapy alone.

Functional Assessment of Cancer Therapy–Fatigue (FACT-F)

No difference existed between expressive supportive therapy and stress management and relaxation therapy in group psychotherapy effect in either group. Group psychotherapy and exercise improved quality of life beyond group psychotherapy only in cancer survivors (active treatment and long-term follow-up). The group psychotherapy intervention did not significantly reduce fatigue; however, the addition of moderate-intensity exercise resulted in a statistically significant improvement in fatigue.

• The group was relatively homogeneous with regard to race (most were Caucasian), educational level (59% had completed university), and socioeconomic status (67% had a median annual family income greater than $40,000).
• The exercise program was only 10 weeks in length and provided no long-term follow-up because of the control group crossover design.
• Some exercise, adherence, and contamination problems were noted; about 20% of the patients in the exercise condition did not meet the minimum cut point of 60 minutes per week of moderate or strenuous exercise, and 20% of patients in the control group met this cut point.
• Contamination may have resulted from having the control condition monitor patients and report their exercise on a weekly basis or because previous exercisers were allowed to participate.
• All patients were selected from among patients who declared themselves interested in a group psychotherapy intervention; thus, the results are generalizable to patients who voluntarily join group psychotherapy classes.
• The authors did not differentiate outcomes achieved by patients who were receiving active treatment and those on long-term follow-up.
• Nontolerance of exercise and safety parameters for exercise in the group psychotherapy and exercise groups was not described.
• For group psychotherapy, a therapist experienced in stress management, relaxation therapy, and expressive-supportive therapy is required. A certified fitness appraiser must appraise and design each individual program.
• Skills and equipment for performing a submaximal cardiovascular treadmill test are needed to evaluate the fitness level of patients prior to having them commence an exercise program.