Hanna, L. R., Avila, P. F., Meteer, J. D., Nicholas, D. R., & Kaminsky, L. A. (2008). The effects of a comprehensive exercise program on physical function, fatigue, and mood in patients with various types of cancer. Oncology Nursing Forum, 35, 461–469.

To evaluate the effectiveness of a comprehensive exercise program consisting of low-to-moderate intensity aerobic and resistance exercise twice a week for 16 sessions to assess improvements in physical function, fatigue, and mood.

Patients received low-to-moderate aerobic and resistance exercise, education, and support twice weekly. At the start of each session, a specialist obtained blood pressure, oxygen saturation, and heart rate for each patient. Patients performed aerobic exercise on a seated machine or treadmill. Progression was obtained through increased exercise duration by adding small increments of three to five minutes per session as tolerated. All patients were able to progress to 40 minutes of aerobic exercise before the end of 16 sessions. Education included various topics focused on symptom management, coping, and wellness, including support groups, survivorship, resources, spirituality, stress management, chemotherapy, radiation, nutrition, energy conservation, relaxation and imagery, drugs and herbs, fatigue and pain, humor therapy, exercise safety and benefits, diagnostic testing, communication issues, financial issues, complementary therapy, and infection control. Average attendance per month was 12 sessions. Support included peer support, exercise environment conducive to discussion within the group, and facilitation of relationships of sharing and encouragement. The specialist inquired about how patients were coping with their disease, side effects, and treatments.

• The sample was comprised of 39 patients (77% female) in active treatment and cancer survivors beyond treatment.
• Patients were older than 18 years. Mean age was 63 years (range 42–87 years; standard deviation = 10.61 years).
• Patients had 13 different cancer types, with the majority being breast cancer (39%). The most common diagnosed stage was stage III (26%); patients also had stage I (23%), stage II (21%), and stage IV (14%) cancer. One patient had ductal carcinoma in situ (DCIS) of the breast. 
• Of the patients, 24% stated that exercise was new to them and 30% indicated that exercise was not at all new to them.

• Single site
• Cancer Center in a 350-bed teaching hospital in east central Indiana

The study was a retrospective analysis of archived data. Patients were eligible if they had a diagnosis of cancer; type and age of diagnosis were not factors.

• Six-minute walk test
• Profile of Mood States (POMS) Questionnaire to evaluate personal and social integrity
• Piper Fatigue Scale (PFS) Questionnaire to measure conservation of energy pre- and postprogram
• The main variables were physical function, fatigue, and mood.

• Pre- and postprogram outcome measures had significant differences (p < 0.05). Patients had significant improvements in physical function, fatigue, and mood.
• Change in fatigue:  On average, patients reported less fatigue on the PFS compared to before the program. Of the sample, 75% improved and 25% stayed the same.
• The study had a small sample size.
• No control comparison was used.

A comprehensive exercise program consisting of low-to-moderate intensity aerobic and resistance exercise, education, and support twice a week for eight weeks resulted in significant improvements in physical function, fatigue, and mood in patients in active treatment and in cancer survivors beyond treatment.

• The study lacked a control group and uniformity. However, the heterogenicity of the group demonstrated that, regardless of diagnosis and stage, improvements can be achieved.
• Of the patients, 69% had a break in exercise consistency.
• Educational sessions were optional, and not all patients attended educational sessions regularly; therefore, the direct role of education on outcome is unknown.

Further studies may need to be conducted comparing the degree of benefit achieved by patients in a comprehensive program versus a single-component exercise or support group program. The study encouraged the use of low-to-moderate intensity exercise to benefit people with all types of cancer. Further studies need to be completed to determine the best mode, duration, and intensity of exercise for survivors. The authors can say with some certainty that low-to moderate intensity exercise produces significant benefits for people with cancer without causing participant overload or drop-out.