Hayes, S. C., Rye, S., DiSipio, T., Yates, P., Bashford, J., Pyke, C., . . . Eakin, E. (2013). Exercise for health: a randomized, controlled trial evaluating the impact of a pragmatic, translational exercise intervention on the quality of life, function and treatment-related side effects following breast cancer. Breast Cancer Research and Treatment, 137, 175–186.

To evaluate two modes of delivery of an exercise intervention:  provided either face-to-face or via the telephone.

Women were randomized to one of three groups:  face-to-face exercise, telephone exercise intervention, or usual care.  For those in the exercise interventions, the intervention involved 16 sessions, starting weekly and tapering to monthly contact after four months.  The exercise prescription was provided in sessions to progress to exercising 45 minutes at least four days per week, incorporating both aerobic and strength-based exercise.  Assessments were performed at baseline and six weeks, six months, and 12 months postsurgery.

• One hundred ninety-four participants were included.           
• Median age was 52 years (range 29–70).
• One hundred percent of patients were female.
• All patients had breast cancer; 69% were getting chemotherapy during the trial, 71% were receiving radiation therapy, and 64% began hormone therapy.

• Single site       
• Outpatient        
• Australia

Patients were undegoing the active antitumor treatment phase of care. 

This was a single-blind, randomized, controlled, longitudinal study.

• Functional Assessment of Cancer Therapy (FACT) – Breast
• Functional Assessement of Chronic Illness Therapy – Fatigue (FACIT)
• Disabilities of the Arm, Shoulder, and Hand Questionnaire
• Greene Climacteric Scale
• Neuropathic pain scale
• Three-minute step test (fitness measure)

Upper body function and adverse effects, such as menopausal symptoms, pain, anxiety, and depression, improved over time for all patients, with no differences between groups. The adherence rate was 88% in the face-to-face exercise group and 81% in the telephonic intervention group.  Patients in both exercise intervention groups showed greater improvement in fatigue symptoms over time (p = 0.032). At the end of the study, fatigue scores improved by 4.9 points in the face-to-face intervention and by 6.8 points in the telephonic group.  In the usual care group, fatigue initially got worse; however, scores improved by 4.6 points by 12 months. Sixty-six percent of those in the usual care group also participated in at least 180 minutes of physical activity per week and had an increased level of activity from baseline.  Quality of life improved significantly more in the intervention groups over time (p = 0.03)

Findings suggested that delivery of an exercise prescription and instruction via the telephone can be an effective method of delivering an exercise intervention for women with breast cancer.  Results of this study support those of others demonstrating improvement in symptoms in all patients over time, but significantly greater improvement in fatigue with exercise interventions.

• The study had risks of bias due to no blinding and no appropriate attentional control condition.
• Unintended interventions or applicable interventions not described would influence the results.
• Findings were not generalizable.
• Patients were not blinded, and it was noted that control group patients also increased their activity, which could have confounded the results.  Although adherence to the exercise intervention was measured, mainly educational and motivational in nature, actual performance of exercise was not clearly measured.

Findings suggested that providing an exercise prescription might be an effective way to engage patients in exercise, which can reduce symptoms of fatigue.  This study demonstrated that providing an exercise program intervention via telephone contact can be as effective as engaging patients in a face-to-face intervention. This suggests that telephonic contact to teach and motivate patients to exercise may be an effective and practical way to deliver an intervention.