Hoffman, A. J., Brintnall, R. A., Brown, J. K., Eye, A. v., Jones, L. W., Alderink, G., . . . Vanotteren, G. M. (2013). Too sick not to exercise: using a 6-week, home-based exercise intervention for cancer-related fatigue self-management for postsurgical non-small cell lung cancer patients. Cancer Nursing, 36, 175–188.

To evaluate the feasibility, safety, acceptability, and effects of a home-based exercise intervention.

Patients were screened for inclusion, and baseline measures were obtained prior to surgery. Each patient was assigned a primary nurse for the duration of the study to ensure continuity of care. Prior to surgery, participants were taught approaches to increase self-efficacy in self-management of fatigue and were prepared to participate in the exercise intervention after surgery. Within three days of hospital discharge, patients were contacted by telephone and screened for readiness to start exercise. When ready, a home visit was scheduled to set up the exercise equipment (the Nintendo Wii Fit Plus), the particpant was educated in the exercise intervention, and teaching for self-management was reinforced. The exercise intervention provided a virtual reality scenario for walking. After week 2, another home visit was performed, and telephone contacts were made at three and six weeks. Patients completed study tools at the end of six weeks via mail.

• Seven participants (28.6% male, 71.4% female) were included.
• Mean age was 64.4 years (range 53–73).
• All participants had lung cancer and were postthoracotomy.  
• Most participans were employed and had no children living at home. 
• Comorbid conditions included osteoarthritis, hypertension, and chronic obstructive pulmonary disease.  
• Some patients started chemotherapy and/or radiation therapy within the study period.

• Multisite 
• Home 
• Michigan

Patients were undergoing the active antitumor treatment phase of care.

This was a prospective, single-group, feasibility trial.

• Acceptability questionnaire
• Brief Fatigue Inventory (BFI)
• Fatigue Self-Management Instrument
• Self-efficacy for walking instrument
• Walking duration instruments
• Activities-Specific Balance Confidence (ABC) scale
• Daily diary to record fatigue and exercise use

Mean adherence to the exercise intervention was 96.6% (range 90%–100%). Participants reported a high level of satisfaction with the exercise intervention.  Overall decline in fatigue was seen from postsurgery to the end of the study. All participants stated that the intervention helped them to manage their fatigue. Fifty percent of those approached for participation consented and completed the study.

Use of the Nintendo Wii Fit Plus sytem for a home-based exercise intervention was shown to be feasible and effective in helping patients self-manage fatigue in this small study.

• The study had a small sample size, with less than 30 participants.
• The study had risks of bias due to no control group, no blinding, no random assignment, and no appropriate attentional control condition.
• Measurements/methods were not described.
• The intervention was expensive, impractical, and had training needs.
• Tools used in the study were not well described. 
• The Nintendo Wii Fit Plus system has associated costs that would need to be met.

Findings suggested that use of home virtual reality exercise programs, such as the Nintendo Wii Fit Plus system, can be a feasible and effective way to promote exercise for the self-management of cancer-related fatigue.