Hsieh, C. C., Sprod, L. K., Hydock, D. S., Carter, S. D., Hayward, R., & Schneider, C. M. (2008). Effects of a supervised exercise intervention on recovery from treatment regimens in breast cancer survivors. Oncology Nursing Forum, 35, 909–915.

To investigate the effects of supervised exercise training on cardiopulmonary function and fatigue in cancer survivors undergoing various clinical treatments.

Patients were divided into four groups based on specific type of treatment:  surgery alone (n = 22); surgery and chemotherapy (n = 30); surgery and radiation (n = 17); and surgery, chemotherapy, and radiation (n = 27). Following comprehensive screening and medical examination, cardiovascular endurance, pulmonary function, and fatigue were assessed. Individualized exercise prescriptions and six-month exercise interventions were developed. Participants attended supervised exercise sessions two to three days per week for six months.

• Ninety-six patients were included in the study.
• This was a convenience sample of breast cancer survivors undergoing various clinical treatments. 
• Age was 57.9 years (standard deviation = 10.4 years). 
• All patients were females with breast cancer. 
• All patients had undergone surgery.
• No significant differences were observed in age, height, or weight between groups.

• Single site
• Outpatient
• Oncology rehabilitation center

This was a pre-/posttest quasiexperimental study.

• Repeated measures ANOVA and ANCOVA were used to compare the effectiveness of the interventions and difference among treatment groups.
• Main variables were systolic and diastolic blood pressure, resting heart rate, forced vital capacity, forced expiratory volume, predicted oxygen consumption, time on treadmill, and fatigue.
• The revised Piper Fatigue Scale (PFS) was used to assess cancer-related fatigue.
• The behavioral fatigue subscale includes six questions and was used to assess the effect of fatigue on school and work, interacting with friends, and the overall interference with activities that are enjoyable.
• The affective fatigue subscale includes five questions to assess the emotional meaning attributed to fatigue.
• The sensory subscale includes five questions to assess mental, physical, and emotional symptoms of fatigue.
• The cognitive and mood fatigue scale consists of six questions.
• The average score on the 22 total questions from the subscales provided the total fatigue score.

Cardiopulmonary function (predicted maximal oxygen consumption and time on treadmill) significantly increased in all groups after exercise training. In addition, resting heart rate and forced vital capacity significantly improved in those undergoing surgery, chemotherapy, and radiation. Psychologically, the exercise intervention resulted in significant reductions in behavioral, affective, sensory, cognitive, mood, and total fatigue scale scores in all three groups who received treatment with surgery. The breast cancer survivors in the surgery alone group showed significant reductions in behavioral, affective, and total fatigue scale scores but not in sensory, cognitive, and mood fatigue scale scores.

The results suggested that moderate-intensity individualized exercise maintains or improves cardiopulmonary function with concomitant reductions in fatigue, regardless of treatment type. Moreover, cancer survivors receiving combination chemotherapy and radiotherapy following surgery appear to benefit to a greater extent as a result of an individualized exercise intervention.

• This was a convenience sample of women from one geographic location.
• The study lacked a control group.

Symptom management recommendations should be given to cancer survivors concerning the effectiveness of exercise throughout the cancer continuum, and the importance of participating in a cancer rehabilitation exercise program should be emphasized.