Pinto, B. M., Papandonatos, G. D., Goldstein, M. G., Marcus, B. H., & Farrell, N. (2013). Home-based physical activity intervention for colorectal cancer survivors. Psycho-Oncology, 22, 54–64.

To test the hypothesis that a home-based exercise intervention would improve fitness and physical activity and to determine the intervention effects on fatigue, self-reported physical functioning, and quality of life (QOL).

Those randomized to the exercise program received in-person instructions on how to exercise at a moderate intensity level, monitoring heart rate and how to warm-up and cool-down with exercise. Patients in the exercise group were asked to keep activity logs and were encouraged to exercise at least 10 minutes two days per week, increasing to 30 minutes per day, at least five days per week. Each received a weekly telephone call for the 12-week study to identify problems and reinforce participation, using cognitive-behavioral processes of change tailored to each patient. Patients in the control condition received weekly calls for 12 weeks for the administration of a symptom questionnaire and problem monitoring. Patients then received monthly telephone calls for three months. Telephone calls were audiotaped, and 25% of the tapes were reviewed for content to ensure fidelity to the study protocol. Study measures were obtained at baseline and at 3, 6, and 12 months.

• The sample was comprised of 46 patients (56.5% female, 43.5% male). 
• Mean age was 55.6 years (standard deviation [SD] = 8.24 years) in the control group and 59.5 years (SD = 11.2 years) in the exercise group. 
• All patients had colorectal cancer, with an average of three years since diagnosis.
• All patients had undergone surgery, and most did not receive radiation or chemotherapy treatment. 
• A majority of the patients had attended college and had a median income of greater than $60,000.

• Single site
• Home
• Rhode Island

Patients were undergoing multiple phases of care.

The study was a randomized, controlled trial.

• Seven-day Physical Activity Recall (7-day PAR)
• Treadwalk maximal fitness test
• Community Health Activities Model Program for Seniors (CHAMPS) questionnaire
• Functional Assessment of Cancer Therapy–Fatigue and Colorectal subscales (FACT-F and FACT-C)
• Short Form 36 (SF-36) physical functioning subscale

Both groups showed improvement in fitness and physical functioning over time, as well as increased physical activity. The exercise group showed a greater increase in physical activity at three months, but there was no difference from the control group at 6 or 12 months. During the first three months, the exercise group also showed significant improvement from baseline in CHAMPS energy expenditure and motivational readiness; however, these effects declined after three months. The intervention group demonstrated better submaximal aerobic fitness than the control group at all time points (p < 0.02). There were no significant intervention effects on fatigue, physical functioning, or QOL. These outcomes improved in all patients, and these improvements were sustained throughout the 12 months of follow-up. The authors speculated that the lack of apparent impact on fatigue may be associated with the fact that patients were highly functioning, although their baseline fatigue levels were lower than those seen in other studies in which exercise was effective.

The home-based exercise program improved patients’ physical activity, motivation, and fitness; however, it did not demonstrate an impact on fatigue or QOL. Activity and motivation were most improved during the first three months, when they received weekly telephone calls, suggesting that frequent contact may have been important in these results.

• The study had a small sample size, wth less than 100 patients.
• No information was provided regarding patient adherence to the recommended exercise program from patient logs.
• The lack of differences in CHAMPS between groups suggests that their actual activity levels were not substantially different.
• The majority of patients were highly educated and in a higher socioeconomic status and almost 100% were white, suggesting that these findings may not be applicable to other types of patients.

The findings suggest that a home-based exercise program can improve physical activity and aerobic fitness, but it did not appear that these improvements translated into reduced fatigue. Further research in the area of exercise and fatigue are needed to determine if exercise may be most effective in patients with greater fatigue at baseline.