Swenson, K.K., Nissen, M.J., Knippenberg, K., Sistermans, A., Spilde, P., Bell, E.M., . . . Tsai, M.L. (2014). Cancer rehabilitation: Outcome evaluation of a strengthening and conditioning program. Cancer Nursing, 37, 162–169.

To evaluate the effects of a supervised outpatient physical therapy strengthening and conditioning program on symptoms and quality of life

The program included aerobic exercise and strength training. The first two sessions were individualized under the supervision of a physical therapist. Patients who needed additional assistance walking, transferring, or using equipment continued to attend one-hour individual sessions. Patients were placed into 90-minute group sessions. The program consisted of intensive work for eight weeks, then six months of maintenance training was offered for those who were interested. Study assessments were done at baseline and after eight weeks.

• N = 75
• MEAN AGE = 62.6 years (SD = 11.9 years)
• MALES: 34.7%, FEMALES: 65.3%
• KEY DISEASE CHARACTERISTICS: Various tumor types (breast and lung were most prevalent)
• OTHER KEY SAMPLE CHARACTERISTICS: 34.7% metastatic disease; 15.3% in active treatment; 26.7% working full- or part-time

• SITE: Single-site  
• SETTING TYPE: Outpatient  
• LOCATION: Minnesota, United States

• PHASE OF CARE: Multiple phases of care

Quasi-experimental

• Short Form 36 (SF-36)
• Six-Minute Walk Test (6MWT)
• MD Anderson Symptom Inventory (MDASI)

The results of the 6MWt were better on average at the end of eight weeks (p < 0.0001). Physical component scores on the SF-36 improved (p < 0.001) as did mental component scores after eight weeks (p < 0.005). At the end of six months, only physical component scores remained higher than reported at baseline. Fatigue (p = 0.003) and dyspnea (p = 0.007) were improved at eight weeks. After six months, fatigue (p = 0.0077), shortness of breath (p = 0.0005), and disturbed sleep (p = 0.045) were improved from baseline. Patients still in active treatment showed significantly less improvement. Those who showed the worst performance at baseline showed the greatest improvement.

The eight-week strengthening and conditioning program improved physical function, fatigue, dyspnea, and sleep disturbance in this study. Improvement was greatest among those who had the worst symptoms and physical performance statuses at baseline and among those who were not in active treatment.

• Small sample (< 100)
• Risk of bias (no control group)
• Risk of bias (no blinding)
• Risk of bias (no random assignment)
• Subject withdrawals ≥ 10%  
• Other limitations/explanation: Greater than 30% of participants withdrew from the study. There were significant differences for individuals still in treatment; however, the sample was too small to adequately analyze study sample subgroups. No information was provided about other relevant interventions that may have occurred during the six months of follow-up.

The findings of this study demonstrated the effectiveness of an exercise program on symptoms of fatigue, shortness of breath, and sleep disturbance among a variety of patients with cancer. These findings add to the large body of evidence about the efficacy of exercise.