Wang, Y. J., Boehmke, M., Wu, Y. W., Dickerson, S. S., & Fisher, N. (2011). Effects of a 6-week walking program on Taiwanese women newly diagnosed with early-stage breast cancer. Cancer Nursing, 34, E1–E13.

To examine the effectiveness of an exercise program on quality of life (QOL), fatigue, sleep disturbances, exercise self-efficacy, exercise behavior, and exercise capacity in women with breast cancer.

Patients were randomly assigned to an exercise or usual care group. The exercise intervention was a six-week walking program based on modified exercise guidelines of the American Cancer Society and American College of Sports Medicine. This program included use of a heart rate ring monitor, pedometer, weekly telephone call, weekly meetings, and an exercise diary. Exercise was of low to moderate intensity (40%–60% maximum heart rate). In this program, patients did weekly goal setting and were given advice and information, and several specific strategies were described that were intended to boost self-efficacy. Patients were oriented to the exercise program prior to surgery, and exercise was begun within a few days after surgery. Data were collected 24 hours prior to surgery and at 24 hours prior to the first cycle of chemotherapy, 7 to 10 days after chemotherapy, and at the end of six weeks.

• The sample was comprised of 62 women. 
• Mean age was 50.42 years (standard deviation = 9.64 years).
• All patients had undergone mastectomy.
• Of the patients, 36% had at least a college education, 80.6% were married, and 51.4% were working full-time.
• All patients had stage I or II disease and were newly diagnosed.

• Single site
• Outpatient
• Taiwan

Patients were undergoing the active treatment phase of care.

The study was a randomized, controlled trial.

• Functional Assessment of Cancer Treatment–General and Fatigue scales (FACT-G, FACT-F)
• Pittsburgh Sleep Quality Index (PSQI)
• Exercise Self-Efficacy Scale (EXSE)
• Godin Leisure-Time Exercise Questionnaire
• 6-minute walk test (6MWT)

The pattern of change in QOL over time showed significant consistent improvement among those in the exercise group compared to usual care controls (p < 0.001). Patterns of change in sleep and sleep disturbance also showed significant improvement over time compared to controls (p < 0.006). The pattern of fatigue showed higher fatigue levels in the exercise group at all study time points. Average fatigue scores changed from 40.5 to 45.8 at week 6 in the exercise group and from 40.1 to 40 with usual care. Patients in the exercise group had significantly better exercise self-efficacy (p ≤ 0.001) and higher levels of exercise behavior (p < 0.001) than those receiving usual care. Patients in the exercise group walked farther on the 6MWT than controls after the intervention (p ≤ 0.001).

Findings showed that a self-managed home exercise program, along with intervention strategies aimed at boosting self-efficacy, had a positive effect on QOL and exercise behavior among women newly diagnosed with breast cancer.

• The study had a small sample size, with less than 100 patients.
• It is not clear what type of relevant patient information and education was provided in the usual care group.
• The duration of the study was relatively short at six weeks.
• The sample was very slightly underpowered.
• Lack of any blinding suggests a potential for bias.
• It is not clear if both groups received weekly telephone calls so that attentional control was provided.
• There was a 30% contamination rate, with 30% of control group patients also exercising at least three times per week.

The findings did not show a positive impact of a home-based exercise self-efficacy intervention on fatigue in the first six weeks after surgery in newly diagnosed patients. However, over a longer period of time, patients in the exercise group did better. Nurses may need to educate patients that adherence to an exercise program may not show results in the short term and that effects may take some time to be felt. Nurses can educate and encourage patients to exercise at home, and support activities to boost patient sense of efficacy may improve patient adherence to an exercise prescription.