Wenzel, J. A., Griffith, K. A., Shang, J., Thompson, C. B., Hedlin, H., Stewart, K. J., . . . Mock, V. (2013). Impact of a home-based walking intervention on outcomes of sleep quality, emotional distress, and fatigue in patients undergoing treatment for solid tumors. The Oncologist, 18, 476-484.

To evaluate the impact of a home-based walking program on patient symptoms of fatigue, sleep disturbances, and mood.

Patients were randomly assigned to the walking program or a usual care control group. The exercise intervention included a walking prescription based on the American College of Sports Medicine guidelines. The targeted exercise prescription included a brisk 20- to 30-minute walk with five-minute warm-ups and cool-downs five days per week. Exercise participants wore pedometers. Usual care patients wore pedometers during the first two weeks only. Throughout the study, patients in both groups received telephone contact on a biweekly basis to discuss physical activity and any concerns. For those in the exercise program, adjustments to the program were made, barriers to walking were discussed, and strategies for resolution were planned.

• One hundred twenty-six patients (61.1% male, 38.9% female) were included.  
• Mean age was 60.2 years (range 28–80).
• Patients had multiple solid tumor types; the most common were prostate, breast, and colorectal tumors.
• All patients were scheduled to receive chemotherapy or radiation therapy.
• Of the patients, 78.6% were Caucasian and 84.9% were married or partnered.

• Single site 
• Home 
• New Jersey

Patients were undergoing the active antitumor treatment phase of care.

This was a randomized, controlled trial.

• Piper Fatigue Scale (PFS)
• Profile of Mood States (POMS)
• Cooper Aerobics Center Longitudinal Study
• Physical Activity Questionnaire (PAQ) for exercise dose
• Pedometer
• Pittsburgh Sleep Quality Index (PSQI)
• Daily exercise and symptom log

Analysis of dropouts showed that significantly more ethnic minorities and those with lower educational levels withdrew (p < 0.03). There were no differences at the end of the study in sleep quality. There were no differences between groups in overall mean emotional distress scores; however, dose-response analysis showed that those who exercised more had less emotional distress (p = 0.03). There were no between-group differences in fatigue; however, analysis showed that those who exercised more had lower fatigue scores (p = 0.03). Subgroup analysis among patients with prostate cancer showed that exercise group members had better sleep quality (p < 0.001), less emotional distress (p = 0.048), and less fatigue (p = 0.009). PAQ findings were moderately correlated with pedometer results, suggesting that the PAQ may be a reasonable measure of exercise dose (Spearman = 0.37; p = 0.002).
 

Findings suggested that a home-based exercise program can be beneficial in patients receiving cancer treatment to reduce fatigue. Among patients with prostate cancer, the program resulted in improved sleep quality and less emotional distress and fatigue.

• The study had a risk of bias due to no blinding.
• Patient withdrawals were 10% or greater.

A home-based walking program is a simple intervention that can be beneficial to patients, and study findings showed that patients who exercised more had less fatigue and improved mood. In patients other than patients with prostate cancer, it did not appear that exercise improved sleep quality. This study included biweekly telephone follow-ups. Other studies have not shown the same level of results with home-based walking, suggesting that the follow-up component is probably important to maintain patient exercise program use. Of interest, patients who were less educated and of ethnic minorities were more likely to drop out of the study. This suggests that these groups of patients need to be examined more in order to see what interventions will be most likely to appeal to them.