Effectiveness Not Established

Exercise

for Caregiver Strain and Burden

Exercise is physical activity that involves repetitive bodily movement done to improve or maintain one or more of the components of physical fitness: cardiorespiratory endurance (aerobic fitness), muscular strength, muscular endurance, flexibility, and body composition. Exercise interventions in patients with cancer have been provided as home-based, patient self-managed programs as well as supervised and unsupervised individual or group exercise sessions of varying duration and frequency. They can include combinations of aerobic and resistance activities. Exercise has been studied in patients with cancer for anxiety, chemotherapy-induced nausea and vomiting, depression, dyspnea, hot flashes, lymphedema, sleep/wake disturbance, pain, and fatigue. It has also been studied for caregiver strain and burden. Users of this information are encouraged to review intervention details in study summaries, as the exercise interventions studied and their timings in the trajectory of cancer care vary and these differences can influence effectiveness.

Research Evidence Summaries

Barber, F.D. (2013). Effects of social support on physical activity, self-efficacy, and quality of life in adult cancer survivors and their caregivers. Oncology Nursing Forum, 40, 481–489. 

Study Purpose

To explore the relationships between adult cancer survivors’ and caregivers’ social support, self-efficacy for physical activity, physical activity, and quality of life, and to understand their perceptions of social support in physical activity participation

Intervention Characteristics/Basic Study Process

Participants attended the FitSTEPS for Life® (FSFL) for one month. FSFL is an individually tailored and supervised community-based exercise program for cancer survivors and their caregivers established by the Cancer-Foundation For Life nonprofit organization. Survivors required a referral from their oncologists to be able to attend FSFL and were expected to exercise at least three times a week.

Sample Characteristics

Only data on caregivers were included in this summary.

  • N = 39 at baseline (eight at follow-up)  
  • MEAN AGE = 62.1 years (SD = 13.8 years)
  • MALES: 10 (25.6%), FEMALES: 29 (74.4%)
  • KEY DISEASE CHARACTERISTICS: Caregivers of patients with various cancers and stages
  • OTHER KEY SAMPLE CHARACTERISTICS: Adults; 30 of 39 were Caucasian; 21 of 24 used mobility devices; able to read, write, and comprehend English; paid caregivers were excluded

Setting

  • SITE: Multi-site    
  • SETTING TYPE: Other  
  • LOCATION: East Texas and Dallas

Phase of Care and Clinical Applications

  • PHASE OF CARE: Late effects and survivorship

Study Design

Mixed-method, quasi-experimental study with written responses to questions and recorded interviews of the caregivers of patients who enrolled in FSFL based on oncologist referrals

Measurement Instruments/Methods

  • Quantitative
    • Social Support and Exercise Survey
    • The Exercise Confidence Survey for self-efficacy for physical activity (SEPA)
    • The 8 Foot Up and Go functional fitness test for physical activity (PA) participation
    • Quality of Life Short Form 8 (SF-8)
  • Qualitative
    • Written responses to open ended-question “please tell us how social support affects your PA each day” at baseline and one month later; and interviews face to face and on the phone responding to a semistructured interview that were recorded and transcribed verbatim.

Results

There was no significant difference in social support, SEPA, PA, or mental quality of life in caregivers at the one month follow-up visit after attending the FSFL program. Functional fitness decreased from baseline (median = 5.99) to follow-up (one month, median = 4.22) indicating improvement, but it was not statistically significant. 
 
There was a significant relationship between family PA participation and family rewards (both are subscales in the Social Support and Exercise Survey). Self-efficacy subscales were significantly correlated (making time for PA and relapse). PA was significantly related to friend-PA participation (subscale of social support). 
 
The results of the qualitative analysis did not separate the findings of caregivers from survivors. It described themes that emerged from all participants (survivors and caregivers together). Themes that emerged were companionship, motivation, and health promotion. 

Conclusions

Participation in FSLP did not have a significant effect on caregivers' PA, quality of life, social support, or SEPA. Qualitative data supported relationships between social support, PA, and quality of life.

Limitations

  • Small sample (< 30): Only eight caregivers completed the one-month follow-up questionnaire
  • Risk of bias (no control group)
  • Risk of bias (no blinding)
  • Risk of bias (no random assignment)
  • Risk of bias(sample characteristics)
  • Questionable protocol fidelity

Nursing Implications

Nurses should consider the role of social support in designing interventions to influence the PA, self efficacy, and quality of life of caregivers. Nurses should encourage cancer survivors and their caregivers to openly discuss their needs for social support. This study was too small to evaluate the effects of exercise, and the high drop out rate suggests that continued involvement in this type of effort may not be acceptable for patients and caregivers.

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