Adherence to moderate-intensity exercise during breast cancer therapy. The effect of aerobic exercise on self-esteem and depressive and anxiety symptoms among breast cancer survivors. One-year follow-up of the 'Starting Again' group rehabilitation programme for cancer patients. Effects of exercise on physiological and psychological variables in cancer survivors. Structured exercise improves physical functioning in women with stages I and II breast cancer: results of a randomized controlled trial. Exercise therapy effect on natural killer cell cytotoxic activity in stomach cancer patients after curative surgery. Exercise reduces daily fatigue in women with breast cancer receiving chemotherapy. Correlates of adherence and contamination in a randomized controlled trial of exercise in cancer survivors: An application of the theory of planned behavior and the five factor model of personality Effects of exercise training on fasting insulin, insulin resistance, insulin-like growth factors, and insulin-like growth factor binding proteins in postmenopausal breast cancer survivors: a randomized controlled trial. Effects of an exercise program on muscle performance in patients undergoing allogeneic bone marrow transplantation Effects of aerobic exercise on the physical performance and incidence of treatment-related complications after high-dose chemotherapy. Effects of exercise on fatigue, physical functioning, and emotional distress during radiation therapy for breast cancer. Randomized controlled trial of exercise training in postmenopausal breast cancer survivors: cardiopulmonary and quality of life outcomes. A nursing rehabilitation program for women with breast cancer receiving adjuvant chemotherapy. Fatigue and quality of life outcomes of exercise during cancer treatment. Effect of upper extremity exercise on secondary lymphedema in breast cancer patients: a pilot study. Fatigue mediates the effects of exercise on quality of life Feasibility of Exercise During Treatment for Multiple Myeloma The Delphi list: a criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus. Psychological and fitness changes associated with exercise participation among women with breast cancer. Effect of aerobic exercise on body weight and composition in patients with breast cancer on adjuvant chemotherapy. A randomized trial of exercise and quality of life in colorectal cancer survivors. Daily fatigue patterns and effect of exercise in women with breast cancer. Resistance exercise in men receiving androgen deprivation therapy for prostate cancer. Physical exercise and quality of life in cancer patients following high dose chemotherapy and autologous bone marrow transplantation. A pilot study of a randomized controlled trial to evaluate the effects of progressive resistance exercise training on shoulder dysfunction caused by spinal accessory neurapraxia/neurectomy in head and neck cancer survivors. Immunological changes after cancer treatment and participation in an exercise program. Effects of Aerobic Interval Training on Cancer Patients' Functional Capacity The group psychotherapy and home-based physical exercise (group-hope) trial in cancer survivors: physical fitness and quality of life outcomes. Effects of physical activity on the fatigue and psychologic status of cancer patients during chemotherapy Effects of resistive exercise on skeletal muscle in marrow transplant recipients receiving total parenteral nutrition.
PURPOSE The aims of this pilot study were the following : 1 ) to examine patterns of adherence to a brisk walking program in women receiving adjuvant chemotherapy or radiation therapy for newly diagnosed breast cancer using a prospect i ve , r and omized , controlled experimental design ; 2 ) to examine the influence of disease symptoms and treatment side effects on exercise levels ; and 3 ) to suggest methods that may improve future clinical trials of moderate-intensity exercise in similar population s. DESCRIPTION OF STUDY Fifty-two patients with newly diagnosed breast cancer were r and omly assigned to one of two treatment arms : usual care or usual care plus exercise . Those assigned to the exercise group received a st and ardized , self-administered , home-based brisk walking intervention in addition to usual care . Each day subjects completed self-report diary forms that elicited information about activity levels , and the occurrence of symptoms and side effects during cancer treatment . RESULTS Analyses of self-reported daily activity levels revealed a diffusion of treatment effect . Fifty percent of the usual-care group reported maintaining or increasing their physical activity to a moderate-intensity level , while 33 % of the exercise group did not exercise at the prescribed levels . Analyses of self-reported disease symptoms and treatment side effects did not reveal clinical ly meaningful differences between the two groups . CLINICAL IMPLICATION S The results of this study suggest that women who exercised regularly before receiving a breast cancer diagnosis attempted to maintain their exercise programs . Women who lead sedentary lifestyles may benefit from a structured exercise program that includes information and support related to exercise adherence strategies PURPOSE / OBJECTIVES To evaluate the effects of 10 weeks of aerobic exercise on depressive and anxiety symptoms and self-esteem of breast cancer survivors . DESIGN Experimental , crossover . SETTING Midwestern university town . SAMPLE Twenty-four breast cancer survivors ( mean time following surgery 41.8 months ; ranging from 1 to 99 months ) recruited via mail and cancer support groups . The mean age of the sample was 48.9 years . METHODS Subjects were assigned r and omly into exercise ( EX ) , exercise-plus-behavior modification ( EX + BM ) , and control groups . EX and EX + BM groups exercised aerobically four days/week at > or = 60 % of age-predicted maximum heart rate for 10 weeks . Data were collected pretest , post-test , and crossover ( 12 weeks following post-test ) . Because pretest or post-test scores showed no statistical differences between EX and EX + BM groups , data were combined to form one group . MAIN RESEARCH VARIABLES Aerobic exercise ( four days/ week ; 30 - 40 minutes/session ) , depression , ( Beck Depression inventory ) , anxiety ( Speilberger State-Trait Anxiety Inventory ) , and self-esteem ( Rosenberg Self-Esteem Inventory ) . FINDINGS Pre- to post-test analyses revealed that women who exercised had significantly less depression and state and trait anxiety over time compared to controls . After the crossover , the control group demonstrated comparable improvements in both depressive and state anxiety scores . Self-esteem did not change significantly . Subjects who received exercise recommendations from their physicians exercised significantly more than subjects who received no recommendation . CONCLUSIONS Mild to moderate aerobic exercise may be of therapeutic value to breast cancer survivors with respect to depressive and anxiety symptoms but not to self-esteem . A physician 's recommendation to exercise appears to be an important factor in a patient 's exercise adherence . IMPLICATION S FOR NURSING PRACTICE To Improve depressive and anxiety symptoms following breast cancer surgery , healthcare professionals should consider recommending mild to moderate exercise In a r and omised prospect i ve study , a brief structured rehabilitation programme , ' Starting Again ' , was evaluated over a follow-up year . 98 patients were assigned to the programme , and 101 to the control condition . The 11 , 2-h sessions emphasised physical training , information and coping skills . Patients in the programme improved significantly more than the controls with respect to appraisal of having received sufficient information , physical training , physical strength and fighting spirit . Results indicate improvement with respect to the three areas focused on in the ' Starting Again ' programme : physical training , information and coping skills training PURPOSE The primary purpose of this study was to examine the effect of aerobic exercise on physiological and psychological function in patients rehabilitating from cancer treatment . A second purpose was to evaluate the differential effects of low- and moderate-intensity exercise on these variables . METHODS Eighteen survivors of breast or colon cancer ( 15 female and 3 male , 40 - 65 yr of age ) served as subjects . The subjects were matched by aerobic capacity and scores on a Quality of Life question naire , and then r and omly assigned to a control , low- ( 25 - 35 % heart rate reserve ( HRR ) ) , or a moderate- ( 40 - 50 % HRR ) intensity exercise group . The exercise groups performed lower-body aerobic exercise three times a week for 10 wk . After the exercise training , there were no statistically significant differences between the two exercise groups on any of the physiological variables . Therefore , the exercise groups were combined into one group for the final analysis . RESULTS The results revealed statistically significant increases in aerobic capacity ( P < 0.001 ) and lower-body flexibility ( P = 0.027 ) , a significant decrease in body fat ( P < 0.001 ) , and a significant increase in quality of life ( P < 0.001 ) and a measure of energy ( P = 0.038 ) in the exercise group when compared with the control group . CONCLUSION Low- and moderate-intensity aerobic-exercise programs were equally effective in improving physiological and psychological function in this population of cancer survivors .  Aerobic exercise appears to be a valuable and well-tolerated component of the cancer-rehabilitation process PURPOSE Self-directed and supervised exercise were compared with usual care in a clinical trial design ed to evaluate the effect of structured exercise on physical functioning and other dimensions of health-related quality of life in women with stages I and II breast cancer . PATIENTS AND METHODS One hundred twenty-three women with stages I and II breast cancer completed baseline evaluations of generic and disease- and site-specific health-related quality of life , aerobic capacity , and body weight . Participants were r and omly allocated to one of three intervention groups : usual care ( control group ) , self-directed exercise , or supervised exercise .  Quality of life , aerobic capacity , and body weight measures were repeated at 26 weeks . The primary outcome was the change in the Short Form-36 physical functioning scale between baseline and 26 weeks . RESULTS Physical functioning in the control group decreased by 4.1 points , whereas it increased by 5.7 points and 2.2 points in the self-directed and supervised exercise groups , respectively ( P = .04 ) . Post hoc analysis showed a moderately large ( and clinical ly important ) difference between the self-directed and control groups ( 9.8 points ; P = .01 ) and a more modest difference between the supervised and control groups ( 6.3 points ; P = .09 ) . No significant differences between groups were observed for changes in quality of life scores . In a secondary analysis of participants stratified by type of adjuvant therapy , supervised exercise improved aerobic capacity ( + 3.5 mL/kg/min ; P = .01 ) and reduced body weight ( -4.8 kg ; P < .05 ) compared with usual care only in participants not receiving chemotherapy . CONCLUSION Physical exercise can blunt some of the negative side effects of breast cancer treatment , including reduced physical functioning .  Self-directed exercise is an effective way to improve physical functioning compared with usual care . In participants not receiving chemotherapy  , supervised exercise may increase aerobic capacity and reduce body weight compared with usual care OBJECTIVE To evaluate the effect of early exercise therapy on the natural killer cell cytotoxic activity ( NKCA ) of patients who had undergone curative resection of stomach cancer . DESIGN Prospect i ve study . PATIENTS Thirty-five stomach cancer patients who had undergone curative surgery were r and omly divided into an exercise group ( n = 17 ) and a control group ( n = 18 ) . INTERVENTION From postoperative day 2 , moderated exercise using arm and bicycle ergometers performed twice a day , 5 times a week , for 14 days . The intensity of exercise was 60 % of maximal heart rate . Venous blood sample s were obtained on postoperative days 1 , 7 , and 14 . MAIN OUTCOME MEASURE Mean sequential change of NKCA . RESULTS The mean sequential change of NKCA decreased until postoperative day 7 and then increased . Mean NKCA of day 7 decreased in both groups , compared with that at postoperative day 1 . At day 14 , the mean NKCA of the exercise group demonstrated a significant increase compared with that of the control group ( p < .05 ) . CONCLUSION This study suggests that early moderate exercise has a beneficial effect on the function of in vitro NK cells in stomach cancer patients after curative surgery PURPOSE Cancer treatment-related fatigue is the most prevalent and distressing symptom of cancer therapy . Interventions to minimize fatigue are needed . The purpose of this study was to examine the relationship between exercise and fatigue over the first three cycles of chemotherapy in women receiving either cyclophosphamide , methotrexate , and fluorouracil ( CMF ) or doxorubicin and cyclophosphamide ( AC ) for breast cancer . METHODS Seventy-two newly diagnosed women with breast cancer were instructed in a home-based moderate-intensity exercise intervention . Measures of functional ability , energy expenditure , and fatigue were obtained at baseline and posttest . Subjects maintained daily records of four types of fatigue , and exercise duration , intensity , and type . RESULTS Exercise significantly reduced all four levels of fatigue ( P < 0.01 ) . As the duration of exercise increased , the intensity of fatigue declined ( P < 0.01 ) . There was a significant carry-over effect of exercise on fatigue , but the effect lasted only 1 d. The level of fatigue at study entry was not associated with number of days of exercise or amount of exercise a woman engaged in . CONCLUSIONS The impact of exercise on fatigue was significant and suggests the effectiveness of a low- to moderate-intensity regular exercise program in maintaining functional ability and reducing fatigue in women with breast cancer receiving chemotherapy In this study , we examined correlates of adherence and contamination in a r and omized controlled trial ( RCT ) of exercise in cancer survivors using the theory of planned behavior and the Five Factor Model of personality ( FFM ) . We r and omly assigned cancer survivors in group psychotherapy classes to either a waiting-list control group ( n = 45 ) or a home-based , moderate intensity exercise program ( n = 51 ) . At baseline , participants completed  measures  of the theory of planned behavior , the FFM , past exercise , physical fitness , medical variables , and demographics . We then monitored exercise over a 10-week period by weekly self-reports . Hierarchical multiple regression analyses indicated that the independent predictors of overall RCT exercise across both conditions were past exercise ( β = .36 , p > .001 ) , assignment to experimental condition ( β = .34 , p > .001 ) , sex ( β = .30 , p > .001 ) , and intention ( β = .14 , p > .10 ) . For exercise adherence in the exercise condition , the independent predictors were sex ( β = .38 , p > .01 ) , extraversion ( β = .30 , p > .05 ) , normative beliefs ( β = -.27 , p > .05 ) , and perceived behavioral control ( β = .23 , p > .10 ) . Finally , the independent predictors of exercise contamination in the control condition were past exercise ( β = .70 , p > .001 ) , sex ( β = .20 , p > .05 ) , and intention ( β = .17 , p > .10 ) . We conclude that the correlates of exercise adherence and contamination differ in kind as well as in degree . Explanations for these findings and practical implication s for conducting exercise RCTs in this population are offered Insulin , insulin-like growth factors ( IGFs ) I and II , and IGF binding proteins ( IGFBPs ) 1 and 3 have been implicated in breast cancer outcomes . We conducted a r and omized controlled trial to determine the physiological effects of exercise training on changes in these biological markers in postmenopausal breast cancer survivors . Fifty-three postmenopausal breast cancer survivors were r and omly assigned to an exercise ( n = 25 ) or control group ( n = 28 ) . The exercise group trained on cycle ergometers three times per week for 15 weeks . The control group did not train . End points included changes in fasting insulin , glucose , insulin resistance , IGF-I , IGF-II , IGFBP-1 , IGFBP-3 , and IGF-I : IGFBP-3 molar ratio between baseline and week 15 . All of the statistical tests were two-sided ( alpha = 0.05 ) . Fifty-two participants completed the trial . The exercise group completed 44.3 of 45 ( 98.4 % ) prescribed exercise sessions . Baseline hormone concentrations did not differ between groups except that IGF-II was higher in the exercise group ( P = 0.011 ) . No significant differences between groups were observed for changes in fasting insulin ( + 6.3 pmol/liter ; P = 0.941 ) , glucose ( + 0.09 mmol/liter ; P = 0.824 ) , insulin resistance ( + 0.4 ; P = 0.247 ) , IGF-II ( -40.7 ng/ml ; P = 0.101 ) , or IGFBP-1 ( + 1.4 ng/ml ; P = 0.774 ) . However , significant differences between groups were observed for changes in IGF-I ( -7.4 ng/ml ; P = 0.045 ) , IGFBP-3 ( + 180.5 ng/ml ; P = 0.021 ) , and IGF-I : IGFBP-3 molar ratio ( -0.006 ; P = 0.017 ) . Exercise training had significant physiological effects on IGF-I , IGFBP-3 , and IGF-I : IGFBP-3 molar ratio in postmenopausal breast cancer survivors . The clinical implication s of these findings remain to be defined Summary : Allogeneic bone marrow transplantation ( BMT ) has been successfully used for the treatment of several hematological malignancies ; however , it is associated with transplant-related toxicities such as functional impairment and muscle weakness . In order to analyze how an exercise program may influence muscle strength in patients undergoing BMT  , we carried out a prospect i ve study assessing patients from the pre-BMT phase to 16 weeks post-BMT .  In all , 18 patients underwent three trials : ( 1 ) pre-BMT , ( 2 ) after marrow engraftment , and ( 3 ) 6 weeks after trial 2 . After trial 2 , the patients were r and omized in a control group ( CG ) or treatment group ( TG ) , which received a 6-week exercise program with active exercise , muscle stretching and treadmill walking . The results obtained in trial 1 showed similar values for CG and TG , as both groups had muscle strength lower than normal patterns based on data concerning age , sex and weight . In trial 2 , CG and TG showed similarly decreased values . In trial 3 , TG showed values higher than CG for all muscle groups tested . These results suggest that the exercise program was efficient in promoting an increase of muscle strength after allogeneic BMT Loss of physical performance is a universal problem of cancer patients undergoing chemotherapy .  We postulated that this impairment can be partially prevented by aerobic exercise . In a r and omized study , 33 cancer patients receiving high-dose chemotherapy followed by autologous peripheral blood stem cell transplantation ( training group , T ) performed an exercise program consisting of biking on an ergometer in the supine position after an interval-training pattern for 30 minutes daily during hospitalization . Patients in the  control group ( C , n = 37 )  did not train . Maximal physical performance was assessed with a treadmill test by admission and discharge . Physical performance of the two groups was not different on admission . The decrement in performance during hospitalization was 27 % greater in the control group than in the training group ( P = .05 ) ; this result ed in a significantly higher maximal physical performance at discharge in the trained patients ( P = .04 ) . Duration of neutropenia ( P = .01 ) and thrombopenia ( P = .06 ) , severity of diarrhea ( P = .04 ) , severity of pain ( P = .01 ) , and duration of hospitalization ( P = . 03 ) were reduced in the training group . We conclude that aerobic exercise can be safely carried out immediately after high-dose chemotherapy and can partially prevent loss of physical performance . Based on the potential significance of the observed outcomes , further studies are warranted to confirm our results PURPOSE S/ OBJECTIVES To test the hypothesis that women participating in a walking exercise program during radiation therapy treatment for breast cancer would demonstrate more adaptive responses as evidence d by higher levels of physical functioning and lower levels of symptom intensity than women who did not participate . DESIGN Experimental , two-group pretest , post-test . SETTING Two university teaching hospital outpatient radiation therapy departments . SAMPLE 46 women beginning a six-week program of radiation therapy for early stage breast cancer . METHODS Following r and om assignment , subjects in the exercise group maintained an individualized , self-paced , home-based walking exercise program throughout treatment . The control group received usual care . Dependent variables were measured prior to and at the end of radiation therapy . In addition , symptoms were assessed at the end of three weeks of treatment . MAIN RESEARCH VARIABLES Participation in the walking exercise program , physical functioning fatigue , emotional distress , and difficulty sleeping . FINDINGS Hypothesis testing by multivariate analysis of covariance , with pretest scores as covariates , indicated significant differences between groups on outcome measures ( p < 0.001 ) . The exercise group scored significantly higher than the usual care group on physical functioning ( p = 0.003 ) and symptom intensity , particularly fatigue , anxiety , and difficulty sleeping . Fatigue was the most frequent and intense subjective symptom reported . CONCLUSIONS A self-paced , home-based walking exercise program can help manage symptoms and improve physical functioning during radiation therapy . IMPLICATION S FOR NURSING PRACTICE Nurse-prescribed and -monitored exercise is an effective , convenient , and low-cost self-care activity that reduces symptoms and facilitates adaptation to breast cancer diagnosis and treatment PURPOSE To determine the effects of exercise training on cardiopulmonary function and quality of life ( QOL ) in postmenopausal breast cancer survivors who had completed surgery , radiotherapy , and /or chemotherapy with or without current hormone therapy use . METHODS Fifty-three postmenopausal breast cancer survivors were r and omly assigned to an exercise ( n = 25 ) or control ( n = 28 ) group . The exercise group trained on cycle ergometers three times per week for 15 weeks at a power output that elicited the ventilatory equivalent for carbon dioxide . The control group did not train . The primary outcomes were changes in peak oxygen consumption and overall QOL from baseline to postintervention . Peak oxygen consumption was assessed by a grade d exercise test using gas exchange analysis . Overall QOL was assessed by the Functional Assessment of Cancer Therapy-Breast scale . RESULTS Fifty-two participants completed the trial . The exercise group completed 98.4 % of the exercise sessions . Baseline values for peak oxygen consumption ( P = .254 ) and overall QOL ( P = .286 ) did not differ between groups . Peak oxygen consumption increased by 0.24 L/min in the exercise group , whereas it decreased by 0.05 L/min in the control group ( mean difference , 0.29 L/min ; 95 % confidence interval [ CI ] , 0.18 to 0.40 ; P < .001 ) . Overall QOL increased by 9.1 points in the exercise group compared with 0.3 points in the control group ( mean difference , 8.8 points ; 95 % CI , 3.6 to 14.0 ; P = .001 ) . Pearson correlations indicated that change in peak oxygen consumption correlated with change in overall QOL ( r = 0.45 ; P < .01 ) . CONCLUSION Exercise training had beneficial effects on cardiopulmonary function and QOL in postmenopausal breast cancer survivors PURPOSE / OBJECTIVES To examine the effects of a comprehensive rehabilitation program on facilitating physical and psychosocial adaptation of women with breast cancer who are receiving adjuvant chemotherapy . DESIGN Experimental . SETTING Breast evaluation clinics of two New Engl and medical centers with comprehensive cancer treatment programs . SAMPLE 14 women ( mean age = 44 years ) receiving adjuvant chemotherapy for breast cancer ( 86 % stage II ) following surgical treatment . METHODS Subjects were assigned r and omly to the experimental group or the usual care group . Experimental group members began a structured exercise program of walking and attended support group meetings . All subjects were tested before beginning chemotherapy , during the course of chemotherapy , and one month following chemotherapy completion . MAIN RESEARCH VARIABLES Performance status , physical functioning , psychosocial adjustment , self-concept and body image , and 12 symptoms ( e.g. , fatigue , nausea , anxiety ) . FINDINGS Measures of physical performance , psychosocial adjustment , and symptom intensity revealed improved adaptation in subjects who completed the walking/support group program . CONCLUSIONS Physical and psychosocial benefits from a modest walking exercise program and a support group are possible for patients receiving adjuvant chemotherapy . IMPLICATION S FOR NURSING PRACTICE Although more detailed research is necessary to answer some of the questions raised by this study , implementing the walking program and forming a support group are achievable in an outpatient setting PURPOSE Despite the recognition of fatigue as a common and distressing symptom during cancer treatment , there are few evidence -based interventions available to manage such fatigue . The purpose of this multi-institutional pilot study was to explore the effects of a home-based moderate walking exercise intervention on fatigue , physical functioning , emotional distress , and quality of life ( QOL ) during breast cancer treatment . DESCRIPTION OF STUDY Fifty-two women were recruited from five university hospital outpatient departments for this pilot study with an experimental design . Subjects were r and omly assigned to the walking program or to usual care during adjuvant chemotherapy or radiation therapy for breast cancer . Symptoms , physical functioning , and QOL were measured at baseline , midtreatment , and at the end of treatment . RESULTS Women who exercised at least 90 minutes per week on 3 or more days reported significantly less fatigue and emotional distress as well as higher functional ability and QOL than women who were less active during treatment . CLINICAL IMPLICATION S A home-based walking exercise program is a potentially effective , low-cost , and safe intervention to manage fatigue and to improve QOL during adjuvant chemotherapy or radiation therapy for breast cancer . This health-promoting self-care activity needs further testing in large r and omized clinical trials PURPOSE To examine the effect of a progressive upper-body exercise program on  lymphedema secondary to breast cancer treatment . METHODS Fourteen breast cancer survivors with unilateral upper extremity lymphedema were r and omly assigned to an exercise ( n = 7 ) or control group ( n = 7 ) . The exercise group followed a progressive , 8-week upper-body exercise program consisting of resistance training plus aerobic exercise using a Monark Rehab Trainer arm ergometer . Lymphedema was assessed by arm circumference and measurement of arm volume by water displacement . Patients were evaluated on five occasions over the experimental period . The Medical Outcomes Trust Short-Form 36 Survey was used to measure quality of life before and after the intervention . Significance was set at alpha < or = 0.01 . RESULTS No changes were found in arm circumference or arm volume as a result of the exercise program . Three of the quality -of-life domains showed trends toward increases in the exercise group : physical functioning ( P = .050 ) , general health ( P = .048 ) , and vitality ( P = .023 ) . Mental health increased , although not significantly , for all subjects ( P = .019 ) . Arm volume measured by water displacement was correlated with calculated arm volume ( r = .973 , P < .001 ) , although the exercise and control group means were significantly different ( P < .001 ) . CONCLUSIONS Participation in an upper-body exercise program caused no changes in arm circumference or arm volume in women with lymphedema after breast cancer , and they may have experienced an increase in quality of life . Additional studies should be done in this area to determine the optimum training program Purpose : Fatigue is a common side effect of cancer treatment that impacts quality of life .  Exercise is one approach suggested to improve fatigue . The purpose of this study was to explore the relationship of exercise to fatigue and quality of life . Methods : Thirty-one subjects with breast cancer were enrolled prior to beginning chemotherapy and 27 completed the study . All baseline measures were obtained before the first chemotherapy treatment . Subjects were instructed on a home-based , 8-week exercise program . Results : Women who adopted the exercise program ( 60 % ) showed significant increases in functional ability and less weight gain . Exploratory , stepwise multiple regression analyses suggested that the maximum effect of exercise on quality of life outcomes may be mediated by fatigue . Conclusions : The low-to-moderate intensity , home-based exercise program was feasible for some women with breast cancer receiving chemotherapy .  The results suggest that exercise may affect quality of life and that this effect may be mediated by the effects of exercise on fatigue . Better retention of functional ability and better weight control are additional possible benefits of exposing breast cancer patients to increased exercise . A r and omized , controlled clinical trial is needed to establish confidence in these observed relationships Fatigue and insomnia are problems for patients with cancer . Research findings show that aerobic exercise decreases cancer-related fatigue . Because patients with cancer who have skeletal muscle wasting may not obtain maximum benefit from aerobic exercise training , exercise programs may need to include resistance training . Thus far , testing exercise as an intervention for fatigue has focused on patients with breast cancer and excluded patients with bone metastasis . There is a need to test the feasibility and effectiveness of exercise for patients with other types of cancer and with bone involvement . The effect of aerobic and strength resistance training on the sleep of patients with cancer has not been tested . A pilot/feasibility study with a r and omized controlled design was conducted to investigate homebased exercise therapy for 24 patients receiving high-dose chemotherapy and autologous peripheral blood stem cell transplantation as treatment for multiple myeloma . None of the patients injured themselves . Because of the small sample size in the feasibility study , the effect of exercise on lean body weight was the only end point that obtained statistical significance . However , the results suggest that an individualized exercise program for patients receiving aggressive treatment for multiple myeloma is feasible and may be effective for decreasing fatigue and mood disturbance , and for improving sleep Most systematic review s rely substantially on the assessment of the method ological quality of the individual trials . The aim of this study was to obtain consensus among experts about a set of generic core items for quality assessment of r and omized clinical trials ( RCTs ) . The invited participants were experts in the field of quality assessment of RCTs . The initial item pool contained all items from existing criteria lists . Subsequently , we reduced the number of items by using the Delphi consensus technique . Each Delphi round comprised a question naire , an analysis , and a feedback report . The feedback report included staff team decisions made on the basis of the analysis and their justification . A total of 33 international experts agreed to participate , of whom 21 completed all question naires . The initial item pool of 206 items was reduced to 9 items in three Delphi rounds . The final criteria list ( the Delphi list ) was satisfactory to all participants . It is a starting point on the way to a minimum reference st and ard for RCTs on many different research topics . This list is not intended to replace , but rather to be used alongside , existing criteria lists Exercise participation has been shown to improve cardiovascular fitness and reduce psychological distress  among women receiving chemotherapy and /or radiation . The purpose of this pilot study was to examine the changes in distress and body image , and fitness following exercise participation among 24 women who had been diagnosed with breast cancer within the previous 3 years . The women were r and omly assigned to participate in a 12-week supervised aerobic exercise program in a hospital setting or a wait-list control group . Assessment s of distress and body image were conducted at pre- and post-treatment . Data showed that the women in the exercise group improved significantly in body image ( Physical Condition and Weight Concerns subscales ) vs control group participants at post-treatment . Reductions in distress were also noted in the exercise group , but these were nonsignificant . At post-treatment , there were modest improvements in fitness in the exercise group This study examined the effect of a supervised , aerobic exercise program on change in body weight and composition ( multi-site subcutaneous skinfold measures , percent body fat , and lean body weight ) of women undergoing adjuvant chemotherapy for breast cancer . Stage II patients with breast cancer ( N = 24 ) were r and omized to an exercise treatment group ( EG , n = 12 ) and a control group ( CG , n = 12 ) . The EG participated in the individualized Winningham Aerobic Interval Training ( WAIT ) exercise program with exertional levels set at 60%-85 % of maximal heart rate for 20 - 30 minutes , 3 times per week , for 10 - 12 weeks . The CG received no exercise treatment , but were asked to continue with their daily activities . Subjects were asked to maintain their customary eating patterns throughout their participation . Data were analyzed using covariate analysis , adjusting for age and pre-test values . Comparisons of pre- and post-test results indicated that exercise had a moderating effect on gain in body fat and altered the subcutaneous body fat profile in both obese ( OB ) and nonobese ( NOB ) subjects . Exercising OB subjects showed a greater increase in lean body weight than NOB subjects , indicating an increase in muscle tissue . Results from this study may be useful in design ing safe and effective weight-control programs for patients with breast cancer on chemotherapy We conducted a r and omized controlled trial to determine the effects of a home-based exercise intervention on change in quality of life ( QOL ) in recently resected colorectal cancer survivors , most of whom were receiving adjuvant therapy . Participants were r and omly assigned in a 2:1 ratio to either an  exercise ( n = 69 ) or control ( n = 33 ) group . The exercise group was asked to perform moderate intensity exercise 3 - 5 times per week for 20 - 30 min each time . The primary outcome was change in QOL as measured by the Functional Assessment of Cancer Therapy-Colorectal ( FACT-C ) scale . Adherence in the exercise group was good ( 75.8 % ) but contamination in the control group was problematic ( 51.6 % ) . Intention-to-treat analysis revealed no significant differences between groups for change in the FACT-C ( mean difference , -1.3 ; 95 % CI , -7.8 to 5.1 ; P = 0.679 ) . In an ' on-treatment ' ancillary analysis , we compared participants who decreased versus increased their cardiovascular fitness over the course of the intervention . This analysis revealed significant differences in favour of the increased fitness group for the FACT-C ( mean difference , 6.5 ; 95 % CI , 0.4 - 12.6 ; P = 0.038 ) . These data suggest that increased cardiovascular fitness is associated with improvements in QOL in colorectal cancer survivors but better controlled trials are needed OBJECTIVES Cancer treatment-related fatigue is a common and disruptive side effect of chemotherapy . Exercise is an intervention proposed to reduce fatigue in cancer patients . The purpose of this study was to describe the patterns of daily fatigue in women with breast cancer who did and did not exercise while receiving the first three cycles of adjuvant chemotherapy .  MATERIAL S AND METHODS Women received instruction to follow an 8-week home-based exercise program and to maintain daily exercise and fatigue diaries . Functional ability ( 12-minute walk ) was measured pretest and post-test . RESULTS Several distinct patterns of fatigue emerged . The most common pattern of fatigue after chemotherapy demonstrated a sharp rise in fatigue . However , several women demonstrated a chaotic pattern with erratic and wide swings in their fatigue throughout the entire study period . Women who adopted exercise experienced fewer days of high fatigue levels and more days of low levels of fatigue for both average and worst levels of fatigue . Women who did not exercise experienced more bad days ( high fatigue ) and fewer good days ( low fatigue ) . CONCLUSIONS Exercise appears to reduce the levels of average and worst fatigue and may help women recognize their pattern of fatigue . Exercise may reduce the intensity of fatigue by reorganizing women 's interpretation of fatigue . Routine clinical assessment and education about fatigue by health professionals can help patients to underst and their pattern of fatigue and may help them to manage the symptom PURPOSE And rogen deprivation therapy is a common treatment in men with prostate cancer that may cause fatigue , functional decline , increased body fatness , and loss of lean body tissue . These physical changes can negatively affect health-related quality of life .  Resistance exercise may help to counter some of these side effects by reducing fatigue , elevating mood , building muscle mass , and reducing body fat . METHODS In a two-site study , 155 men with prostate cancer who were scheduled to receive and rogen deprivation therapy for at least 3 months after recruitment were r and omly assigned to an intervention group that participated in a resistance exercise program three times per week for 12 weeks ( 82 men ) or to a waiting list control group ( 73 men ) . The primary outcomes were fatigue and disease-specific quality of life as assessed by self-reported question naires after 12 weeks . Secondary outcomes were muscular fitness and body composition . RESULTS Men assigned to resistance exercise had less interference from fatigue on activities of daily living ( P = .002 ) and higher quality of life ( P = .001 ) than men in the control group . Men in the intervention group demonstrated higher levels of upper body ( P = .009 ) and lower body ( P < .001 ) muscular fitness than men in the control group . The 12-week resistance exercise intervention did not improve body composition as measured by changes in body weight , body mass index , waist circumference , or subcutaneous skinfolds . CONCLUSION Resistance exercise reduces fatigue and improves quality of life and muscular fitness in men with prostate cancer receiving and rogen deprivation therapy .  This form of exercise can be an important component of supportive care for these patients Preliminary evidence indicates that physical exercise may be an effective strategy for the rehabilitation of cancer patients following high dose chemotherapy ( HDC ) and bone marrow transplantation ( BMT )  , but the focus of this research has been on physical fitness and medical outcomes . In the present study , we employed a prospect i ve design to examine the relationship between physical exercise and various quality of life ( QOL ) indices in 25 BMT patients . Participants completed weekly self-administered question naires upon being admitted to hospital , and monitored the frequency and duration of their  exercise  during hospitalization . Statistical analyses indicated that  exercise during hospitalization was significantly correlated with almost all QOL indices , including physical well-being , psychological well-being , depression , anxiety and days hospitalized . Moreover , only some of the correlations were attenuated after controlling for relevant demographic and medical variables . It was concluded that physical exercise may be related to QOL in  BMT patients , but that experimental research is needed before any definitive conclusions can be drawn BACKGROUND Shoulder dysfunction remains a frequent complication after neck dissection procedures for head and neck cancer . METHODS We conducted a pilot study to evaluate the effects of progressive resistance exercise training ( PRET ) on shoulder dysfunction caused by spinal accessory neurapraxia/neurectomy in patients with head and neck cancer . Twenty patients ( mean age , 61 + /- 7.7 years ) were r and omly assigned to PRET or st and ard care intervention . Subjects assigned to the PRET group exercised three times per week for 12 weeks . The goal of the exercise program was to enhance scapular stability and strength of the upper extremity . The resistance-training program was progressive in terms of number of sets and repetitions performed , as well as the amount of weight lifted , depending on performance status . RESULTS The completion rate for the trial was 85 % ( 17 of 20 ) . The exercise group completed 93 % of scheduled exercise sessions . Significant improvements were found in favor of the PRET group in active shoulder external rotation ( p = .001 ) , shoulder pain ( p = .038 ) , and overall score for shoulder pain and disability ( p = .045 ) . CONCLUSIONS The study results demonstrate a high rate of completion and adherence with our PRET program among patients with head and neck cancer . The preliminary findings , although limited , also suggest a potential therapeutic role for resistance exercise as an adjunct to st and ard physical therapy treatment PURPOSE The purpose of this investigation was to evaluate the impact of undertaking peripheral blood stem cell transplantation ( PBST ) on T-cell number and function , and to determine the role of a mixed type , moderate intensity exercise program in facilitating the recovery of T-cell number and function . METHODS Immunological measures of white blood cell , lymphocyte , CD3 , CD4 , and CD8 counts , and CD3 cell function were assessed pretransplant ( PI ) , immediately posttransplant ( PII ) , and 1 month ( I1 ) , 2 months ( I2 ) and 3 months ( PIII ) posttransplant . After PII , 12 patients were divided equally into a control group ( CG ) or exercise intervention group ( EG ) . RESULTS Lower total T-cell , helper T-cell , and suppressor T-cell counts ( P < 0.01 ) , as well as lower T-cell function ( P < 0.01 ) , when compared with normative data , were found at PI . More specifically , 88 % of the group had CD3 , CD4 , and CD8 counts that were more than 40 % , 20 % , and 50 % below normal at PI , respectively . Undertaking a PBST caused further adverse changes to the total leukocyte , lymphocyte , CD3 , CD4 and CD8 count , and the helper/suppressor ratio . Although CD8 counts had returned to normal by PIII , CD3 , CD4 , and the CD4 /CD8 ratio remained significantly lower than normative data ( P < 0.01 ) , with 66 % , 100 % , and 100 % of the subject group reporting counts and ratios , respectively , below the normal range . CONCLUSION The PBST patients were immunocompromised before undertaking the transplant , and the transplant procedure imposed further adverse changes to the leukocyte and lymphocyte counts . The leukocyte and CD8 counts returned to normal within 3 months posttransplant ; however , the other immunological parameters assessed demonstrated a delayed recovery . Although participation in the exercise program did not facilitate a faster immune cell recovery , neither did the exercise program hinder or delay recovery The effect of a 10-week aerobic interval-training cycle ergometer protocol on the functional capacity ( VO2Lmax ) of 45 women receiving chemotherapy for treatment of Stage II breast cancer was studied . Subjects were stratified by baseline functional capacity ( ± 1 MET ) and r and omized to experimental ( EX ) , placebo ( PL ) , and control ( CO ) groups . EX subjects completed a 10-week , 3 times/week exercise training program ; PL subjects participated in 10 weeks of nonaerobic stretching and flexibility exercises ; the CO group maintained normal activities . The EX group showed significant , p < .05 , improvement on pre- to posttest VO2Lmax as well as workload and test time compared to the PL and CO groups . The interval-training exercise intervention was effective in improving the functional capacity of Stage II breast cancer patients on adjuvant chemotherapy Physical exercise has been shown to enhance quality of life ( QOL ) in cancer survivors using pretest-posttest design s and compared to usual care ( i.e. no intervention ) . In the present study , we conducted a r and omized controlled trial to determine if exercise could improve QOL in cancer survivors beyond the known benefits of group psychotherapy ( GP ) . We matched 22 GP classes ( N=108 ) on content and then r and omly assigned 11 ( n=48 ) to GP alone and 11 ( n=60 ) to GP plus home-based , moderate-intensity exercise ( GP+EX ) . Participants completed a physical fitness test and QOL measures ( e.g. Functional Assessment of Cancer Therapy scales ) at the beginning and end of GP classes ( about 10 weeks ) . We had excellent recruitment ( 81 % ) , retention ( 89 % ) , and adherence ( 84 % ) rates and a modest contamination ( 22 % ) rate . Using intention-to-treat repeated measures analyses of variance , we found significant Time by Condition interactions for functional well-being , fatigue , and sum of skinfolds . We also found borderline significant interactions for physical well-being , satisfaction with life , and flexibility . All interactions favored the GP+EX condition . We conclude that a home-based , moderate intensity exercise program may im-prove QOL in cancer survivors beyond the benefits of GP , particularly in relation to physical and functional well-being Fatigue is a common and often severe problem in cancer patients undergoing chemotherapy .  The authors postulated that physical activity training can reduce the intensity of fatigue in this group of patients Skeletal muscle protein loss occurs during marrow transplantation despite total parenteral nutrition . To determine if muscle atrophy could be minimized with exercise therapy , 30 patients undergoing marrow transplantation for acute leukemia completed a prospect i ve r and omized trial to receive : ( 1 ) no therapy ( controls ) , ( 2 ) physical therapy thrice weekly ( PT3 ) , or ( 3 ) physical therapy five times weekly ( PT5 ) . Patients were studied through 35 days posttransplant . Muscle protein status and turnover was assessed by weekly nitrogen balance , and creatinine and 3-methylhistidine excretion . Results favored a muscle protein-sparing effect of exercise , as a significant decrease in creatinine excretion in controls only suggested muscle protein loss associated with inactivity . Changes in arm muscle area correlated with energy , but not protein intake . Large individual variation , inadequate nutritional support and differences in admission arm muscle area may have clouded these results
PURPOSE To systematic ally review the method ologic quality of , and summarize the evidence from trials examining the effectiveness of physical exercise in improving the level of physical functioning and psychological well-being of cancer patients during and after medical treatment .
Various exercise modalities have been applied , differing in content , frequency , intensity , and duration .