Feasibility and efficacy of a supervised exercise intervention in de-conditioned cancer survivors during the early survivorship phase: the PEACH trial
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
This study aims to evaluate the feasibility and efficacy of an 8-week supervised exercise program in de-conditioned cancer survivors within 2–6 months of chemotherapy completion.
Participants were randomly assigned to an 8-week, twice-weekly, supervised aerobic exercise training regime (n = 23) or a usual care group (n = 20). Feasibility was assessed by recruitment rate, program adherence and participant feedback. The primary outcome was aerobic fitness assessed by the Modified Bruce fitness test at baseline (0 weeks), post-intervention (8 weeks) and at 3-month follow-up. Secondary outcomes included physical activity, waist circumference, fatigue and quality of life.
The recruitment rate was 81 % and adherence to the supervised exercise was 78.3 %. Meaningful differences in aerobic fitness between the exercise and usual care groups at both the 8-week [mean 3.0 mL kg−1 min−1 (95 % CI −1.1–7.0)] and 3-month follow-up [2.1 mL kg−1 min−1 (−2.3–6.6)] were found, although these differences did not achieve statistical significance (p values >0.14). Self-reported physical activity increased in the exercise group (EG) compared to the usual care group at both 8-week (p = 0.01) and 3-month follow-up (p = 0.03) and significant differences in favour of the EG were found for physical well-being at both the 8-week (p = 0.03) and 3-month follow-up (p = 0.04). Improvements in fatigue (p = 0.01), total quality of life plus fatigue (p = 0.04), and a composite physical functioning score (p = 0.01) at the 3-month follow-up were also found.
The PEACH trial suggests that 8 weeks of supervised aerobic exercise training was feasible and may improve aerobic fitness, fatigue and quality of life in de-conditioned cancer survivors during the early survivorship phase.
Implications for Cancer Survivors
Exercise interventions commenced in the early survivorship phase appear safe, feasible and may lead to improvements in QOL and fatigue.
- Das P, Horton R. Rethinking our approach to physical activity. Lancet. 2012;380(9838):189–90. doi:10.1016/s0140-6736(12)61024-1. CrossRef
- Spence RR, Heesch KC, Brown WJ. Exercise and cancer rehabilitation: a systematic review. Cancer Treat Rev. 2010;36(2):185–94. doi:10.1016/j.ctrv.2009.11.003. CrossRef
- Ferrer RA, Huedo-Medina TB, Johnson BT, Ryan S, Pescatello LS. Exercise interventions for cancer survivors: a meta-analysis of quality of life outcomes. Ann Behav Med. 2011;41(1):32–47. doi:10.1007/s12160-010-9225-1. CrossRef
- Jones LW, Liang Y, Pituskin EN, Battaglini CL, Scott JM, et al. Effect of exercise training on peak oxygen consumption in patients with cancer: a meta-analysis. Oncologist. 2011;16(1):112–20. doi:10.1634/theoncologist.2010-0197. CrossRef
- Speck RM, Courneya KS, Masse LC, Duval S, Schmitz KH. An update of controlled physical activity trials in cancer survivors: a systematic review and meta-analysis. J Cancer Surviv. 2010;4(2):87–100. doi:10.1007/s11764-009-0110-5. CrossRef
- Duijts SF, Faber MM, Oldenburg HS, van Beurden M, Aaronson NK. Effectiveness of behavioral techniques and physical exercise on psychosocial functioning and health-related quality of life in breast cancer patients and survivors—a meta-analysis. Psychooncology. 2011;20(2):115–26. doi:10.1002/pon.1728. CrossRef
- Courneya KS, Friedenreich CM. Framework PEACE: an organizational model for examining physical exercise across the cancer experience. Ann Behav Med. 2001;23(4):263–72. CrossRef
- Demark-Wahnefried W, Aziz NM, Rowland JH, Pinto BM. Riding the crest of the teachable moment: promoting long-term health after the diagnosis of cancer. J Clin Oncol. 2005;23(24):5814–30. doi:10.1200/jco.2005.01.230. CrossRef
- Jones LW, Courneya KS, Mackey JR, Muss HB, Pituskin EN, et al. Cardiopulmonary function and age-related decline across the breast cancer survivorship continuum. J Clin Oncol. 2012;30(20):2530–7. doi:10.1200/jco.2011.39.9014. CrossRef
- Thorsen L, Skovlund E, Stromme SB, Hornslien K, Dahl AA, et al. Effectiveness of physical activity on cardiorespiratory fitness and health-related quality of life in young and middle-aged cancer patients shortly after chemotherapy. J Clin Oncol. 2005;23(10):2378–88. doi:10.1200/jco.2005.04.106. CrossRef
- Jones LW, Haykowsky MJ, Swartz JJ, Douglas PS, Mackey JR. Early breast cancer therapy and cardiovascular injury. J Am Coll Cardiol. 2007;50(15):1435–41. doi:10.1016/j.jacc.2007.06.037. CrossRef
- McGowan EL, Speed-Andrews AE, Blanchard CM, Rhodes RE, Friedenreich CM, et al. Physical activity preferences among a population-based sample of colorectal cancer survivors. Oncol Nurs Forum. 2013;40(1):44–52. doi:10.1188/13.onf.44-52. CrossRef
- Vallance JK, Courneya KS, Jones LW, Reiman T. Exercise preferences among a population-based sample of non-Hodgkin’s lymphoma survivors. Eur J Cancer Care (Engl). 2006;15(1):34–43. doi:10.1111/j.1365-2354.2005.00617.x. CrossRef
- Karvinen KH, Courneya KS, Venner P, North S. Exercise programming and counseling preferences in bladder cancer survivors: a population-based study. J Cancer Surviv. 2007;1(1):27–34. doi:10.1007/s11764-007-0010-5. CrossRef
- Karvinen KH, Courneya KS, Campbell KL, Pearcey RG, Dundas G, et al. Exercise preferences of endometrial cancer survivors: a population-based study. Cancer Nurs. 2006;29(4):259–65. CrossRef
- Courneya KS, Friedenreich CM. Physical activity and cancer control. Semin Oncol Nurs. 2007;23(4):242–52. doi:10.1016/j.soncn.2007.08.002. CrossRef
- Irwin ML, Crumlet D, Mc Tiernan A. Physical activity levels before and after a diagnosis of breast carcinoma: the Health, Eating, Activity (HEAL) study. Cancer. 2003;97(7):1746–57. CrossRef
- Matthews CE, Wilcox S, Hanby CL, Der Ananian C, Heiney SP, et al. Evaluation of a 12-week home-based walking intervention for breast cancer survivors. Support Care Cancer. 2007;15(2):203–11. doi:10.1007/s00520-006-0122-x. CrossRef
- Nikander R, Sievanen H, Ojala K, Oivanen T, Kellokumpu-Lehtinen PL, et al. Effect of a vigorous aerobic regimen on physical performance in breast cancer patients—a randomized controlled pilot trial. Acta Oncol. 2007;46(2):181–6. doi:10.1080/02841860600833145. CrossRef
- Trinh L, Plotnikoff RC, Rhodes RE, North S, Courneya KS. Physical activity preferences in a population-based sample of kidney cancer survivors. Support Care Cancer. 2012;20(8):1709–17. doi:10.1007/s00520-011-1264-z. CrossRef
- Vallance JK, Courneya KS, Jones LW, Reiman T. Exercise preferences among a population-based sample of non-Hodgkin’s lymphoma survivors. Eur J Cancer Care. 2005;15:34–43. CrossRef
- Jones L, Courneya KS. Exercise counseling and programming preferences of cancer survivors. Cancer Pract. 2002;10:208–15. CrossRef
- Rogers LQ, Markwell SJ, Verhulst S, McAuley E, Courneya KS. Rural breast cancer survivors: exercise preferences and their determinants. Psychooncology. 2009;18(4):412–21. doi:10.1002/pon.1497. CrossRef
- Walsh JM, Hussey J, Guinan E, O’Donnell D. 'Pragmatic randomized controlled trial of individually prescribed exercise versus usual care in a heterogeneous cancer survivor population': a feasibility study PEACH trial: prescribed exercise after chemotherapy. BMC Cancer. 2010;10:42. doi:10.1186/1471-2407-10-42. CrossRef
- Fletcher GF, Balady GJ, Amsterdam EA, Chaitman B, Eckel R, et al. Exercise standards for testing and training. A statement for healthcare professionals from the American Heart Association. Circulation. 2001;104:1694–740. CrossRef
- Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14(5):377–81. CrossRef
- Ajzen I. The theory of planned behaviour. Organ Behav Hum Decis Process. 1991;50:179–211. CrossRef
- Schmitz KH, Courneya KS, Matthews C, Demark-Wahnefried W, Galvao DA, et al. American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc. 2010;42(7):1409–26. doi:10.1249/MSS.0b013e3181e0c112. CrossRef
- Fielding RA, Frontera WR, Hughes VA, Fisher EC, Evans WJ. The reproducibility of the Bruce protocol exercise test for the determination of aerobic capacity in older women. Med Sci Sports Exerc. 1997;29(8):1109–13. CrossRef
- Glass S, Dwyer G. ACSM’s metabolic calculations handbook. 1st ed. Baltimore: Lippincott Williams and Wilkins; 2006.
- McArdle WD, Katch FI, Katch FI. Essentials of exercise physiology. 4th ed: Lippincott Williams and Wilkins; 2010.
- Cella D, Tulsky DS, Gray G, Sarafin B, Linn E, et al. The Functional Assessment of Cancer Therapy Scale: development and validation of the general measure. J Clin Oncol. 1993;11(3):570–9.
- Cella D, Eton DT, Lai JS. Combining anchor and distribution based methods to derive clinically important differences on the Functional Assessment of Cancer Therapy (FACT) anemia and fatigue scales. J Pain Symptom Manage. 2002;24:547–61. CrossRef
- Cella D. The Functional Assessment of Cancer Therapy-Anemia (FACT-An) Scale: a new tool for the assessment of outcomes in cancer anemia and fatigue. Semin Hematol. 1997;34(3 Suppl 2):13–9.
- Ware JE, Snow KK, Kosinski M, Gandek B. SF-36 health survey. Manual and interpretation guide. Boston: The Health institute, New England Medical Center; 1993.
- Ware JE, Kosinski M, Dewey JE. How to score Version Two of the SF-36 Health Survey. Lincoln: Quality Metric; 2000.
- Rowlands AV, Thomas PWM, Eston RG, Topping R. Validation of the RT3 triaxial accelerometer for the assessment of physical activity. Med Sci Sports Exerc. 2004;36(3):518–24. doi:10.1249/01.MSS.0000117158.14542.E7. CrossRef
- Powell SMP, Rowlands AV. Inter-monitor variability of the RT3 accelerometer during a variety of physical activities. Med Sci Sports Exerc. 2004;36:324–30. doi:10.1249/01.MSS.0000113743.68789.36. CrossRef
- Trost SG, McIver KL, Pate RR. Conducting accelerometer-based activity assessments in field-based research. Med Sci Sports Exerc. 2005;37(11 Suppl):S531–43. CrossRef
- Matthews CE, Chen KY, Freedson PS, Buchowski MS, Beech BM, et al. Amount of time spent in sedentary behaviors in the United States, 2003–2004. Am J Epidemiol. 2008;167(7):875–81. doi:10.1093/aje/kwm390. CrossRef
- Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN, et al. Physical activity and public health: updated recommendations for adults from the American College of Sports Medicine and the American Heart Association. Circulation. 2007;116:1081–93. doi:10.1161/CIRCULATIONAHA.107.185649. CrossRef
- Godin G, Shephard RJ. A simple method to assess exercise behaviour in the community. Can J Appl Sports Sci. 1985;10:141–6.
- Godin G, Shephard RJ. Godin Leisure-Time Exercise Questionnaire. Med Sci Sports Exerc. 1997;29 June Supplement:S36–S8.
- Borm GF, Fransen J, Lemmens WA. A simple sample size formula for analysis of covariance in randomized clinical trials. J Clin Epidemiol. 2007;60(12):1234–8. doi:10.1016/j.jclinepi.2007.02.006. CrossRef
- Stevinson C, Lawlor DA, Fox KR. Exercise interventions for cancer patients: systematic review of controlled trials. Cancer Causes Control. 2004;15(10):1035–56. CrossRef
- Milne HM, Wallman KE, Gordon S, Courneya KS. Effects of a combined aerobic and resistance exercise program in breast cancer survivors: a randomized controlled trial. Breast Cancer Res Treat. 2008;108(2):279–88. doi:10.1007/s10549-007-9602-z. CrossRef
- Courneya KS, Friedenreich CM. Physical activity and cancer control. Semin Oncol. 2007;23(4):242–52. CrossRef
- Myers J, Prakash M, Froelicher V. Exercise capacity and mortality among men referred for exercise testing. N Engl J Med. 2002;346:793–801. CrossRef
- Courneya KS, Mackey JR, Bell GJ, Jones LW, Field CJ, et al. Randomized controlled trial of exercise training in post-menopausal breast cancer survivors: cardiopulmonary and quality of life outcomes. J Clin Oncol. 2003;21:1660–8. CrossRef
- Courneya KS, Sellar CM, Stevinson C, McNeely ML, Peddle CJ, et al. Randomized controlled trial of the effects of aerobic exercise on physical functioning and quality of life in lymphoma patients. J Clin Oncol. 2009;27(27):4605–12. doi:10.1200/jco.2008.20.0634. CrossRef
- McNeely ML. Effects of exercise on breast cancer patients and survivors: a systematic review and meta-analysis. Can Med Assoc J. 2006;175(1):34–41. doi:10.1503/cmaj.051073. CrossRef
- Dimeo FC, Stieglitz RD, Novelli-Fischer U, Fetscher S, Keul J. Effects of physical activity on the fatigue and physiologic status of cancer patients during chemotherapy. Cancer. 1999;85:2273–7. CrossRef
- Pinto BM, Frierson GM, Rabin C, Trunzo JJ, Marcus BH. Home-based physical activity intervention for breast cancer patients. J Clin Oncol. 2005;23(15):3577–87. doi:10.1200/jco.2005.03.080. CrossRef
- Rogers LQ, Hopkins-Price P, Vicari S, Pamenter R, Courneya KS, et al. A randomized trial to increase physical activity in breast cancer survivors. Med Sci Sports Exerc. 2009;41(4):935–46. doi:10.1249/MSS.0b013e31818e0e1b. CrossRef
- Vallance JK, Courneya KS, Plotnikoff RC, Yasui Y, Mackey JR. Randomized controlled trial of the effects of print materials and step pedometers on physical activity and quality of life in breast cancer survivors. J Clin Oncol. 2007;25(17):2352–9. doi:10.1200/jco.2006.07.9988. CrossRef
- Feasibility and efficacy of a supervised exercise intervention in de-conditioned cancer survivors during the early survivorship phase: the PEACH trial
Journal of Cancer Survivorship
Volume 7, Issue 4 , pp 551-562
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Quality of life
- Physical activity
- Feasibility study
- Randomised controlled trial
- Industry Sectors
- Author Affiliations
- 1. School of Medicine, Trinity Centre for Health Science, St. James’s Hospital, St. James’s Street, Dublin 8, Ireland
- 2. Academic Unit of Clinical and Medical Oncology, St. James’s Hospital, St. James’s Street, Dublin 8, Ireland
- 3. Prostate Molecular Oncology, Dept. of Clinical Medicine, Trinity College Dublin, Dublin, Ireland
- 4. Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Canada
- 5. Faculty of Kinesiology, University of Calgary, Calgary, Canada
- 6. Department of Pharmacology and Therapeutics, Trinity Centre for Health Science, St. James’s Hospital, Dublin 8, Ireland