Supportive Care in Cancer

, Volume 14, Issue 2, pp 116–127

The effect of a multidimensional exercise intervention on physical capacity, well-being and quality of life in cancer patients undergoing chemotherapy

  • Lis Adamsen
  • Morten Quist
  • Julie Midtgaard
  • Christina Andersen
  • Tom Møller
  • Lasse Knutsen
  • Anders Tveterås
  • Mikael Rorth
Original Article

Abstract

The aim of the present study was to investigate the impact of a multidimensional exercise intervention focusing on physical capacity; one-repetition maximum (1RM) and maximum oxygen uptake (VO2Max), activity level, general well-being and quality of life in cancer patients undergoing chemotherapy. The intervention comprised resistance and fitness training, massage, relaxation and body-awareness training. Eighty-two cancer patients, with or without evidence of residual disease, were included: 66 patients with 13 different types of solid tumours and 16 patients with 6 types of haematological malignancies. The patients trained in mixed groups for 9 h weekly for 6 weeks. Physical capacity, physical activity level and psychosocial well-being as measured by the Medical Outcomes Study 36-item Short-Form Health Survey and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 were assessed pre- and post-intervention. Highly significant increases were achieved in muscular strength (p<0.001), physical fitness (p<0.001) and physical activity levels (p<0.001). The patients reported significant reduction in treatment-related symptoms, i.e., fatigue (p=0.006) and pain (p=0.03). Highly significant improvements were observed in physical functioning (p<0.001) and role functioning (p<0.001). Even patients with advanced disease were able to improve their results after 6 weeks. It is concluded that a multidimensional exercise intervention, including resistance training, may be beneficial for cancer patients undergoing chemotherapy. This study indicates significant clinical meaningful improvements. The exact role of the intervention has to be defined in a randomized controlled design. A clinically controlled trial including 250 patients is currently being carried out.

Keywords

Exercise Resistance training Cancer Chemotherapy Quality of life 

References

  1. 1.
    Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, de Haes JC et al (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85:365–376PubMedGoogle Scholar
  2. 2.
    Adamsen L, Rasmussen JM, Pedersen LS (2001) ‘Brothers in arms’: how men with cancer experience a sense of comradeship through group intervention which combines physical activity with information relay. J Clin Nurs 10:528–537PubMedGoogle Scholar
  3. 3.
    Adamsen L, Rasmussen JM (2001) Sociological perspectives on self-help groups: reflections on conceptualization and social processes. J Adv Nurs 35:909–917PubMedGoogle Scholar
  4. 4.
    Adamsen L (2002) ‘From victim to agent’: the clinical and social significance of self-help group participation for people with life-threatening diseases. Scand J Caring Sci 16:224–231PubMedGoogle Scholar
  5. 5.
    Adamsen L, Midtgaard J, Rorth M, Borregaard N, Andersen C, Quist M, Moller T, Zacho M, Madsen JK, Knutsen L (2003) Feasibility, physical capacity, and health benefits of a multidimensional exercise programme for cancer patients undergoing chemotherapy. Support Care Cancer 11:707–716PubMedGoogle Scholar
  6. 6.
    Adamsen L, Midtgaard J, Andersen C, Quist M, Moeller T, Roerth M (2004) Transforming the nature of fatigue through exercise: qualitative findings from a multidimensional exercise program in cancer patients undergoing chemotherapy. Eur J Cancer Care 13:362–370CrossRefGoogle Scholar
  7. 7.
    Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ, O’Brien WL, Bassett DR Jr, Schmitz KH, Emplaincourt PO, Jacobs DR Jr, Leon AS (2000) Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc 32(9 Suppl):S498–S504CrossRefPubMedGoogle Scholar
  8. 8.
    Andersen LB (1995) A maximal cycle exercise protocol to predict maximal oxygen uptake. Scand J Med Sci Sports 5:143–146PubMedGoogle Scholar
  9. 9.
    Arakawa S (1997) Relaxation to reduce nausea, vomiting, and anxiety induced by chemotherapy in Japanese patients. Cancer Nurs 20:342–349PubMedGoogle Scholar
  10. 10.
    Ballard-Barbash R, Blair A, Blair SN, Byers T, Hoffman-Goetz L, Lee I-M, Troiano R, Westerlind K (2002) Physical activity across the cancer continuum: report of a workshop: review of existing knowledge and innovative designs for future research. Cancer 95:1134–1143CrossRefPubMedGoogle Scholar
  11. 11.
    Bindemann S, Soukop M, Kaye SB (1991) Randomised controlled study of relaxation training. Eur J Cancer 27:170–174PubMedGoogle Scholar
  12. 12.
    Bjorner JB, Damsgaard MT, Watt T, Groenvold M (1998) Tests of data quality, scaling assumptions, and reliability of the Danish SF-36. J Clin Epidemiol 51:1001–1011CrossRefPubMedGoogle Scholar
  13. 13.
    Bredin M, Corner J, Krishnasamy M, Plant H, Bailey C, A’Hern R (1999) Multicentre randomised controlled trial of nursing intervention for breathlessness in patients with lung cancer. BMJ 318:901–904PubMedGoogle Scholar
  14. 14.
    Bridge LR, Benson P, Pietroni PC, Priest RG (1988) Relaxation and imagery in the treatment of breast cancer. BMJ 297:1169–1172PubMedGoogle Scholar
  15. 15.
    Brzycki M (1993) Strength testing: predicting a one-rep max from reps to fatigue. J Phys Educ Recreat Dance 64:88–90Google Scholar
  16. 16.
    Bunkan BH, Schultz CM (1998) Medisinsk massasje (Medical massage), 2nd edn. Universitetsforlaget, Oslo, NorwayGoogle Scholar
  17. 17.
    Burish TG, Lyles JN (1981) Effectiveness of relaxation training in reducing adverse reactions to cancer chemotherapy. J Behav Med 4:65–78CrossRefPubMedGoogle Scholar
  18. 18.
    Coleman EA, Coon S, Hall-Barrow J, Richards K, Gaylor D, Stewart B (2003) Feasibility of exercise during treatment for multiple myeloma. Cancer Nurs 26:410–419PubMedGoogle Scholar
  19. 19.
    Courneya KS, Friedenreich CM (1999) Physical exercise and quality of life following cancer diagnosis: a literature review. Ann Behav Med 21:171–179PubMedGoogle Scholar
  20. 20.
    Courneya KS, Keats MR, Turner AR (2000) Physical exercise and quality of life in cancer patients following high dose chemotherapy and autologous bone marrow transplantation. Psychooncology 9:127–136PubMedGoogle Scholar
  21. 21.
    Courneya KS (2003) Exercise in cancer survivors: an overview of research. Med Sci Sports Exerc 35:1846–852PubMedGoogle Scholar
  22. 22.
    Curt GA (2000) Impact of fatigue on quality of life in oncology patients. Semin Hematol 37(Suppl 6):14–17CrossRefPubMedGoogle Scholar
  23. 23.
    Dimeo FC, Stieglitz R-D, Novelli-Fischer U, Fetscher S, Keul J (1999) Effects of physical activity on the fatigue and psychologic status of cancer patients during chemotherapy. Cancer 85:2273–2277CrossRefPubMedGoogle Scholar
  24. 24.
    Dimeo F, Schwartz S, Fietz T, Wanjura T, Boning D, Thiel E (2003) Effects of endurance training on the physical performance of patients with hematological malignancies during chemotherapy. Support Care Cancer 11:623–628CrossRefPubMedGoogle Scholar
  25. 25.
    Dimeo FC (2001) Effects of exercise on cancer-related fatigue. Cancer 92(6 Suppl):1689–1693CrossRefPubMedGoogle Scholar
  26. 26.
    Durak EP, Lilly PC (1998) The application of an exercise and wellness program for cancer patients: a preliminary outcomes report. J Strength Cond Res 12:3–6CrossRefGoogle Scholar
  27. 27.
    Fentem PH (1994) ABC of sports medicine: benefits of exercise in health and disease. BMJ 308:1291–1295PubMedGoogle Scholar
  28. 28.
    Galvão DA, Newton RU (2005) Review of exercise intervention studies in cancer patients. J Clin Oncol 23:899–909CrossRefPubMedGoogle Scholar
  29. 29.
    Green S (1994) A definition and systems view of anaerobic capacity. Eur J Appl Physiol Occup Physiol 69:168–173CrossRefPubMedGoogle Scholar
  30. 30.
    Greene D, Nai LM, Fieler VK, Dudgeon D, Jones LS (1994) A comparison of patient-reported side effects among three chemotherapy regimens for breast cancer. Cancer Pract 2:57–62PubMedGoogle Scholar
  31. 31.
    Griffin AM, Butow PN, Coates AS, Childs AM, Ellis PM, Dunn SM, Tattersall MH (1996) On the receiving end. V. Patient perceptions of the side effects of cancer chemotherapy in 1993. Ann Oncol 7:189–195PubMedGoogle Scholar
  32. 32.
    Groenvold M, Klee MC, Sprangers MA, Aaronson NK (1997) Validation of the EORTC QLQ-C30 quality of life questionnaire through combined qualitative and quantitative assessment of patient–observer agreement. J Clin Epidemiol 50:441–450CrossRefPubMedGoogle Scholar
  33. 33.
    Irvine D, Vincent L, Graydon JE, Bubela N, Thompson L (1994) The prevalence and correlates of fatigue in patients receiving treatment with chemotherapy and radiotherapy. A comparison with the fatigue experienced by healthy individuals. Cancer Nurs 17:367–378PubMedGoogle Scholar
  34. 34.
    Klee M, Groenvold M, Machin D (1997) Quality of life of Danish women: population-based norms of the EORTC QLQ-C30. Qual Life Res 6:27–34CrossRefPubMedGoogle Scholar
  35. 35.
    Kolden GG, Strauman TJ, Ward A, Kuta J, Woods TE, Schneider KL, Heerey E, Sanborn L, Burt C, Millbrandt L, Kalin NH, Stewart JA, Mullen B (2002) A pilot study of group exercise training (GET) for women with primary breast cancer: feasibility and health benefits. Psychooncology 11:447–456PubMedGoogle Scholar
  36. 36.
    Lucia A, Earnest C, Perez M (2003) Cancer-related fatigue: can exercise physiology assist oncologists? Lancet Oncol 4:616–625CrossRefPubMedGoogle Scholar
  37. 37.
    Luebbert K, Dahme B, Hasenbring M (2001) The effectiveness of relaxation training in reducing treatment-related symptoms and improving emotional adjustment in acute non-surgical cancer treatment: a meta-analytical review. Psychooncology 10:490–502PubMedGoogle Scholar
  38. 38.
    Lyles JN, Burish TG, Krozely MG, Oldham RK (1982) Efficacy of relaxation training and guided imagery in reducing the aversiveness of cancer chemotherapy. J Consult Clin Psychol 50:509–524CrossRefPubMedGoogle Scholar
  39. 39.
    MacVicar MG, Winningham ML, Nickel JL (1989) Effects of aerobic interval training on cancer patients’ functional capacity. Nurs Res 38:348–351PubMedGoogle Scholar
  40. 40.
    Malterud K (2001) The art and science of clinical knowledge: evidence beyond measures and numbers. Lancet 358:397–400CrossRefPubMedGoogle Scholar
  41. 41.
    Michelson H, Bolund C, Nilsson B, Brandberg Y (2000) Health-related quality of life measured by the EORTC QLQ-C30-reference values from a large sample of Swedish population. Acta Oncol 39:477–484CrossRefPubMedGoogle Scholar
  42. 42.
    Mock V, Pickett M, Ropka ME, Muscari E, Stewart KJ, Rhodes VA, McDaniel R, Grimm PM, Krumm S, McCorkle R (2001) Fatigue and quality of life outcomes of exercise during cancer treatment. Cancer Pract 9:119–127CrossRefPubMedGoogle Scholar
  43. 43.
    Mock V, Frangakis C, Davidson NE, Ropka ME, Pickett M, Poniatowski B, Stewart KJ, Cameron L, Zawacki K, Podewils LJ, Cohen G, McCorkle R (2005) Exercise manages fatigue during breast cancer treatment: a randomized controlled trial. Psychooncology 14:464–477PubMedGoogle Scholar
  44. 44.
    Molassiotis A, Yung HP, Yam BMC, Chan FYS, Mok TSK (2002) The effectiveness of progressive muscle relaxation training in managing chemotherapy-induced nausea and vomiting in Chinese breast cancer patients: a randomised controlled trial. Support Care Cancer 10:237–246CrossRefPubMedGoogle Scholar
  45. 45.
    Nail LM, Jones LS (1995) Fatigue as a side effect of cancer treatment: impact on quality of life. Qual Life—A Nursing Challenge 4:8–13Google Scholar
  46. 46.
    Pensgaard AM, Ursin H (1998) Stress, control, and coping in elite athletes. Scand J Med Sci Sports 8:183–189PubMedGoogle Scholar
  47. 47.
    Pinto BM, Eakin E, Maruyama NC (2000) Health behavior changes after a cancer diagnosis: what do we know and where do we go from here? Ann Behav Med 22:38–52PubMedGoogle Scholar
  48. 48.
    Polit DF, Beck CT (2003) Nursing research: principles and methods, 7th edn. Lippincott Williams & Wilkins, PhiladelphiaGoogle Scholar
  49. 49.
    Saltin B, Gollnick PD (1983) Skeletal muscle adaptability: significance for metabolism and performance. In: Peachey LD, Adrian PH, Geiger SR (eds) Handbook of physiology—skeletal muscle, American Physiological Society, Washington, DC, pp 555–631Google Scholar
  50. 50.
    Schwartz AL (1999) Fatigue mediates the effects of exercise on quality of life. Qual Life Res 8:529–538CrossRefPubMedGoogle Scholar
  51. 51.
    Schwartz AL, Mori M, Gao R, Nail LM, King ME (2001) Exercise reduces daily fatigue in women with breast cancer receiving chemotherapy. Med Sci Sports Exerc 33:718–723CrossRefPubMedGoogle Scholar
  52. 52.
    Segal R, Evans W, Johnson D, Smith J, Colletta S, Gayton J, Woodard S, Wells G, Reid R (2001) Structured exercise improves physical functioning in women with stages I and II breast cancer: results of a randomized controlled trial. J Clin Oncol 19:657–665PubMedGoogle Scholar
  53. 53.
    Sloman R, Brown P, Aldana E, Chee E (1994) The use of relaxation for the promotion of comfort and pain relief in persons with advanced cancer. Contemp Nurse 3:6–12PubMedGoogle Scholar
  54. 54.
    Sloman R (1995) Relaxation and the relief of cancer pain. Nurs Clin North Am 30:697–709PubMedGoogle Scholar
  55. 55.
    Smets EM, Garssen B, Schuster-Uitterhoeve AL, de Haes JC (1993) Fatigue in cancer patients. Br J Cancer 68:220–224PubMedGoogle Scholar
  56. 56.
    Stricker CT, Drake D, Hoyer K-A, Mock V (2004) Evidence-based practice for fatigue management in adults with cancer: exercise as an intervention. Oncol Nurs Forum 31:963–976PubMedGoogle Scholar
  57. 57.
    Syrjala KL, Donaldson GW, Davis MW, Kippes ME, Carr JE (1995) Relaxation and imagery and cognitive-behavioral training reduce pain during cancer treatment: a controlled clinical trial. Pain 63:189–198CrossRefPubMedGoogle Scholar
  58. 58.
    Troesch LM, Rodehaver CB, Delaney EA, Yanes B (1993) The influence of guided imagery on chemotherapy-related nausea and vomiting. Oncol Nurs Forum 20:1179–1185PubMedGoogle Scholar
  59. 59.
    Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36) I: conceptual framework and item selection. Med Care 30:473–483PubMedGoogle Scholar
  60. 60.
    Weinrich SP, Weinrich MC (1990) The effect of massage on pain in cancer patients. Appl Nurs Res 3:140–145PubMedGoogle Scholar
  61. 61.
    Winningham ML, MacVicar MG, Burke CA (1986) Exercise for cancer patients: guidelines and precautions. Phys Sportsmed 14:125–134Google Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Lis Adamsen
    • 1
  • Morten Quist
    • 1
  • Julie Midtgaard
    • 1
  • Christina Andersen
    • 2
  • Tom Møller
    • 3
  • Lasse Knutsen
    • 1
  • Anders Tveterås
    • 1
  • Mikael Rorth
    • 2
  1. 1.The University Hospitals Centre for Nursing and Care Research, Department 7331The University Hospital of CopenhagenCopenhagenDenmark
  2. 2.Department of Oncology, Department 5073The University Hospital of CopenhagenCopenhagenDenmark
  3. 3.Department of Hematology, Department 4042The University Hospital of CopenhagenCopenhagenDenmark

Personalised recommendations