Abstract
Cancer patients frequently experience considerable loss of physical capacity and general wellbeing when diagnosed and treated for their disease. The aim of this study was to evaluate the feasibility, physical capacity, and health benefits of a multidimensional exercise program for cancer patients during advanced stages of disease who are undergoing adjuvant or high-dose chemotherapy. The supervised program included high- and low-intensity activities (physical exercise, relaxation, massage, and body-awareness training). A total of 23 patients between 18 and 65 years of age (median 40 years) participated in groups of seven to nine patients for 9 h weekly for 6 weeks. Physical capacity in terms of repetition maximum (RM) and maximal oxygen uptake (VO2max), physical activity level and psychosocial wellbeing (EORTC QLQ-C30, SF-36, HAD) were compared prior to and after completion of the program. The program was safe and well tolerated. The completion rate was 85.2%. Highly significant increases in physical capacity (1RM, VO2max) and an improved level of physical activity were achieved. Quality of life and general wellbeing assessments indicated improvements in several measures, but without reaching significance. It is concluded that an exercise program, which combines high- and low-intensity physical activities, may be used to prevent and/or minimize physical inactivity, fatigue, muscle wasting and energy loss in cancer patients undergoing chemotherapy.
Similar content being viewed by others
References
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 85:365–376
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 16:224–231
Adamsen L, Rasmussen JM (2003) Exploring and encouraging through social interaction: a qualitative study of nurses' participation in self-help groups for cancer patients. Cancer Nurs 26:28–36
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 10:528–537
Andersen LB (1995) A maximal cycle exercise protocol to predict maximal oxygen uptake. Scand J Med Sci Sports 5:143–146
Arakawa S (1997) Relaxation to reduce nausea, vomiting, and anxiety induced by chemotherapy in Japanese patients. Cancer Nurs 20:342–349
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 95:1134–1143
Baum A, Andersen BL (2001) Introduction. In: Baum A, Andersen BL (eds) Psychosocial interventions for cancer. American Psychological Association, Washington DC, pp 3–15
Benson H, Klipper MZ (1992) The relaxation response. Wings Books, New York
Berglund G, Bolund C, Gustavsson UL, Sjödén PO (1993) Starting again: a comparison study of a group rehabilitation program for cancer patients. Acta Oncol 32:15–21
Berglund G, Bolund C, Gustafsson UL, Sjödén PO (1994) A randomized study of a rehabilitation program for cancer patients: the 'Starting Again' Group. Psychooncology 3:109–120
Bjørner JB, Damsgaard MT, Watt T, Grønvold M (1998) Tests of data quality, scaling assumptions, and reliability of the Danish SF-36. J Clin Epidemiol 51:1001–1011
Blanchard CM, Courneya KS, Laing D (2001) Effects of acute exercise on state anxiety in breast cancer survivors. Oncol Nurs Forum 28:1617–1621
Bridge LR, Benson P, Pietroni PC, Priest RG (1988) Relaxation and imagery in the treatment of breast cancer. BMJ 297:1169–1172
Brzycki M (1993) Strength testing: predicting a one-rep max from a reps-to-fatigue. J Phys Educ Recreation Dance 64:88–90
Bunkan BH, Schultz CM (1998) Medisinsk massasje/Medical massage, 2nd edn. Universitetsforlaget, Oslo
Burish TG, Jenkins RA (1992) Effectiveness of biofeedback and relaxation training in reducing the side effects of cancer chemotherapy. Health Psychol 11:17–23
Carroll BT, Kathol RG, Noyes R, Wald TG, Clamon GH (1993) Screening for depression and anxiety in cancer patients using the Hospital Anxiety and Depression Scale. Gen Hosp Psychiatry 15:69–74
Courneya KS, Friedenreich CM (1999) Physical exercise and quality of life following cancer diagnosis: a literature review. Ann Behav Med 21:171–179
Courneya KS, Keats MR, Turner AR (2000) Social cognitive determinants of hospital-based exercise in cancer patients following high-dose chemotherapy and bone marrow transplantation. Int J Behav Med 7:189–203
Danish National Board of Health (2001) Fysisk aktivitet og sundhed: en litteraturgennemgang/Physical activity and health: a literature review, 1st edn. Danish National Board of Health, Copenhagen
Decker WA, Turner-McGlade J, Fehir KM (1989) Psychosocial aspects and the physiological effects of a cardiopulmonary exercise program in patients undergoing bone marrow transplantation (BMT) for acute leukemia (AL). Transplant Proc 21(1 part 3):3068–3069
Diemo FC (2001) Effects of exercise on cancer-related fatigue. Cancer 92 [Suppl 6]:1689–1693
Dimeo F, Bertz H, Finke J, Fetscher S, Mertelsmann R, Keul J (1996) An aerobic exercise program for patients with haematological malignancies after bone marrow transplantation. Bone Marrow Transplant 18:1157–1160
Dimeo FC, Tilmann MH, Bertz H, Kanz L, Mertelsmann R, Keul J (1997) Aerobic exercise in the rehabilitation of cancer patients after high dose chemotherapy and autologous peripheral stem cell transplantation. Cancer 79:1717–1722
Dimeo FC, Stieglitz RD, Novelli-Fischer U, Fetscher S, Keul J (1999) Effects of physical activity on the fatigue and psychological status of cancer patients during chemotherapy. Cancer 85:2273–2277
Dombernowsky P, Hansen HH, Hansen M, Hansen MM, Hansen NE, Mouridsen H, Rorth M (1997) Medicinsk behandling af kraeftsygdomme/Clinical treatment of cancer. Ugeskr Laeger 159 [Suppl 3]:1–14
Durak EP, Lilly PC (1998) The application of an exercise and wellness program for cancer patients: a preliminary outcomes report. J Strength Cond Res 12:3–6
Dychtwald K (1977) Bodymind, 1st edn. Pantheon Books, New York
Fentem PH (1994) ABC of sports medicine: benefits of exercise in health and disease (review). BMJ 308:1291–1295
Ferrell-Torry AT, Glick OJ (1993) The use of therapeutic massage as a nursing intervention to modify anxiety and the perception of cancer pain. Cancer Nurs 16:93–101
Goleman D, Gurin J (1993) Mind, body medicine: how to use your mind for better health. Consumer Reports Books, Yonkers, NY
Grealish L, Lomasney A, Whiteman B (2000) Foot massage: a nursing intervention to modify the distressing symptoms of pain and nausea in patients hospitalized with cancer. Cancer Nurs 23:237–243
Green S (1994) A definition and systems view of anaerobic capacity. Eur J Appl Physiol Occup Physiol 69:168–173
Grimby G, Wilhelmsen L, Björntorp P, Saltin B, Tibblin G (1971) Habitual physical activity: aerobic power and blood lipids, plasma lipoprotein and physical activity: a review. In: Pernow B, Saltin B (eds) Muscle metabolism during exercise: proceedings of a Karolinska Institutet symposium held in Stockholm, Sweden, 6–9 September 1970. Plenum Press, New York, pp 469–481
Grønvold M, Klee M, Sprangers MAG, 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 50:441–450
Hansen HH, Nissen N (eds) (1986) Medicinsk onkologi/Medical Oncology. FADL, Copenhagen
Hardy L, Jones G, Gauld D (1999) Understanding psychological preparation for sport: theory and practice of elite performers. Wiley, Chichester
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 17:367–378
Jacobson E (1929) Progressive relaxation: a physiological and clinical investigation of muscular states and their significance in psychology and medical practice. The University of Chicago Press, Chicago
Johnston M, Pollard B, Hennessey P (2000) Construct validation of the hospital anxiety and depression scale with clinical populations. J Psychosom Res 48:579–584
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 11:447–456
Lerman C, Rimer B, Blumberg B, Cristinzio S, Engstrom PF, MacElwee N, O'Connor K, Seay J (1990) Effects of coping style and relaxation on cancer chemotherapy side effects and emotional responses. Cancer Nurs 13:308–315
Lloyd-Williams M, Friedman T, Rudd N (2001) An analysis of the validity of the hospital anxiety and depression scale as a screening tool in patients with advanced metastatic cancer. J Pain Symptom Manage 22:990–996
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 50:509–524
McHorney CA, Kosinski M, Ware JE Jr (1994) Comparisons of the costs and quality of norms for the SF-36 health survey collected by mail versus telephone interview: results from a national survey. Med Care 32:551–567
MacVicar MG, Winningham ML (1986) Promoting the functional capacity of cancer. Cancer Bull 38:235–239
MacVicar MG, Winningham ML, Nickel JL (1989) Effects of aerobic interval training on cancer patients' functional capacity. Nurs Res 38:348–351
Mock V, Burke MB, Sheehan P, Creaton EM, Winningham ML, McKenney-Tedder S, Schwager LP, Liebman M (1994) A nursing rehabilitation program for women with breast cancer receiving adjuvant chemotherapy. Oncol Nurs Forum 21:899–907
Moorey S, Greer S, Watson M, Gorman C, Rowden L, Tunmore R, Robertson B, Bliss J (1991) The factor structure and factor stability of the hospital anxiety and depression scale in patients with cancer. Br J Psychiatry 158:255–259
Nieman DC, Cook VD, Henson DA, Suttles J, Rejeski WJ, Ribisl PM, Fagoaga OR, Nehlsen-Cannarella SL (1995) Moderate exercise training and natural killer cell cytotoxic activity in breast cancer patients. Int J Sports Med 16:334–337
Nissen NI, Hansen HH (1999) Medicinsk onkologi/Medical oncology. In: Lorentzen I, Bendixen G, Hansen NE (eds) Medicinsk kompendium/Medical compendium, 15th edn. Nyt Nordisk Forlag, Copenhagen, pp 1941–1960
Pensgaard AM, Ursin H (1998) Stress, control, and coping in elite athletes. Scand J Med Sci Sports 8:183–189
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? (review). Ann Behav Med 22:38–52
Sabo CE, Michael SR (1996) The influence of personal message with music on anxiety and side effects associated with chemotherapy. Cancer Nurs 19:283–289
Sale D, MacDougall D (1981) Specificity in strength training: a review for the coach and athlete (review). Can J Appl Sport Sci 6:87–92
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 555–631
Saltin B, Grimby G (1968) Physiological analysis of middle-aged and old former athletes. Comparison with still active athletes of the same ages. Circulation 38:1104–1115
Saltin B, Pilegaard H (2002) Metabolisk fitness: fysisk aktivitet og sundhed/Metabolic fitness: physical activity and health (review). Ugeskr Laeger 164:2156–2162
Schwartz AL (1999) Fatigue mediates the effects of exercise on quality of life. Qual Life Res 8:529–538
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 19:657–665
Seifert E, Ewert S, Werle J (1992) Bewegungs- und Sporttherapie fur Patienten mit Kopf-Hals-Tumoren/Exercise and sports therapy for patients with head and neck tumors. Rehabilitation (Stuttg) 31:33–37
Sloman R (1995) Relaxation and the relief of cancer pain. Nurs Clin North Am 30:697–709
Smets EM, Garssen B, Schuster-Uitterhoeve AL, de Haes JC (1993) Fatigue in cancer patients (review). Br J Cancer 68:220–224
Troesch LM, Rodehaver CB, Delaney EA, Yanes B (1993) The influence of guided imagery on chemotherapy-related nausea and vomiting. Oncol Nurs Forum 20:1179–1185
Uneståhl L-E (1986) Ideal performance. In: Uneståhl LE (ed) Sport psychology in theory and practice. Veje, Örebro, pp 21–38
Vinsløv K, Vinggård R, Kopp K (1991) Kvalme og opkastning/Nausea and vomiting. Sygeplejersken 91(36):10–13
Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36) I: conceptual framework and item selection. Med Care 30:473–483
Weinrich SP, Weinrich MC (1990) The effect of massage on pain in cancer patients. Appl Nurs Res 3:140–145
Winningham ML (1983) Effects of a bicycle ergometry program on functional capacity and feelings of control in women with breast cancer (dissertation). The Ohio State University, Columbus
Winningham ML, MacVicar MG (1988) The effect of aerobic exercise on patient reports of nausea. Oncol Nurs Forum 15:447–450
Winningham ML, MacVicar MG, Burke BS (1986) Exercise for cancer patients: guidelines and precautions. Phys Sportsmed 14:125–134
Winningham ML, MacVicar MG, Bondoc M, Anderson JI, Minton JP (1989) Effect of aerobic exercise on body weight and composition in patients with breast cancer on adjuvant chemotherapy. Oncol Nurs Forum 16:683–689
World Health Organization (1994) ICD-10: international statistical classification of diseases and related health problems: tenth revision. World Health Organization, Geneva
Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370
Acknowledgements
This research was supported by grants from the Danish Medical Research Council, Ministry of Culture's Media and Grants Secretariat, the Egmont Foundation, the Lundbeck Foundation and the Copenhagen Hospital Corporation.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Adamsen, L., Midtgaard, J., Rorth, M. et al. Feasibility, physical capacity, and health benefits of a multidimensional exercise program for cancer patients undergoing chemotherapy. Support Care Cancer 11, 707–716 (2003). https://doi.org/10.1007/s00520-003-0504-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00520-003-0504-2