Journal of Cancer Survivorship

, Volume 7, Issue 4, pp 551–562 | Cite as

Feasibility and efficacy of a supervised exercise intervention in de-conditioned cancer survivors during the early survivorship phase: the PEACH trial

  • J. M. BroderickEmail author
  • E. Guinan
  • M. J. Kennedy
  • D. Hollywood
  • K. S. Courneya
  • S. N. Culos-Reed
  • K. Bennett
  • D. M. O’ Donnell
  • J. Hussey



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.


Quality of life Physical activity Fitness Fatigue Feasibility study Randomised controlled trial 



We would like to acknowledge Professor Donal Hollywood, one of the co-authors of this work who has passed away recently, sadly missed by his colleagues.

Funding information

This study was funded by the Health Research Board, Ireland


  1. 1.
    Das P, Horton R. Rethinking our approach to physical activity. Lancet. 2012;380(9838):189–90. doi: 10.1016/s0140-6736(12)61024-1.PubMedCrossRefGoogle Scholar
  2. 2.
    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.PubMedCrossRefGoogle Scholar
  3. 3.
    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.PubMedCrossRefGoogle Scholar
  4. 4.
    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.PubMedCrossRefGoogle Scholar
  5. 5.
    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.PubMedCrossRefGoogle Scholar
  6. 6.
    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.PubMedCrossRefGoogle Scholar
  7. 7.
    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.PubMedCrossRefGoogle Scholar
  8. 8.
    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.PubMedCrossRefGoogle Scholar
  9. 9.
    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.PubMedCrossRefGoogle Scholar
  10. 10.
    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.PubMedCrossRefGoogle Scholar
  11. 11.
    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.PubMedCrossRefGoogle Scholar
  12. 12.
    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.PubMedCrossRefGoogle Scholar
  13. 13.
    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.CrossRefGoogle Scholar
  14. 14.
    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.PubMedCrossRefGoogle Scholar
  15. 15.
    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.PubMedCrossRefGoogle Scholar
  16. 16.
    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.PubMedCrossRefGoogle Scholar
  17. 17.
    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.PubMedCrossRefGoogle Scholar
  18. 18.
    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.PubMedCrossRefGoogle Scholar
  19. 19.
    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.PubMedCrossRefGoogle Scholar
  20. 20.
    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.PubMedCrossRefGoogle Scholar
  21. 21.
    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.CrossRefGoogle Scholar
  22. 22.
    Jones L, Courneya KS. Exercise counseling and programming preferences of cancer survivors. Cancer Pract. 2002;10:208–15.PubMedCrossRefGoogle Scholar
  23. 23.
    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.PubMedCrossRefGoogle Scholar
  24. 24.
    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.PubMedCrossRefGoogle Scholar
  25. 25.
    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.PubMedCrossRefGoogle Scholar
  26. 26.
    Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14(5):377–81.PubMedCrossRefGoogle Scholar
  27. 27.
    Ajzen I. The theory of planned behaviour. Organ Behav Hum Decis Process. 1991;50:179–211.CrossRefGoogle Scholar
  28. 28.
    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.PubMedCrossRefGoogle Scholar
  29. 29.
    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.PubMedCrossRefGoogle Scholar
  30. 30.
    Glass S, Dwyer G. ACSM’s metabolic calculations handbook. 1st ed. Baltimore: Lippincott Williams and Wilkins; 2006.Google Scholar
  31. 31.
    McArdle WD, Katch FI, Katch FI. Essentials of exercise physiology. 4th ed: Lippincott Williams and Wilkins; 2010.Google Scholar
  32. 32.
    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.PubMedGoogle Scholar
  33. 33.
    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.PubMedCrossRefGoogle Scholar
  34. 34.
    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.PubMedGoogle Scholar
  35. 35.
    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.Google Scholar
  36. 36.
    Ware JE, Kosinski M, Dewey JE. How to score Version Two of the SF-36 Health Survey. Lincoln: Quality Metric; 2000.Google Scholar
  37. 37.
    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.PubMedCrossRefGoogle Scholar
  38. 38.
    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.PubMedCrossRefGoogle Scholar
  39. 39.
    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.PubMedCrossRefGoogle Scholar
  40. 40.
    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.PubMedCrossRefGoogle Scholar
  41. 41.
    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.PubMedCrossRefGoogle Scholar
  42. 42.
    Godin G, Shephard RJ. A simple method to assess exercise behaviour in the community. Can J Appl Sports Sci. 1985;10:141–6.Google Scholar
  43. 43.
    Godin G, Shephard RJ. Godin Leisure-Time Exercise Questionnaire. Med Sci Sports Exerc. 1997;29 June Supplement:S36–S8.Google Scholar
  44. 44.
    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.PubMedCrossRefGoogle Scholar
  45. 45.
    Stevinson C, Lawlor DA, Fox KR. Exercise interventions for cancer patients: systematic review of controlled trials. Cancer Causes Control. 2004;15(10):1035–56.PubMedCrossRefGoogle Scholar
  46. 46.
    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.PubMedCrossRefGoogle Scholar
  47. 47.
    Courneya KS, Friedenreich CM. Physical activity and cancer control. Semin Oncol. 2007;23(4):242–52.CrossRefGoogle Scholar
  48. 48.
    Myers J, Prakash M, Froelicher V. Exercise capacity and mortality among men referred for exercise testing. N Engl J Med. 2002;346:793–801.PubMedCrossRefGoogle Scholar
  49. 49.
    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.PubMedCrossRefGoogle Scholar
  50. 50.
    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.PubMedCrossRefGoogle Scholar
  51. 51.
    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.CrossRefGoogle Scholar
  52. 52.
    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.PubMedCrossRefGoogle Scholar
  53. 53.
    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.PubMedCrossRefGoogle Scholar
  54. 54.
    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.PubMedCrossRefGoogle Scholar
  55. 55.
    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.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • J. M. Broderick
    • 1
    Email author
  • E. Guinan
    • 1
  • M. J. Kennedy
    • 2
  • D. Hollywood
    • 3
  • K. S. Courneya
    • 4
  • S. N. Culos-Reed
    • 5
  • K. Bennett
    • 6
  • D. M. O’ Donnell
    • 2
  • J. Hussey
    • 1
  1. 1.School of Medicine, Trinity Centre for Health ScienceSt. James’s HospitalDublin 8Ireland
  2. 2.Academic Unit of Clinical and Medical OncologySt. James’s HospitalDublin 8Ireland
  3. 3.Prostate Molecular Oncology, Dept. of Clinical MedicineTrinity College DublinDublinIreland
  4. 4.Faculty of Physical Education and RecreationUniversity of AlbertaEdmontonCanada
  5. 5.Faculty of KinesiologyUniversity of CalgaryCalgaryCanada
  6. 6.Department of Pharmacology and Therapeutics, Trinity Centre for Health ScienceSt. James’s HospitalDublin 8Ireland

Personalised recommendations