Exercise Programme Improves Physical Performance And Reduces Fatigue In Cancer Patients After Treatment

Main Category: Cancer / Oncology
Also Included In: Sports Medicine / Fitness;  Clinical Trials / Drug Trials
Article Date: 29 Apr 2008 - 1:00 PDT

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A three-week programme of walking and muscle strengthening exercise significantly improved physical functioning and reduced fatigue in people with a range of cancers and persistent fatigue, a study has shown.

More than two-thirds (70%) of cancer patients have fatigue during chemotherapy and radiotherapy or after surgery. The problem can last for a long time, continuing for months after treatment, even in patients in complete remission from their cancer.

People with cancer report a combination of fatigue symptoms, including being unable to carry out physical exertion, tiredness, lack of interest or motivation and impaired short-term memory, attention or concentration. These problems are often accompanied by sleep disturbance, anxiety and feeling more emotional than usual. Fatigue can severely limit people's ability to work or perform daily activities, which can greatly reduce their quality of life.

Patients suffering fatigue are currently often advised to rest and reduce their activities. But inactivity causes muscle tissue to break down, which can perpetuate fatigue. Several studies have suggested that exercise might improve the functional status of cancer patients undergoing chemo- or radiotherapy, but there has been little research on the impact on fatigue.

So researchers studied a consecutive series of 32 cancer patients, with a range of solid or haematological tumours, who consulted the department of haematology, oncology and transfusion medicine at the Charité Universitätsmedizin Berlin, Germany, with mild to severe, persistent fatigue. They all scored more than 25 on a scale of fatigue, the Brief Fatigue Inventory, which asks 10 questions about activities, ability to walk, mood and work. Previous studies have shown that scores of 25-30 on this inventory indicate mild fatigue; 31-60 equates to moderate fatigue and someone with severe fatigue scores over 60.

The patients carried out a carefully planned, three-week programme of endurance training. This included walking on a treadmill at an intensity tailored for each individual to achieve a heart rate of around 80% of that occurring during maximal effort for three minutes, followed by three minutes at half-speed to recover, repeated for a total of 30 minutes. They also took part in resistance training with a series of exercise using their own body weight, rubber bands and dumbbells, designed to increase the strength of their arms, legs and lower back.

The patients worked out on an average of 10 days during the three weeks of the study. None of them suffered complications and none dropped out.

Results showed a significant improvement in the patients' physical performance after the three-week exercise programme. Their average exercise capacity increased by 28% (from a starting workload of 61 watts to 78 watts after the programme; p<0.0001). Their fatigue scores fell by 25% (from an average of 38 on the Brief Fatigue Inventory before exercising, to 31 afterwards; p=0.0007). Other scoring systems also showed a reduction in mental and physical fatigue, but no improvement in cognitive fatigue. Depression and anxiety scores were unchanged.

The researchers cautioned that factors other than exercise might have improved the patients' fatigue. The increased social contact, motivation and expectations associated with taking part in the study could have improved their energy levels. The study had no control group - a matched group of patients not taking exercise - so could not rule this out. However, the patients' physical performance improved but not their cognitive fatigue, anxiety or depression, which might be expected to be more improved by social contact, indicating that the benefits seen were likely to be due to exercise.

The researchers concluded: "The results of the study show that exercise is a promising and effective therapeutic approach to persistent cancer-related fatigue. A three-week exercise program leads to a substantial improvement of physical performance and reduction of mental and physical fatigue in cancer patients after treatment."

Reference

Dimeo F, Schwartz S, Wesel N, Voigt A, Thiel, E. Effects of an endurance and resistance exercise program on persistent cancer-related fatigue after treatment. Annals of Oncology Advance Access. April 1, 2008. doi:10.1093/annonc/mdn068

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