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Published in: BMC Medicine 1/2018

Open Access 01-12-2018 | Research article

Four-year effects of exercise on fatigue and physical activity in patients with cancer

Authors: Lenja Witlox, Anouk E. Hiensch, Miranda J. Velthuis, Charlotte N. Steins Bisschop, Maartje Los, Frans L. G. Erdkamp, Haiko J. Bloemendal, Marlies Verhaar, Daan ten Bokkel Huinink, Elsken van der Wall, Petra H. M. Peeters, Anne M. May

Published in: BMC Medicine | Issue 1/2018

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Abstract

Background

In the earlier randomized controlled Physical Activity during Cancer Treatment (PACT) study, we found beneficial effects of an 18-week supervised exercise program on fatigue in patients with newly diagnosed breast or colon cancer undergoing adjuvant treatment. The present study assessed long-term effects of the exercise program on levels of fatigue and physical activity 4 years after participation in the PACT study.

Methods

The original study was a two-armed, multicenter randomized controlled trial comparing an 18-week supervised exercise program to usual care among 204 breast cancer patients and 33 colon cancer patients undergoing adjuvant treatment. Of the 237 PACT participants, 197 participants were eligible and approached to participate in the 4-year post-baseline measurements, and 128 patients responded. We assessed fatigue and physical activity levels at 4 years post-baseline and compared this to levels at baseline, post-intervention (18 weeks post-baseline), and at 36 weeks post-baseline.

Results

Intention-to-treat mixed linear effects model analyses showed that cancer patients in the intervention group reported significantly higher moderate-to-vigorous total physical activity levels (141.46 min/week (95% confidence interval (CI) 1.31, 281.61, effect size (ES) = 0.22) after 4 years compared to the usual care group. Furthermore, cancer patients in the intervention group tended to experience less physical fatigue at 4 years post-baseline compared to the usual care group (− 1.13, 95% CI –2.45, 0.20, ES = 0.22), although the result was not statistically significant.

Conclusion

Patients with breast or colon cancer who participated in the 18-week exercise intervention showed significant higher levels of moderate-to-vigorous total physical activity levels and a tendency towards lower physical fatigue levels 4 years post-baseline. Our result indicate that exercising during chemotherapy is a promising strategy for minimizing treatment-related side effects, both short and long term.

Trial registration

Current Controlled Trials ISRCTN43801571, Dutch Trial Register NTR2138. Trial registered on 9 December 2009.
Literature
1.
go back to reference Cleeland CS, Zhao F, Chang VT, Sloan JA, O’Mara AM, Gilman PB, et al. The symptom burden of cancer: evidence for a core set of cancer-related and treatment-related symptoms from the Eastern Cooperative Oncology Group Symptom Outcomes and Practice Patterns study. Cancer. 2013;119(24):4333–40.CrossRefPubMed Cleeland CS, Zhao F, Chang VT, Sloan JA, O’Mara AM, Gilman PB, et al. The symptom burden of cancer: evidence for a core set of cancer-related and treatment-related symptoms from the Eastern Cooperative Oncology Group Symptom Outcomes and Practice Patterns study. Cancer. 2013;119(24):4333–40.CrossRefPubMed
3.
go back to reference Bower J, Ganz P, Desmond K, Rowland J, Meyerowitz B, Belin T, et al. Fatigue in breast cancer survivors: occurrence, correlates, and impact on quality of life. J Clin Oncol. 2000;18(4):743–53.CrossRefPubMed Bower J, Ganz P, Desmond K, Rowland J, Meyerowitz B, Belin T, et al. Fatigue in breast cancer survivors: occurrence, correlates, and impact on quality of life. J Clin Oncol. 2000;18(4):743–53.CrossRefPubMed
4.
go back to reference Furmaniak A, Menig M, Markes M. Exercise for women receiving adjuvant therapy for breast cancer. Cochrane Database Syst Rev. 2016;9:CD005001.PubMed Furmaniak A, Menig M, Markes M. Exercise for women receiving adjuvant therapy for breast cancer. Cochrane Database Syst Rev. 2016;9:CD005001.PubMed
5.
go back to reference Van Vulpen JK, Peeters PHM, Velthuis MJ, Van Der Wall E, May AM. Effects of physical exercise during adjuvant breast cancer treatment on physical and psychosocial dimensions of cancer-related fatigue: a meta-analysis. Maturitas. 2016;85:104–11.CrossRefPubMed Van Vulpen JK, Peeters PHM, Velthuis MJ, Van Der Wall E, May AM. Effects of physical exercise during adjuvant breast cancer treatment on physical and psychosocial dimensions of cancer-related fatigue: a meta-analysis. Maturitas. 2016;85:104–11.CrossRefPubMed
6.
go back to reference Travier N, Velthuis MJ, Steins Bisschop CN, van den Buijs B, Monninkhof EM, Backx F, et al. Effects of an 18-week exercise programme started early during breast cancer treatment: a randomised controlled trial. BMC Med. 2015;13:121.CrossRefPubMedPubMedCentral Travier N, Velthuis MJ, Steins Bisschop CN, van den Buijs B, Monninkhof EM, Backx F, et al. Effects of an 18-week exercise programme started early during breast cancer treatment: a randomised controlled trial. BMC Med. 2015;13:121.CrossRefPubMedPubMedCentral
7.
go back to reference Van Vulpen JK, Velthuis MJ, Bisschop CNS, Travier N, Van Den Buijs BJW, Backx FJG, et al. Effects of an exercise program in colon cancer patients undergoing chemotherapy. Med Sci Sports Exerc. 2016;48(5):767–75.CrossRefPubMed Van Vulpen JK, Velthuis MJ, Bisschop CNS, Travier N, Van Den Buijs BJW, Backx FJG, et al. Effects of an exercise program in colon cancer patients undergoing chemotherapy. Med Sci Sports Exerc. 2016;48(5):767–75.CrossRefPubMed
8.
go back to reference Bandura A. Social foundations of thought and action: a social cognitive theory. Englewood Cliffs: Prentice-Hall; 1986. Bandura A. Social foundations of thought and action: a social cognitive theory. Englewood Cliffs: Prentice-Hall; 1986.
9.
go back to reference Juvet LK, Thune I, Elvsaas IKØ, Fors EA, Lundgren S, Bertheussen G, et al. The effect of exercise on fatigue and physical functioning in breast cancer patients during and after treatment and at 6 months follow-up: a meta-analysis. Breast. 2017;33:166–77.CrossRefPubMed Juvet LK, Thune I, Elvsaas IKØ, Fors EA, Lundgren S, Bertheussen G, et al. The effect of exercise on fatigue and physical functioning in breast cancer patients during and after treatment and at 6 months follow-up: a meta-analysis. Breast. 2017;33:166–77.CrossRefPubMed
10.
go back to reference Miller KD, Siegel RL, Lin CC, Mariotto AB, Kramer JL, Rowland JH, et al. Cancer treatment and survivorship statistics, 2016. CA Cancer J Clin. 2016;66(4):271–89.CrossRefPubMed Miller KD, Siegel RL, Lin CC, Mariotto AB, Kramer JL, Rowland JH, et al. Cancer treatment and survivorship statistics, 2016. CA Cancer J Clin. 2016;66(4):271–89.CrossRefPubMed
11.
go back to reference Van Waart H, Stuiver MM, Van Harten WH, Geleijn E, Kieffer JM, Buffart LM, et al. Effect of low-intensity physical activity and moderate- to high-intensity physical exercise during adjuvant chemotherapy on physical fitness, fatigue, and chemotherapy completion rates: results of the PACES randomized clinical trial. J Clin Oncol. 2015;33(17):1918–27.CrossRefPubMed Van Waart H, Stuiver MM, Van Harten WH, Geleijn E, Kieffer JM, Buffart LM, et al. Effect of low-intensity physical activity and moderate- to high-intensity physical exercise during adjuvant chemotherapy on physical fitness, fatigue, and chemotherapy completion rates: results of the PACES randomized clinical trial. J Clin Oncol. 2015;33(17):1918–27.CrossRefPubMed
12.
go back to reference Courneya KS, Segal RJ, Gelmon K, Reid RD, Mackey JR, Friedenreich CM, et al. Six-month follow-up of patient-rated outcomes in a randomized controlled trial of exercise training during breast cancer chemotherapy. Cancer Epidemiol Biomark Prev. 2007;16(12):2572–8.CrossRef Courneya KS, Segal RJ, Gelmon K, Reid RD, Mackey JR, Friedenreich CM, et al. Six-month follow-up of patient-rated outcomes in a randomized controlled trial of exercise training during breast cancer chemotherapy. Cancer Epidemiol Biomark Prev. 2007;16(12):2572–8.CrossRef
13.
go back to reference Mutrie N, Campbell AM, Whyte F, McConnachie A, Emslie C, Lee L, et al. Benefits of supervised group exercise programme for women being treated for early stage breast cancer: pragmatic randomised controlled trial. BMJ. 2007;334(7592):517.CrossRefPubMedPubMedCentral Mutrie N, Campbell AM, Whyte F, McConnachie A, Emslie C, Lee L, et al. Benefits of supervised group exercise programme for women being treated for early stage breast cancer: pragmatic randomised controlled trial. BMJ. 2007;334(7592):517.CrossRefPubMedPubMedCentral
14.
go back to reference Mutrie N, Campbell A, Barry S, Hefferon K, McConnachie A, Ritchie D, et al. Five-year follow-up of participants in a randomised controlled trial showing benefits from exercise for breast cancer survivors during adjuvant treatment. Are there lasting effects? J Cancer Surviv. 2012;6(4):420–30.CrossRefPubMedPubMedCentral Mutrie N, Campbell A, Barry S, Hefferon K, McConnachie A, Ritchie D, et al. Five-year follow-up of participants in a randomised controlled trial showing benefits from exercise for breast cancer survivors during adjuvant treatment. Are there lasting effects? J Cancer Surviv. 2012;6(4):420–30.CrossRefPubMedPubMedCentral
16.
go back to reference Velthuis MJ, May AM, Koppejan-Rensenbrink RA, Gijsen BCM, van Breda E, de Wit GA, et al. Physical Activity during Cancer Treatment (PACT) Study: design of a randomised clinical trial. BMC Cancer. 2010;10:272.CrossRefPubMedPubMedCentral Velthuis MJ, May AM, Koppejan-Rensenbrink RA, Gijsen BCM, van Breda E, de Wit GA, et al. Physical Activity during Cancer Treatment (PACT) Study: design of a randomised clinical trial. BMC Cancer. 2010;10:272.CrossRefPubMedPubMedCentral
17.
go back to reference Kemper H, Ooijendijk W, Stiggelbout M. Consensus about the Dutch physical activity guideline. Tijdschr Soc Geneeskd. 2000;78:180–3. Kemper H, Ooijendijk W, Stiggelbout M. Consensus about the Dutch physical activity guideline. Tijdschr Soc Geneeskd. 2000;78:180–3.
18.
go back to reference Smets EMA, Garssen B, Bonke B, De Haes JCJM. The Multidimensional Fatigue Inventory (MFI) psychometric qualities of an instrument to assess fatigue. J Psychosom Res. 1995;39(3):315–25.CrossRefPubMed Smets EMA, Garssen B, Bonke B, De Haes JCJM. The Multidimensional Fatigue Inventory (MFI) psychometric qualities of an instrument to assess fatigue. J Psychosom Res. 1995;39(3):315–25.CrossRefPubMed
19.
go back to reference Wendel-Vos GCW, Schuit AJ, Saris WHM, Kromhout D. Reproducibility and relative validity of the Short Questionnaire to Assess Health-enhancing physical activity. J Clin Epidemiol. 2003;56(12):1163–9.CrossRefPubMed Wendel-Vos GCW, Schuit AJ, Saris WHM, Kromhout D. Reproducibility and relative validity of the Short Questionnaire to Assess Health-enhancing physical activity. J Clin Epidemiol. 2003;56(12):1163–9.CrossRefPubMed
20.
go back to reference Borm GF, Fransen J, Lemmens WAJG. A simple sample size formula for analysis of covariance in randomized clinical trials. J Clin Epidemiol. 2007;60(12):1234–8.CrossRefPubMed Borm GF, Fransen J, Lemmens WAJG. A simple sample size formula for analysis of covariance in randomized clinical trials. J Clin Epidemiol. 2007;60(12):1234–8.CrossRefPubMed
21.
go back to reference Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale: Lawrence Erlbaum; 1988. Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale: Lawrence Erlbaum; 1988.
22.
go back to reference Duregon F, Vendramin B, Bullo V, Gobbo S, Cugusi L, Di Blasio A, et al. Effects of exercise on cancer patients suffering chemotherapy-induced peripheral neuropathy undergoing treatment: a systematic review. Crit Rev Oncol Hematol. 2018;121:90–100. Duregon F, Vendramin B, Bullo V, Gobbo S, Cugusi L, Di Blasio A, et al. Effects of exercise on cancer patients suffering chemotherapy-induced peripheral neuropathy undergoing treatment: a systematic review. Crit Rev Oncol Hematol. 2018;121:90–100.
23.
go back to reference Kwiatkowski F, Mouret-Reynier M-A, Duclos M, Bridon F, Hanh T, Van Praagh-Doreau I, et al. Long-term improvement of breast cancer survivors’ quality of life by a 2-week group physical and educational intervention: 5-year update of the “PACThe” trial. Br J Cancer. 2017;116(11):1389–93.CrossRefPubMedPubMedCentral Kwiatkowski F, Mouret-Reynier M-A, Duclos M, Bridon F, Hanh T, Van Praagh-Doreau I, et al. Long-term improvement of breast cancer survivors’ quality of life by a 2-week group physical and educational intervention: 5-year update of the “PACThe” trial. Br J Cancer. 2017;116(11):1389–93.CrossRefPubMedPubMedCentral
24.
go back to reference Harris TJ, Owen CG, Victor CR, Adams R, Ekelund ULF, Cook DG. A comparison of questionnaire, accelerometer, and pedometer: measures in older people. Med Sci Sports Exerc. 2009;41(7):1392–402.CrossRefPubMed Harris TJ, Owen CG, Victor CR, Adams R, Ekelund ULF, Cook DG. A comparison of questionnaire, accelerometer, and pedometer: measures in older people. Med Sci Sports Exerc. 2009;41(7):1392–402.CrossRefPubMed
25.
go back to reference Neill BO, Mcdonough SM, Wilson JJ, Bradbury I, Hayes K, Kirk A, et al. Comparing accelerometer, pedometer and a questionnaire for measuring physical activity in bronchiectasis: a validity and feasibility study? Respir Res. 2017;18(1):16.CrossRef Neill BO, Mcdonough SM, Wilson JJ, Bradbury I, Hayes K, Kirk A, et al. Comparing accelerometer, pedometer and a questionnaire for measuring physical activity in bronchiectasis: a validity and feasibility study? Respir Res. 2017;18(1):16.CrossRef
Metadata
Title
Four-year effects of exercise on fatigue and physical activity in patients with cancer
Authors
Lenja Witlox
Anouk E. Hiensch
Miranda J. Velthuis
Charlotte N. Steins Bisschop
Maartje Los
Frans L. G. Erdkamp
Haiko J. Bloemendal
Marlies Verhaar
Daan ten Bokkel Huinink
Elsken van der Wall
Petra H. M. Peeters
Anne M. May
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Medicine / Issue 1/2018
Electronic ISSN: 1741-7015
DOI
https://doi.org/10.1186/s12916-018-1075-x

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