# Exercise as it relates to Disease/Effects of exercise on physical health and quality of life in Cancer Patients

The following is an analyses of a paper looking at the effects of exercise on physical health and quality of life in cancer patients, the paper appraised is: Adamsen, L., Quist, M., Midtgaard, J., Andersen, C., Møller, T., Knutsen, L.,& Rorth, M. (2006). The effect of a multidimensional exercise intervention on physical capacity, well-being and quality of life in cancer patients undergoing chemotherapy. Supportive care in cancer, 14(2), 116–127.

## What is the background to this research?

Many symptoms arise while cancer patients are on chemotherapy, reducing their quality of life (QOL), including fatigue. Fatigue can affect 75% - 100% of those undergoing chemotherapy, which lead to low physical activity levels, strength and over all function, resulting in a low QOL This research focuses on the role of exercise on cancer patients who are on chemotherapy treatment and the effects it has on their physical activity, fatigue levels and QOL.

## Where is the research from?

The study was conducted by researchers from the University Hospital of Copenhagen in Denmark. The studies approval came from scientific committees of Copenhagen and Frederiksberg municipalities and the Danish Data Protection Agency.

## What kind of research was this?

This research was done via a prospective study, using a one-group design. Whilst the results, discussed below, show positive effects of exercise, the reliability of these results can be questioned. A one group design, does not give any comparison between interventions given or not given, leading to question the results by asking, how do we know it was the exercise that helped QOL, not something else? A prospective study usually involves following outcomes over a period of time, this study however is a short 6 weeks with no follow up. It is important to keep the quality of this study in mind when thinking of the practical implications of the results.

## What did the research involve?

The research involved 82 cancer patients undergoing chemotherapy, who did 9 hours a week for 6 weeks of exercise, body awareness and relaxation. The interventions included:
-High intensity training, involving resistance training, balance training and aerobic training.
-Low intensity training, which involved the relaxation and body awareness components.
-Outcome measures included V02 max via stepwise work method on a stationary bike, 1RM for strength and a QOL questionnaire.

## What were the basic results?

The results found significant increases in physical capacity over the 6 week period, including:
-Significant increase strength, up to 40%
-Increase in V02max
-Significant reduction in fatigue,
-Significant increases in physical function
-An increase in QOL, determined by improvements in the QOL questionnaire
Because the study had no comparison groups, it is difficult to know which intervention made the most significant effect. However the study did find direct connections between improved strength and decrease pain, and improved V02 and decreased breathlessness. Unfortunately there is no understanding to which form of intervention made the biggest impact, high intensity or low intensity. The authors acknowledge that further and more reliable research needs to be done in the area, including randomized control trial

## What conclusions can we take from this research?

The current study's results unfortunately lack reliability due to the method, as explained earlier, thus comparing results to other studies is needed. A systematic review looking at effects of exercise on breast cancer patients found similar results of decreased fatigue and improved QOL. Another systematic review looking into exercise and prostate cancer favored results in increased strength and decreased fatigue as for the discussed study. With this further evidence to back up the results, we can conclude from this study that exercise can help improve symptoms of chemotherapy in cancer patients, including fatigue and function, improving quality of life.

## Practical advice

It has been shown through multiple studies that exercise has a beneficial effect on fatigue and QOL in cancer patients, even those undergoing chemotherapy. This discussed study indicates a combination of aerobic and strength training as well as relaxation training can improve QOL: (It is important to consult medical and health professionals, including your GP before commencing any exercise)
To improve aerobic/cardiovascular fitness:
-Ten minutes of interval training at 60-100% HR max
-Three times a week
To improve strength:
-Strength training consisting of 5-8 repetitions of 85-95% one repetition max
-Two to three times a week
Relaxation Technique:
-Tensing your muscles followed by relaxing your muscles
-Do Each muscle group separately

## Further information/resources

This section provides further resources regarding benefits of exercise on cancer patients, click the arrow button to open the link.
Below is a link explaining more on the effects of exercise in cancer patients:
* American Cancer Society
Below is a link to further relaxation techniques:
* Health direct

## References

* 1 2 3 4 5 6 7 Adamsen L, Quist M, Midtgaard J, Andersen C, Møller T, Knutsen L, Tveterås A, Rorth M. The effect of a multidimensional exercise intervention on physical capacity, well-being and quality of life in cancer patients undergoing chemotherapy. Supportive care in cancer. 2006 Feb 1;14(2):116-27.
* ↑ Smets EM, Garssen B, Schuster-Uitterhoeve AL, De Haes JC. Fatigue in cancer patients. British Journal of Cancer. 1993 Aug;68(2):220.
* ↑ McNeely ML, Campbell KL, Rowe BH, Klassen TP, Mackey JR, Courneya KS. Effects of exercise on breast cancer patients and survivors: a systematic review and meta-analysis. Canadian Medical Association Journal. 2006 Jul 4;175(1):34-41.
* ↑ Gardner JR, Livingston PM, Fraser SF. Effects of exercise on treatment-related adverse effects for patients with prostate cancer receiving androgen-deprivation therapy: a systematic review. Journal of Clinical Oncology. 2013 Dec 16:JCO-2013.