# Exercise as it relates to Disease/Does physical activity limit the level of fatigue experienced in cancer patients undergoing chemotherapy?

This Wiki Books Fact Sheet analyses and discusses the article "Effects of physical activity on the fatigue and psychologic status of cancer patients during chemotherapy".

## What is the background to this research?

Fatigue is heavily associated with cancer patients undergoing chemotherapy.
This study looks at how physical activity can have an effect on the level of fatigue both physically and psychologically. Up to 70% of cancer patients experience symptoms of fatigue through the course of chemotherapy treatment. Fatigue is believed to be dependant on more than just physical factors, the study suggests psychological and social aspects are just as influential. Patients undergoing chemotherapy display reduced fitness and loss of muscular strength.
Table A: Psychological and Physical Effects of Chemotherapy in Cancer Patients. :
| Psychological | Physical |
| Depression | Physical fatigue |
| Anger | Anaemia |
| Vigour | Cardiorespiratory |
| Obsessive compulsive traits | Muscle Loss |
| Interpersonal Sensitivity | Renal Insufficiency |
| Anxiety | Ischemia |
| Somatization | Acquired Immunodeficiency |
It is advised to cancer patients to engage in physical activity to counteract or reduce the intensity of fatigue and thus limiting the factors shown in Table A.

## Where is the research from?

This study was held within a hospital, funded by the Nenad Keul Foundation, Freiburg and Daimler-Benz AG, Stuttgart, Germany. Approved by the Ethical Commission of the University of Freiburg and informed consent was collected from each patient.

## What kind of research was this?

The research conducted was a quantitative study. The use of two questionnaires which were both collated and scored at the cessation of the study. One being the Profile Mood Status, the other being a Checklist of Symptoms. The questionnaires were carried out on both the control group and training group.

## What did the research involve?

The research required a group of 63 cancer patients with either tumours or lymphomas. Each subject was aged between 18 and 60, and were required to have an absence of psychiatric issues, muscular issues, cardiovascular disease or pulmonary disease. An additional understanding for German was also essential. Each patient was receiving High Dose Chemotherapy, then received a autologous peripheral blood stem cell transplantation. These subjects were given an exercise program to follow whilst in hospital which consisted of 30 minutes on a supine cycle ergometer for 30 minutes a day. The 30 minutes were broken down into one minute exercise and one minute rest, thus accumulating to 30 minutes total and 15 minutes direct exercise. Exercise was placed at a Heart Rate 50% of the Cardiac Reserve. Using the 220 - Age - resting HR equation.
The control group did not exercise at all throughout treatment. Psychological status was assessed using the two questionnaires, where high scores indicated a greater effect on psychological wellness. To increase the validity of the experiment, the dosage of each medication for all subjects were recorded.

## What were the basic results?

Table B: Results of the Control Group. :
| POMS | Increase or decrease |
| Depression | No Significant Change |
| Anger | No significant Change |
| Vigour | Decrease |
| Fatigue | Increase |
| SCL-90 R | Increase or decrease |
| Obsessive compulsive traits | No Significant Change |
| Interpersonal Sensitivity | No significant Change |
| Anxiety | No Significant Change |
| Somatization | Increase |
Table C: Results of the Training Group. :
| POMS | Increase or decrease |
| Depression | No Significant Change |
| Anger | No significant Change |
| Vigour | Decrease |
| Fatigue | No Significant Change |
| SCL-90 R | Increase or decrease |
| Obsessive compulsive traits | Decrease |
| Interpersonal Sensitivity | Decrease |
| Anxiety | Decrease |
| Somatization | Increase |
| Phobic Anxiety | Decrease |
The Tables above were based on a P Value, therefore some values with 'No significant Change' still showed slight improvement or degradation, however to ensure the data was more accurate only significant changes were noted. Further analysis can be carried out looking at the raw data and comparison between admission and discharge values.

## How did the researchers interpret the results?

The researchers found many positive correlations between exercise and increase psychological function. This is evident in the results tables B and C. There was no significant evidence in the reduction of fatigue, however the study explains that in comparison to the control group, the decrease of fatigue was significantly less within the training group. The study justified these results by explaining that there is a heavy correlation between fatigue and High Dose Chemotherapy, these physiological effects are to be expected in addition to excessive time in bed - sedentary behaviour.

## What conclusions can we take from this research?

The results reflected that the subjects undertaking exercise will enhance psychological conditions and limit the intensity of physical fatigue. This is important for cancer patients to be able to carry out daily tasks with the least fatigue possible, ensuring better quality of life. Additional studies confirm that physical activity/ exercise can contribute to quality of life via reduction of fatigue and increase psychological function. As mentioned the effect of physical activity is not restricted to just an increase in cardiovascular and muscle function. It addition to the psychological benefits, it was noted that the reduction in anxiety assisted individuals in social interaction.

## What are the implications of this research

This study was a highly monitored program delivered within the safety of a hospital, therefore patients will not receive the same level of observation. It is a major risk factor for cancer patients to engage in physical activity, therefore it is essential to conduct a Pre screening exercise.

## Further readings

* The risk of sedentary behaviour on endometrial cancer - https://scholar.google.com/scholar?hl=en&as_sdt=0,5&q=sedentary+behaviour+of+cancer+patients -
* Physical fatigue during high dose chemotherapy - http://www.bloodjournal.org/content/90/9/3390.short?sso-checked=true
* Chemotherapy induced weakness and fatigue - http://online.liebertpub.com/doi/abs/10.1089/ars.2011.3965
* Psychological effects of chemotherapy - http://www.ingentaconnect.com/content/springer/sinp/2000/00000014/00000004/art00001

## References

* 1 2 3 4 5 6 7 8 9 Dimeo FC, Stieglitz RD, Novelli‐Fischer U, Fetscher S, Keul J. Effects of physical activity on the fatigue and psychologic status of cancer patients during chemotherapy. Cancer. 1999 May 15;85(10):2273-7.
* ↑ Brown JK, Byers T, Doyle C, Courneya KS, Demark‐Wahnefried W, Kushi LH, McTiernan A, Rock CL, Aziz N, Bloch AS, Eldridge B. Nutrition and physical activity during and after cancer treatment: an American Cancer Society guide for informed choices. CA: a cancer journal for clinicians. 2003 Sep 1;53(5):268-91.
* ↑ Bourke L, Homer KE, Thaha MA, Steed L, Rosario DJ, Robb KA, Saxton JM, Taylor SJ. Interventions to improve exercise behaviour in sedentary people living with and beyond cancer: a systematic review. British journal of cancer. 2014 Feb 18;110(4):831.
* ↑ Stephenson LE, Bebb DG, Reimer RA, Culos-Reed SN. Physical activity and diet behaviour in colorectal cancer patients receiving chemotherapy: associations with quality of life. BMC gastroenterology. 2009 Jul 27;9(1):60.
* ↑ Douglas E. Exercise in cancer patients. Physical therapy reviews. 2005 Jun 1;10(2):71-88.
* ↑ Oldervoll LM, Loge JH, Lydersen S, Paltiel H, Asp MB, Nygaard UV, Oredalen E, Frantzen TL, Lesteberg I, Amundsen L, Hjermstad MJ. Physical exercise for cancer patients with advanced disease: a randomized controlled trial. The oncologist. 2011 Nov 1;16(11):1649-57.
* ↑ Jones LW, Eves ND, Peppercorn J. Pre-exercise screening and prescription guidelines for cancer patients. The lancet oncology. 2010 Oct;11(10):914.
* ↑ Gierach GL, Chang SC, Brinton LA, Lacey JV, Hollenbeck AR, Schatzkin A, Leitzmann MF. Physical activity, sedentary behavior, and endometrial cancer risk in the NIH‐AARP Diet and Health Study. International journal of cancer. 2009 May 1;124(9):2139-47.
* ↑ Dimeo F, Fetscher S, Lange W, Mertelsmann R, Keul J. Effects of aerobic exercise on the physical performance and incidence of treatment-related complications after high-dose chemotherapy. Blood. 1997 Nov 1;90(9):3390-4.
* ↑ Gilliam LA, St. Clair DK. Chemotherapy-induced weakness and fatigue in skeletal muscle: the role of oxidative stress. Antioxidants & redox signaling. 2011 Nov 1;15(9):2543-63.
* ↑ Redeker NS, Lev EL, Ruggiero J. Insomnia, fatigue, anxiety, depression, and quality of life of cancer patients undergoing chemotherapy. Scholarly inquiry for nursing practice. 2000 Jan 1;14(4):275-90.