# Exercise as it relates to Disease/Multimodal high-intensity exercise for Cancer patients

This is an analysis of the journal article "Effect of a multimodal high intensity exercise intervention in cancer patients undergoing chemotherapy: randomised controlled trial" by Lis Adamsen et al. (2009).

## Research Background

Cancer is a difficult time and there are many side effects that come from having the disease as well as all the treatment involved. As a side effect of chemotherapy in particular, a patients physical activity often diminished due to the large amount of fatigue experienced. Receiving a diagnosis and undergoing treatment often results in an inactive daily life and a large loss in muscle mass and strength. Research has shown that a reduction in fatigue, improved physical capacity and improved quality of life occur when we exercise, however there are few interventions that are conducted and little evidence to show when those patients undergoing chemotherapy have the same result, most studies are conducted on breast cancer patients undergoing cytostatic treatment. One particular trend in exercise to see results is the inclusion of High intensity as well as multimodal exercise and this has been shown to benefit the healthy population. Low intensity interventions have been recommended to cancer patients in the past such as massage and relaxation so this research investigates whether having an incorporation of both forms of exercise can provide a good outcome to patients undergoing treatment.

## Where is the research from?

The study was conducted in Copenhagen, Denmark within the oncology and haematology departments of two university hospitals; Rigshospitalet and Herlev. The study was undertaken from March 2004 until March 2007 and the paper was published in 2009.

## Type of Research

The study conducted was a randomised control trial - the participant's baseline measures were established and then they were randomly allocated to either the intervention or control group, both groups were then monitored over the trial period.

## What did the research involve?

Subjects
269 participants were recruited initially in to the study and 235 of these patients continued through to completion. 73 patients were male and the other 196 women, all of which had received a diagnosis of cancer and completed at least one round of treatment; chemotherapy or an adjuvant treatment, were aged between 20 and 65 (mean age of 47 years) and had a WHO performance status of 0 or 1. Those with thrombocytopenia, recent myocardial infarction, uncontrolled hypertension and brain or bone cancer were excluded from the study.
Method
The subjects completed their baseline measures which included physical tests and questionnaires and forms:
* 1 Rep Max test
* VO$_2$ Max test (Maximal oxygen uptake)
* European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30)
* Medical Outcomes Study Short Form (MOS SF-36)
* Leisure Time Physical Activity Questionnaire.
They were then randomly divided in to the control group (undergoing only conventional care) and the intervention group (exercise intervention in addition to conventional care). Those in the intervention group underwent supervised exercise 9 hours a week for 6 weeks which included;
* Relaxation and body awareness
* Massage
* High intensity cardiovascular and resistance training

## Basic Results

After accounting for each type of cancer present and the demographic covariaties the results indicated that the intervention group at 6 weeks showed significant improvement in:
* Fatigue level
* Vitaity
* Physical functioning and capacity
* Role physical and emotional
* Mental health
However, there was no significant effect on the quality of life (global health status) of the individuals in the intervention group compared to those in the control condition.

## Results Interpretation and Conclusion

The results would indicate that by providing a multi-modal approach to exercise and incorporating the high intensity aspects that are often avoided when patients undergo treatment, create large improvement in many aspects of physical function and fatigue. Though the reduction in fatigue for these patients was not down to the level of the general population, it was significantly reduced and with the treatment the patients are undergoing, it is a tough ask to reduce fatigue levels to that of the normal population. The Study had some strengths and weaknesses:
Strengths
* Large sample size was used
* A variety of cancer diagnosis present giving a broad indication of effects
* The exercise interventions were well structured and supervised.
Weaknesses
* Adherence rate to the intervention was only 70.8%.
* There was an option for the control group after the initial 6 week intervention to undergo the exercise condition and 59.7% chose to do so meaning that the results from the follow up at 3 months post the intervention were not able to be used.
Overall the study has further reinforced the information current about the positive effects of exercise and that is does provide a reduction in many of the side effects associated with treatment and the inactive life that often comes with it.

## Implications of the Research

The study has indicated that perhaps there is further need for research into the area of exercise during cancer treatment and that interventions should be created for such patients. Further investigation should be undertaken to try and incorporate an improved quality of life aspect in addition as this study did not manage to see a change in this area. It is important to monitor the patients carefully as to not worsen their condition, but with this research and hopefully future research to come, intervention programs should be developed and implemented for those who are diagnosed with cancer and continued during their treatment as it allows for a reduction in fatigue allowing the patients to be able to get out and do more, without a limited physical capacity. Not only this but if physical functioning can be maintained during treatment, then this can allow for better functioning once treatment is completed and the patient is hopefully recovered and returning to normal life.

## Further reading

* American Cancer Society
* National Comprehensive Cancer Network
* Cancer Support Community

### References

* 1 2 3 4 5 Adamsen L, Quist M, Andersen C, Moller T, Herrstedt J, Kronborg D, Baadsgaard M.T, Vistisen K, Midtgaard J, Christiansen B, Stage M, Kronborg M.T & Rorth M. Effect of a multimodal high intensity exercise intervention in cancer patients undergoing chemotherapy: randomised controlled trial. BMJ [internet]. 2009 [cited 2015 September 25]; 339 : b3410. Available from: http://www.bmj.com/content/bmj/339/bmj.b3410.full.pdf
* ↑ Smets EM, Garssen B, Schuster-Uitterhoeve AL, de Haes JC. Fatigue in cancer patients. Br J Cancer1993;68:220-4.
* ↑ Pinto BM, Eakin E, Maruyama NC. Health behavior changes after a cancer diagnosis: what do we know and where do we go from here? Ann Behav Med2000;22:38-52.
* 1 2 Fentem PH. ABC of sports medicine: benefits of exercise in health and disease. BMJ1994;308:1291-5.
* ↑ Lucía A, Earnest C, Pérez M. Cancer-related fatigue: can exercise physiology assist oncologists? Lancet Oncol2003;4:616-25.
* ↑ Schmitz KH, Holtzman J, Courneya KS, Mâsse LC, Duval S, Kane R. Controlled physical activity trials in cancer survivors: a systematic review and meta-analysis. Cancer Epidemiol Biomarkers Prev2005;14:1588-95.
* ↑ 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. CMAJ2006;175:34-41.
* ↑ Markes M, Brockow T, Resch KL. Exercise for women receiving adjuvant therapy for breast cancer. Cochrane Database Syst Rev2006;(4):CD005001.
* ↑ Kraemer WJ, Adams K, Cafarelli E, Dudley GA, Dooly C, Feigenbaum MS, et al. American College of Sports Medicine position stand: progression models in resistance training for healthy adults. Med Sci Sports Exerc2002;34:364-80.
* ↑ Kangas M, Bovbjerg DH, Montgomery GH. Cancer-related fatigue: a systematic and meta-analytic review of non-pharmacological therapies for cancer patients. Psychol Bull2008;134:700-41.
* ↑ Kwekkeboom KL, Hau H, Wanta B, Bumpus M. Patients’ perceptions of the effectiveness of guided imagery and progressive muscle relaxation interventions used for cancer pain. Complement Ther Clin Pract2008;14:185-94.