Tailored Exercise Interventions to Reduce Fatigue in Cancer Survivors
Condition: Cancer-related Fatigue
MeSH terms: Fatigue
Study type: Interventional

Summary: 
      Cancer-related fatigue (CRF) is a common and distressing symptom of cancer and/or cancer
      treatment that can persist for months or years in cancer survivors. Exercise is beneficial
      for the management of CRF, and general exercise guidelines for cancer survivors are
      available. However, exercise interventions have not been tailored to alleviate CRF in
      fatigued cancer survivors, and thus the potential to alleviate CRF may not have been
      realized. The primary aim of this research is to investigate the effect of a traditional vs.
      tailored 12-week exercise intervention on self-reported CRF severity.
    

Detailed description: 
      Background and Rationale

      Approximately one-third of cancer survivors experience severe and persistent fatigue for a
      number of years post-treatment, but this distressing symptom is often under-treated by
      healthcare professionals due to a lack of mechanism-targeted interventions. The assessment of
      cancer-related fatigue (CRF) is reliant on subjective fatigue measurements such as
      self-report questionnaires. Less attention has been given to objective physiological
      measurements. However, there are well-established techniques which allow the assessment of
      neuromuscular fatigue and its peripheral and central origins which could be utilized in the
      study of CRF. Very few studies have considered these objective measures alongside self-report
      scales in the study of CRF and only two have used such techniques in cancer survivors. To
      date, no studies have investigated neuromuscular fatigue in whole body, dynamic activity as
      relevant to daily tasks (and involving the lower limb due to its functional relevance to
      locomotion). Novel testing developed in our laboratory could be used as part of a wider
      screening to develop individualized interventions to alleviate CRF. It is well accepted in
      the field that CRF is multidimensional and in addition to a potential neuromuscular
      component, the role of sleep disturbance may also be implicated. Interventions targeted at
      improving sleep quality are therefore warranted, and there is sound evidence for the efficacy
      of exercise interventions in particular for improving CRF in cancer survivors. As a
      non-pharmacological intervention, physical activity has the strongest evidence base for
      treating CRF. However, the mechanisms explaining the reduction of CRF with exercise are not
      understood. Due to the complex and multi-factorial nature of CRF, it would be of benefit to
      tailor exercise interventions to the specific deficits (in regards to neuromuscular
      mechanisms) or difficulties (for example sleep disturbance) experienced by the individual.
      Ultimately, mechanism-targeted exercise interventions could be translated to clinical
      rehabilitation programs and lead to an improved quality of for cancer survivors.

      Research Question & Objectives

      The primary aim of this research is to investigate the effect of a traditional vs. tailored
      12-week exercise intervention on self-reported CRF severity.

      Methods

      Fatigued cancer survivors who have completed primary treatment ≥ 3 months and ≤ 5 years from
      enrollment will be randomly allocated to one of two treatment arms: traditional (active
      control) and tailored exercise. Participants in the traditional exercise group will engage in
      aerobic and resistance exercise that is consistent with published recommendations. The
      tailored exercise group will be prescribed an intervention designed to address individual
      deficits (identified at baseline) that may be related to CRF. Participants will be assessed
      before and after the intervention for patient-reported outcomes, neuromuscular function and
      fatigue in response to whole-body exercise, sleep quantity and quality, physical activity
      levels, cardiorespiratory fitness and blood biomarkers.
    

Intervention name(s): Traditional Exercise; Tailored Exercise
Intervention type(s): Other; Other
Intervention description(s): The traditional exercise group will undertake a supervised exercise intervention involving aerobic exercise and light resistance training, in line with published guidelines for exercise in cancer survivors.; The tailored training group will be prescribed an individualized exercise intervention designed specifically to counteract deficits (e.g. neuromuscular) of difficulties (e.g. sleep disturbance) identified during pre-intervention testing.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Participants are assigned to one of two groups in parallel for the duration of the study.
Masking: None (Open Label)
Primary purpose: Treatment