Leg and walking self-exercise (LAWS) program for older adults with cancer during treatment.
Authors: Nishijima Tomohiro F. , Shimokawa Mototsugu , Hamabe Tomoko , Komoda Masato , Okumura Yuta , Hanamura Fumiyasu , Morita Masaru , Esaki Taito , Toh Yasushi 
Published: June 2023

e24009

Background: Regular aerobic and resistance exercise during cancer treatment is recommended by guidelines. We developed Leg And Walking Self-exercise (LAWS), a self-directed exercise program informed by the Exercise Is Medicine initiative. The acceptability and feasibility of the LAWS program was evaluated in older adults with advanced cancer during treatment. Methods: This was a prospective study of 40 consecutive older adults who received comprehensive geriatric assessment (CGA) at a geriatric oncology service (GOS) and started a new line of systemic therapy for advanced cancer on a medical oncology floor over a 1-year period. The LAWS consists of three leg exercises (sit-to-stand, calf raise, and knee extension) and walking. We set three intensity levels for the leg exercises based on a number of repetitions per day and for walking based on minutes per day as follows: level 1 = 10, level 2 = 20, level 3 = 30. We instructed patients to adjust the intensity level with a goal rating of perceived exertion (RPE) of 3 or 4 on a 0–10 scale, where 0 = no exertion and 10 = maximal exertion, and encouraged them to do both leg resistance training and walking every day. The LAWS program was introduced to a patient by the GOS during CGA consultation. When the patient was admitted to a medical oncology floor, a nurse went over the LAWS program and gave an exercise diary to the patient. During inpatient stay, a nurse checked exercise diary and helped the patient keep the diary as needed. Upon discharge from hospital, a nurse instructed the patient to continue the LAWS at home and maintain an exercise diary. Adherence was quantified as the proportion of patients who performed the LAWS program at least level 1 intensity more than 50% of each study period. Patient perspectives on the LAWS program were evaluated using the Acceptability of Intervention Measure (AIM) and the Feasibility of Intervention Measure (FIM). A summary score of each measure ranges from 1 to 5 (higher is better). Results: Mean age was 78 years and 48% had colorectal cancer. Overall, 28% of patients were fit, 53% were pre-frail, and 20% were frail based on a CGA. During hospitalization, 63% of the patients adhered to both leg exercise and walking: on average, over 12 days in hospital, 2.8 leg exercises, 23 repetitions a day, 5.6 days/week, with a mean RPE of 3.0 (low intensity) and 19 minutes of waking a day, 4.9 days/week, with a mean RPE of 3.0. During the period between discharge and first outpatient appointment, 71% of patients adhered to the LAWS program: on average, over 11 days at home, 2.6 leg exercises, 22 repetitions a day, 5.9 days/week, with a mean RPE of 3.0 and 22 minutes of waking a day, 5.4 days/week, with a mean RPE of 3.2. Patients reported high acceptability (AIM mean score = 4.2; SD = 0.7) and feasibility (FIM mean score = 4.2; SD = 0.5) of the program. Conclusions: The LAWS is an acceptable and feasible self-directed exercise program for older adults with advanced cancer receiving treatment.