Abstract
Fatigue and impaired physical performance are common and sometimes serious problems of cancer patients during and after treatment. To avoid fatigue, cancer patients are often advised to rest and downregulate their daily activities. However, these recommendations can cause paradoxical results. Since inactivity induces muscular wasting, prolonged rest can result in further loss of endurance. Recent studies suggest that exercise, as well as behavioral and some psychosocial interventions, may reduce fatigue and improve the performance status of cancer patients. In this paper, we review interventions proposed for the treatment of cancer-related fatigue and present the results of a study about the effects of exercise on the physical performance of patients with hematological malignancies. Sixty-six inpatients (34 men, 32 women) undergoing conventional (n=45) or high-dose chemotherapy with stem cell rescue (n=21) for the treatment of a hematological malignancy exercised daily on a treadmill. Physical performance was assessed on admission and once a week during hospitalization (30±10 days, range 10–49). Physical performance remained unchanged in a submaximal standard stress test (on admission: 5.5±1.4 km/h; midhospitalization: 5.3±1.3 km/h; at discharge: 5.5±1.3 km/h; p=0.60) despite chemotherapy and its related complications. A significant decrease in the mean hemoglobin concentration (from 10.3±2.0 g/dl on admission to 9.6±1.2 g/dl at discharge; p=0.03). We conclude that a daily endurance-training program reduces the treatment-related loss of physical performance in patients with hematological malignancies undergoing chemotherapy.
Similar content being viewed by others
References
Stone P, Richards M, Hardy J (1998) Fatigue in patients with cancer. Eur J Cancer 34:1670–1676
Jereczek-Fossa BA, Marsiglia HR, Orecchia R (2002) Radiotherapy-related fatigue. Crit Rev Oncol Hematol 41:317–325
Smets EMA, Garssen B, Schuster-Uitterhoeve ALJ, et al (1993) Fatigue in cancer patients. Br J Cancer 68:220–224
Winningham ML, Nail LM, Barton B, et al (1994) Fatigue and the cancer experience: the state of the knowledge. Oncology Nurse Forum 21:23–36
Bruera E, Brenneis C, Michaud M, et al (1988) Muscle electrophysiology in patients with advanced breast cancer. J Natl Cancer Inst 80:282–285
Dimeo F, Stieglitz RD, Novelli-Fischer U, et al (1997) Correlation between physical performance and fatigue in cancer patients. Ann Oncol 8:1251–1255
Hutchinson TA, Boyed NF, Feinstein AR, (1978) Scientific problems in clinical scales as demonstrated in the Karnofsky Index of Performance Status. J Chron Diseases 32:661–666
Tisdale MJ (1999) Wasting in cancer. J Nutr 129 1(Suppl):243–246
Dimeo F, Rumberger BG, Keul J (1998) Aerobic exercise as therapy for cancer fatigue. Med Sci Sports Exer 30:475–478
Winningham ML (1992) The role of exercise in cancer therapy. In: Watson R, Eisinger M (eds) Exercise and disease, CRC Press, Boca Raton pp 63–70
Puccio M, Nathanson L, (1997) The cancer cachexia syndrome. Semin Oncol 24:277–287
Gagnon B, Bruera E, (1998) A review of the drug treatment of cachexia associated with cancer. Drugs 55:675–688
Iconomou G, Koutras A, Rigopoulos A, et al (2003) Effect of recombinant human erythropoietin on quality of life in cancer patients receiving chemotherapy. Results of a randomized controlled trial. J Pain Symptom Manage 25:512–518
Boogaerts M, Coiffier B, Kainz C, (2003) Impact of epoetin beta on quality of life in patients with malignant disease. Br J Cancer 88:988–995
Vansteenkiste J, Pirker R, Massuti B, et al (2002) Double-blind placebo-controlled randomized phase III trial of darbepoetin alfa in lung cancer patients receiving chemotherapy. J Natl Cancer Inst 94:1211–1220
Mock V, Atkinson A, Barsevic A, et al (2000) NCCN Practise guidelines for cancer-related fatigue. Oncology 14:151–161
Andersen B L (1992) Psychological interventions for cancer patients to enhance the quality of life. J Consult Clin Psychol 60:552–568
Forester B, Kornfeld DS, Fleiss JL (1985) Psychotherapy during radiotherapy: effects on emotional and physical distress. Am J Psychiatry 142:22–27
Forester B, Kornfeld DS, Fleiss JL et al (1993) Group psychotherapy during radiotherapy: effects on emotional and physical distress. Am J Psychiatry 150:1700–1706
Courneya KS, Friedenreich CM, Sela RA, et al (2003) The group psychotherapy and home-based physical exercise (group-hope) trial in cancer survivors: Physical fitness and quality of life outcomes. Psychooncology 12:357–374
Bordeleau L, Szalai JP, Ennis M, et al (2003) Quality of life in a randomized trial of group psychosocial support in metastatic breast cancer: overall effects of the intervention and an exploration of missing data. J Clin Oncol 21:1944–1951
Fawzy FI, Cousins N, Fawzy NW, et al (1990) A structured psychiatric intervention for cancer patients. I. Changes over time in methods of coping and affective disturbance. Arch Gen Psychiatry 47:720–725
Fawzy NW (1995) A psychoeducational nursing intervention to enhance coping and affective state in newly diagnosed malignant melanoma patients. Cancer Nurs 18:427–438
Gaston-Johansson F, Fall-Dickson JM, Nanda J et al (2000) The effectiveness of the comprehensive coping strategy program on clinical outcomes in breast cancer autologous bone marrow transplantation. Cancer Nurs 23:277–285
Given B, Given CW, McCorkle R, et al (2002) Pain and fatigue management: results of a nursing randomized clinical trial. Oncol Nurs Forum 29:949–956
Jacobsen PB, Meade CD, Stein KD, et al (2002) Efficacy and costs of two forms of stress management training for cancer patients undergoing chemotherapy. J Clin Oncol 20:2851–2862
Dimeo F, Tilmann MH, Bertz H, et al (1997) Aerobic exercise in the rehabilitation of cancer patients after high dose chemotherapy and autologous peripheral stem cell transplantation. Cancer 79:1717–1722
Dimeo F, Bertz H, Finke J, et al (1996) An aerobic exercise program for patients with haematological malignancies after bone marrow transplantation. Bone Marrow Transplant 18:1157–1160
Dimeo F, Fetscher S, Lange W, et al (1997) Effects of aerobic exercise on the physical performance and incidence of treatment-related complications after high-dose chemotherapy. Blood 90:330–3394
Dimeo F, Stieglitz RD, Novelli-Fischer U, et al (1998) Effects of aerobic exercise on the fatigue and psychological status of cancer patients during chemotherapy. Cancer 85(10):2273–2277
Courneya KS, Mackey JR, Bell GJ, et al (2003) Randomized controlled trial of exercise training in postmenopausal breast cancer survivors: cardiopulmonary and quality of life outcomes. J Clin Oncol 21:1660–1668
Mock V, Burke MB, Sheehan P, et al (1994) A nursing rehabilitation program for women with breast cancer receiving adjuvant chemotherapy. Oncol Nurs Forum 21:899–907
Mock V, Dow KH, Meares CJ, et al (1997) Effects of exercise on fatigue physical functioning and emotional distress during radiation therapy for breast cancer. Oncol Nurs Forum 24:991–1000
Schwartz AL, Mori M, Gao R, et al (2001) Exercise reduces daily fatigue in women with breast cancer receiving chemotherapy. Med Sci Sports Exerc 33:718–723
Segal R, Evans W, Johnson D, et al (2001) Structured exercise improves physical functioning in women with stages I and II breast cancer: results of a randomized controlled trial. J Clin Oncol 19:657–665
Porock D, Kristjanson LJ, Tinnelly K, et al (2000) An exercise intervention for advanced cancer patients experiencing fatigue: a pilot study. J Palliat Care 16:30–36
Schwartz AL, Thompson JA, Masood N (2002) Interferon-induced fatigue in patients with melanoma: a pilot study of exercise and methylphenidate. Oncol Nurs Forum 29:E85–E90
Segal RJ, Reid RD, Courneya KS, et al (2003) Resistance exercise in men receiving androgen deprivation therapy for prostate cancer. J Clin Oncol 21:1653–1659
Wang XS, Giralt SA, Mendoza TR, et al (2002) Clinical factors associated with cancer-related fatigue in patients being treated for leukemia and non-Hodgkin's lymphoma. J Clin Oncol 20:1319–1328
Fobair P, Hoppe RT, Bloom J, et al (1986) Psychosocial problems among survivors of Hodgkin's disease. J Clin Oncol 4:805–814
Borg G (1970) Perceived exertion as an indicator of somatic stress. Scand J Rehabil Med 3:92–98
Kornblith AB, Herndon JE, Zuckerman E, et al (1998) Comparison of psychosocial adaptation of advanced stage Hodgkin's disease and acute leukemia survivors. Cancer and Leukemia Group B. Ann Oncol 9:297–306
Metra M, Nodari S, Raccagni D, et al (1998) Maximal and submaximal exercise testing in heart failure. J Cardiovasc Pharmacol 32 [Suppl 1]:36–45
Author information
Authors and Affiliations
Corresponding author
Additional information
Presented as an invited lecture at the 15th International Symposium Supportive Care in Cancer, Berlin, Germany, 18–21 June 2003
Rights and permissions
About this article
Cite this article
Dimeo, F., Schwartz, S., Fietz, T. et al. Effects of endurance training on the physical performance of patients with hematological malignancies during chemotherapy. Support Care Cancer 11, 623–628 (2003). https://doi.org/10.1007/s00520-003-0512-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00520-003-0512-2