Original article
Differential Effects of Cardiovascular and Resistance Exercise on Functional Mobility in Individuals With Advanced Cancer: A Randomized Trial

Presented to the American Physical Therapy Association, January 23, 2013, San Diego, CA.
https://doi.org/10.1016/j.apmr.2013.06.008Get rights and content

Abstract

Objective

To compare the effects of resistance and cardiovascular exercise on functional mobility in individuals with advanced cancer.

Design

Prospective, 2-group pretest-posttest pilot study with randomization to either resistance or cardiovascular exercise mode.

Setting

Comprehensive community cancer center and a hospital-based fitness facility.

Participants

Volunteer sample of individuals (N=66; 30 men; 36 women; mean age, 62y) with advanced cancer recruited through the cancer center, palliative care service, rehabilitation department, and a local hospice.

Interventions

Ten weeks of individualized resistance or cardiovascular exercise, prescribed and monitored by oncology-trained exercise personnel.

Main Outcome Measures

Functional mobility was assessed using the Short Physical Performance Battery (SPPB); self-reported pain and fatigue were assessed secondarily using visual analog scales. Data were analyzed using a split plot 2×2 analysis of variance (α=.05).

Results

Fifty-two patients (78.8%) completed the study: 23 (67.7%) of 34 patients in the resistance arm and 29 (90.6%) of 32 patients in the cardiovascular arm. No participant withdrew because of study adverse events. Ten-week outcomes (n=52) included a significant increase in SPPB total score (P<.001), increase in gait speed (P=.001), and reduction in fatigue (P=.05). Although cardiovascular exercise participants had a modestly greater improvement in SPPB total score than resistance training participants (F1,49=4.21, P=.045), the difference was not confirmed in a subsequent intention-to-treat analysis (N=66).

Conclusions

Individuals with advanced cancer appear to benefit from exercise for improving functional mobility. Neither resistance nor cardiovascular exercise appeared to have a strong differential effect on outcome.

Section snippets

Participants

Participants were patients aged ≥18 years with advanced cancer who were recruited to attend an oncology-specific exercise program at a hospital-based fitness facility between February 2010 and March 2012. We operationally defined advanced cancers as those determined by an oncologist to be in the terminal (ie, tertiary, incurable) stage of diagnosis. Participants were recruited through the cancer center, palliative care service, rehabilitation department, and a local hospice. Study candidates

Results

Sixty-six participants (30 men; 36 women; mean age ± SD, 62.35±12.49y) were randomly assigned to either the resistance (n=34) or cardiovascular (n=32) group. Most were white, with a diagnosis of breast, lung, or colorectal cancer. Many participants reported receiving chemotherapy or combination treatment during the study. There were no significant differences in age or sex between groups. Baseline participant demographic characteristics appear in table 1. The trial was discontinued once the

Discussion

The findings revealed that both resistance and cardiovascular training appeared to contribute to improved functional mobility in a sample of individuals with advanced cancer who were interested in exercise. The results generally confirmed the outcome of preliminary studies.21, 22 In contrast with the initial hypothesis, however, there did not appear to be a substantial differential effect of 1 mode of exercise compared with the other. Indeed, the modest differential effect identified in the

Conclusions

Individuals with advanced cancer struggle with disease and treatment-related symptoms that limit their functional mobility. The findings of this pilot study suggested that for individuals with advanced cancer who are willing and interested in exercise, the benefits of exercise for reducing fatigue and improving functional mobility do not appear to depend on exercise mode. Future research that supports the ongoing development of exercise guidelines for this population is strongly encouraged.

Suppliers

  • a.

    SPSS Inc, 233 S Wacker Dr, 11th Fl, Chicago, IL 60606.

  • b.

    NuStep TRS 4000; NuStep Inc, 5111 Venture Dr, Ste 1, Ann Arbor, MI 48108.

  • c.

    LifeGlider 3000; Rehabco, LLC, 424 Commerce Rd, Staunton, VA 24401.

Acknowledgments

This study would not have been possible without the dedication of our inspirational cancer survivors. We wish to thank the staff of Exeter Hospital Center for Cancer Care and the Cancer Well-fit Program for its help conducting the study. We also wish to thank the Northern New England Clinical Oncology Society for its generous support.

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    Current affiliations for Litterini, Department of Physical Therapy, University of New England, Portland, ME; and Fieler, Department of Nursing, St. Joseph Hospital, Nashua, NH.

    Supported by the Northern New England Clinical Oncology Society and Exeter Hospital.

    No commercial party having a direct financial interest in the results of the research supporting this article has conferred or will confer a benefit on the authors or on any organization with which the authors are associated.

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