Nurse-led physical activity program may benefit people undergoing cancer treatment
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The concept of patients continuing to exercise while undergoing active cancer treatment is not new, but it may need reinforcing.
“This really isn’t cutting edge; this is something we have been trying to encourage patients to do for maybe 20 years,” Judi K. Forner, DNP, APRN, ACNS-BC, RN-BC, an adult health clinical nurse specialist and lead author of a pilot study published in Clinical Journal of Oncology Nursing, said in an interview with Healio. “Yet, when I proposed this study, I had people telling me that when they went through cancer treatment, they were told to rest and not exercise. That was only about 2 years ago.”
In the study, Forner and researchers found that their Get Up, Get Moving initiative, combined with nurse telephone calls, increased daily steps, reduced fatigue and maintained health-related quality of life among patients during active cancer treatment .
Forner and her colleagues created t he campaign to encourage evidence-based practice changes among oncology nurses and promote the benefits of exercise in patients undergoing treatment. Forner spoke with Healio about the misconceptions around exercise during treatment, the success of Get Up, Get Moving and possible implementation of the program on a wider scale.
Healio: How did this program originate?
Forner: It started out with just patients with breast cancer, but we had to move to patients with solid-organ cancer, as well, because of the pandemic. We wanted to evaluate this program, which teaches oncology nurses how to assess and instruct patients with cancer on exercise during treatment. It doesn’t need to be high impact; it just needs to involve them continuing to move and be active. Historically, during cancer treatment, patients would be instructed to rest and wait until after treatment to exercise. However, patients lose muscle mass when they are not exercising. So, even just walking will help these patients keep their energy levels up and maintain muscle mass. It also helps emotionally. In our study, patients who walked had a more optimistic outlook on life than the patients who didn’t exercise.
Healio: What did the study entail?
Forner: We received a grant for the 12-week program. Each participant wore a Fitbit step tracker and filled out a survey at the start about how much they exercised. They also completed a quality-of-life survey. I spoke with the control group in the beginning and contacted them 6 weeks later to see how they were doing. The control group continued with the traditional programs they had been instructed to do by their oncologists and oncology nurses. I called participants in the experimental group once a week and they would give me an update on how many steps they had walked and how they felt. Some patients would say they didn’t do so great, and we would talk about how they could maybe increase their steps the next week and we’d set a goal. Some of these calls would last 2 minutes, some would last 15.
Healio: What did you find?
Forner: Before the study period, both groups exercised about the same amount — about 30 minutes in a typical week. That isn’t very much. At the end of the 12 weeks, the control group’s exercise time decreased; at the start of the study, they exercised 34 minutes a week , but at the end they dropped down to 29 minutes. The interventional group started at 31 minutes, but they increased their time to 48 minutes by the end of the study.
For the quality - of - life analysis , the groups completed the [Short Form 36 Health Survey ( SF-36 )] questionnaire. We found that the control group decreased about nine points in their energy and fatigue scores — from 47 to 38. The intervention group started out at 48 and increased to 54. In terms of role limitations due to physical health, the control group started at 65 and decreased to 46. The intervention group went from 41 to 63. It should be noted that participants decreased their level of physical activity on weeks when they underwent chemotherapy or radiation, then increased their steps during off weeks.
Many patients in the intervention group said they felt that they would continue exercising, which is exciting. Past research has also indicated that patients who exercise during cancer treatment will continue and will have a higher rate of lifetime exercise as opposed to patients who did not exercise.
Healio: Is exercise appropriate for people with all cancer types?
Forner: We initially looked at patients with breast cancer , then included patients with colon and prostate cancers, as well. All study participants were cleared to exercise by their oncologists before starting the walking program. I would strongly encourage all patients with cancer to discuss the types of physical activity their oncologist recommends for them specifically.
Healio: Does exercise play a role in reducing adverse events associated with cancer treatment?
Forner: Yes, studies support that exercise can benefit the feelings of fatigue and decrease nausea. However, we found that oncologists and oncology nurses are proactive at combating the effects of nausea, so it wasn’t that reportable because as soon as patients began to experience nausea, the oncology team instructed them to take medications to mitigate it. So, that was hard to measure.
Healio: What is next for this program?
Forner: The study is entering a new phase, and I have handed it off to another researcher. The next phase will be conducted face-to-face rather than over the phone. I think nurses and oncologists are on board with encouraging exercise among patients undergoing cancer treatment, and the Get Up, Get Moving program has excellent tools nurses can download to teach and assist their patients functionally with exercise.
Healio: Is there anything else you think is important to mention on this topic?
Forner: I want oncologists and nurses to reassure and educate patients that exercise during cancer treatment does not need to be high impact or intense — it can simply be walking. Being physically active can be safe and healthy during treatment. These patients should be training for lifelong quality of life, not the Chicago Marathon.
For more information:
Judi K. Forner, DNP, APRN, ACNS-BC, RN-BC, can be reached at OSF Saint Anthony Medical Center, 5666 E. State St., Rockford, IL 61108; email: judi.k.forner@osfhealthcare.org.
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