TABLE 1.
Research on PA in Patients With Advanced-Stage Cancer From 1994–2010
| Study | Purpose | Design and Sample | Findings | Limitations |
|---|---|---|---|---|
| Carson et al., 2007 | Determine the feasibility of a yoga-based intervention in women with metastatic breast cancer, and examine its effects on pain, fatigue, distress, invigoration, acceptance, and relaxation. | Pilot/feasibility study; N = 13 women with metastatic breast cancer; X̄ age = 59 years (SD = 44–75 years) | Yoga improved daily invigoration and acceptance, with trends for improved pain and relaxation. Yoga practice is predictive of improved levels of next-day pain, fatigue, invigoration, acceptance, and relaxation. Program was appropriate and very useful. |
Small sample sizea limits generalizability of findings; lack of control group |
| Crevenna, Schmidinger, Keilani, Nuhr, Fialka-Moser, et al., 2003 | Determine the feasibility and effects of an aerobic exercise program for patients with bone metastases. | Prospective case study; 48-year-old woman with breast cancer and advanced metastasis to the lung, liver, and bone | Exercise was safe, practical, and feasible. Compliance was excellent. Improvements were seen in endurance, physical and social functioning, mental health, pain, vitality, and general health perception. Immense benefit was reported from the PA. |
Case study, making generalizing to other populations difficult |
| Crevenna, Schmidinger, Keilani, Nuhr, Nur, et al., 2003 | Determine the feasibility and effects of an aerobic exercise program for a patient with advanced hepatocellular cancer. | Prospective case study; 55-year-old male with advanced hepatocellular carcinoma | The exercise was safe, practical, and feasible, leading to improvements in physical performance; physical, role, emotional, and social functioning; mental health; pain; and vitality. | Case study, making generalizing to other populations difficult |
| Headley et al., 2004 | Examine the effects of a seated exercise program on fatigue and QOL in patients with metastatic breast cancer. | Randomized, controlled longitudinal trial (N = 32) | Intervention group had a slower decline in total and physical well-being and QOL and less increase in fatigue scores starting with the third cycle of chemotherapy. | Potential confounders such as spousal support; 16% attrition; small sample sizea |
| Jones & Peppercorn, 2010 | Determine the safety and feasibility of cardiopulmonary exercise testing with advanced-stage cancer. | Cross-sectional pilot study enrolling consecutive patients with inoperable NSCLC or metastatic breast cancer (N = 85) | A symptom-limited, individualized cardiopulmonary exercise testing appears to be a relatively safe and feasible assessment tool to evaluate physical functioning in patients with advanced cancer. | Potential selection bias; exclusion of patients with low performance status; cross-sectional design; small sample sizea |
| Kelm et al., 2003 | Evaluate the role of strength and endurance training during intrahepatic chemotherapy. | Case study of a 58-year-old male with rectal adenocarcinoma | The intervention led to improvements in endurance and lung function as well as an increase in QOL by 22%. | Case study; does not discuss limitations |
| Laakso et al., 2003 | Measure the effects of physiotherapy on QOL and functional levels in patients in a palliative care setting. | Randomized trial (optimal trial physiotherapy service versus usual care) (N = 40) | The intervention group was more likely to be discharged home (p = 0.05) and die at home (p = 0.01). QOL trends improved in the intervention group and declined in the control group. |
Small sample sizea; does not discuss demographics, specific exercise details; mean length of study |
| Lowe et al., 2010 | Examine the PA interests and preferences of patients in a palliative care setting. | Cross-sectional survey (N = 50); patients with advanced-stage cancer aged 18 years and older with a life expectancy of less than 12 months | The majority of the participants were interested and able to participate in a PA program (92%). Home-based PA programs were preferred by 84%. Less than 20 minutes of PA once a day was preferred by 42%. Walking was the preferred method of PA (72%). |
Small sample sizea; possible selection bias (self-selection) |
| Lowe, Watanabe, Baracos, et al., 2009 | Examine the association between PA and QOL in patients with cancer receiving palliative care. | Cross-sectional survey (N = 50); advanced-stage cancer in patients aged 18 years and older with a life expectancy of less than 12 months | The study noted trends toward higher physical functioning in participants who engaged in 30-plus minutes of PA per day, and trends toward better reported symptoms in those with self-reported higher PA. An association was seen between PA and QOL. |
Self-reported data; small sample sizea |
| Montagnini et al., 2003 | Assess the use of PT in a hospital-based palliative care unit, characterize functional disabilities in patients who received PT; identify factors related to functional improvement following PT. | Retrospective chart review (N = 100) (96% of patients had end-stage cancer) | Less than 40% received PT and 10% improved in activities of daily living after two weeks. By week two, improvements were seen in 56% of patients receiving PT, and 33% improved throughout the length of PT program. Higher albumin levels correlated significantly with improved function. Patients who were more independent were more likely to receive PT referral. |
Retrospective design; difficult to determine if PT alone facilitated the improvements observed |
| Oldervoll et al., 2005 | Identify patients in a palliative care setting who are willing and able to complete a group PA training program. | Phase II intervention study (N = 34); diagnosed with incurable cancer; life expectancy of less than one year | Sixty-three percent of patients with incurable cancer were willing to participate in PA program, with 54% completing the PA program despite severe illness. | Lack of control group; mostly Caucasian; small sample sizea; high attrition (46%) |
| Oldervoll et al., 2006 | Assess the effects of PA on physical performance and QOL in a population with incurable cancer and a short life expectancy. | Phase II pilot study (N = 34) (15 male and 19 female); life expectancy of 3–12 months with a Karofsky Performance Scale score of 60 or higher | Significant improvements were found in endurance, emotional functioning, fatigue, role, and social functioning. PA appears to be a feasible way to improve well-being among patients with advanced-stage cancer. |
Lack of control group; mostly Caucasian participants; small sample sizea; high attrition (46%) |
| Paltiel et al., 2009 | Understand the meaning of PA intervention for the individual participant. | Qualitative semi-structured interview; 5 patients randomly selected from 34 who completed PA intervention | An individually adjusted group exercise program with competent leaders can provide a setting to enhance psychological well-being in patients with cancer who have a life expectancy of less than one year. | Small sample sizea |
| Pop & Adamek, 2010 | Assess the dynamics of PA in patients in long-term palliative care. | Observational (N = 60) (35 female and 25 male); X̄ age = 71 years (SD = 35–71) | PA increased by 10%–20% in 20% of the participants, no change in 36%, and 44% had a decrease in activity. QOL improved in consecutive weeks of the study and correlated with PA level. |
Small sample sizea; does not address limitations of study |
| Porock et al., 2000 | Test the effects of a 28-day exercise intervention on levels of fatigue in patients with advanced-stage cancer. | Pilot experimental pre-and post-test design (N = 9) (6 female and 3 male); Eastern Cooperative Oncology Group Score greater than 1; life expectancy greater than one month | PA levels were increased without an increase in fatigue. Trends showed increasing QOL and lower anxiety, and findings provided evidence that PA is suitable for patients in a palliative care setting. |
Small sample sizea; type of exercise is not discussed for each participant, only length of stay |
| Yoshioka, 1994 | Determine if physical therapy in the terminal stage of cancer can be significantly effective for dying patients. | Observation of rehabilitation intervention (N = 301 terminal patients); questionnaires mailed to family members within three months after patient death (N = 169 returned) | Almost all of the patients experienced relief from pain, dyspnea, edema, constipation, and difficulty completing activities of daily living, with an average improvement of 27%. The questionnaires showed that 88% of the patients desired ambulation, 78% were satisfied with rehabilitation, and 98% were satisfied with terminal care. |
56% response rate from follow-up questionnaire; observational nonrandomized study; does not address limitations |
a
Small sample sizes in studies enrolling patients with advanced cancer generally are seen because of challenges in recruitment and retention of this population.
NSCLC—non-small cell lung cancer; PA—physical activity; PT—physical therapy; QOL—quality of life