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Presented by: by Dr. Anna L. Schwartz, Ph.D., ARNP, FAAN.
Topic:
EXERCISE REDUCES FOUR TYPES OF FATIGUE IN WOMEN UNDERGOING CHEMOTHERAPY
INDIANAPOLIS-The American College of Sports Medicine (ACSM) will publish a study in the May 2001 issue of its official monthly journal, Medicine & Science in Sports & Exercise® that examines the effects of exercise training on cancer patients who are in the first three cycles of chemotherapy. The results of the study clearly indicate that daily exercise is an optimal way to reduce the kinds of fatigue that often accompanies chemotherapy.
The researchers, led by Anna L. Schwartz, Ph.D., ARNP, from the Oregon Health Sciences University School of Nursing, noted that fatigue is a symptom commonly associated with several diseases and their medical or pharmacological treatments. Cancer chemotherapy patients, however, suffer different and more disruptive fatigue. Indeed, cancer treatment related fatigue is the most prevalent and disruptive aspect of treatment in most cases. It is described as relentless, intense, severe, unpredictable and overwhelming and often leads to declines in emotional, psychological and physical function. The research group reviewed previous studies that indicated exercise in the aggregate reduces cancer fatigue noting that day-to-day fluctuations in fatigue are not addressed by that approach. "We wanted to understand the relationship between exercise and fatigue inside smaller time frames," said Schwartz. "That way we could determine whether a certain amount, or dose, of exercise could be prescribed to reduce different kinds of chemotherapy fatigue." The team devised five specific questions for their work, asking whether exercise decreases same-day fatigue, whether the amount of exercise correlates with fatigue level, whether exercise has a cumulative effect on fatigue level, whether the effect is cumulative or long-lasting, and whether there is a relationship between exercise intensity and fatigue level.
Sixty-one women were recruited and screened for an eight-week home-based aerobic exercise program, ranging in age from 27 to 69 years old; they were mostly married, employed, Caucasian, and were being treated on a 21-day cycle for stage II infiltrating ductal carcinoma of the breast. They were receiving either cyclophosphamide, methotrexate and fluorouracil (CMF) or doxorubicin and cyclophosphamide (AC). None had received radiation.
A baseline and post-test assessment of 12-minute walk time was made with each participant, because a 12-minute walk is relevant to daily activities. Each participant was asked to wear an accelerometer so the intensity (calories expended) of the walk could be determined, and then to record that intensity in an exercise diary. Each participant also kept a "fatigue diary" where she recorded four measurements: worst fatigue in the last 24 hours, least fatigue in the last 24 hours, average fatigue over the last 24 hours, and fatigue felt at the time of writing. Each woman recorded her fatigue levels at bedtime.
Investigation and analysis revealed important findings about exercise and fatigue in individuals undergoing chemotherapy. As the amount of exercise performed increased, the level of fatigue decreased. However, the effect of exercise was short-lived, as fatigue was not reduced on non-exercise days. Finally, as one would expect, as fatigue levels rose both the intensity and volume of exercise accomplished declined. The researchers found significant answers to all five of the questions they posed. First, all measures of fatigue were significantly reduced on the exercise days as compared with the non-exercise days. The amount of exercise (measured in minutes) correlated inversely with fatigue levels. The cumulative amount of exercise showed only a trend toward decreasing fatigue. The impact of exercise on fatigue appeared to be more immediate than long-lasting, and exercise intensity generally related inversely to fatigue levels.
The research team concluded that the impact of exercise on all four types of fatigue was significant, reflecting the effectiveness of low- to moderate-intensity regular exercise in both maintaining functional ability and reducing fatigue. Determining the optimal realistic and achievable dose of exercise remained elusive, however. The research team recommended further study, namely a randomized trial, to validate these results.
The American College of Sports Medicine is the largest sports medicine and exercise science organization in the world. More than 18,000 members throughout the U.S. and the world are dedicated to promoting and integrating scientific research, education, and practical applications of sport medicine and exercise science to maintain and enhance physical performance, fitness, health, and quality of life.
NOTE: Medicine & Science in Sports & Exercise® is the official journal of the American College of Sports Medicine, and is available from Lippincott, Williams & Wilkins at 1-800-638-6423. For a complete copy of the research paper (Vol. 33, No. 5, page 718) or to speak with a leading sports medicine expert on the topic, contact the Department of Communications and Public Information at 317-637-9200. Visit ACSM online at www.acsm.org.
The conclusions outlined in this news release are those of the researchers only, and should not be construed as an official statement of the American College of Sports Medicine.
