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. 2018 Jun 8;16(1):86.
doi: 10.1186/s12916-018-1075-x.

Four-year effects of exercise on fatigue and physical activity in patients with cancer

Lenja Witlox  1 , Anouk E Hiensch  1 , Miranda J Velthuis  2 , Charlotte N Steins Bisschop  1 , Maartje Los  3 , Frans L G Erdkamp  4 , Haiko J Bloemendal  5 , Marlies Verhaar  6 , Daan Ten Bokkel Huinink  7 , Elsken van der Wall  8 , Petra H M Peeters  1 , Anne M May  9
Affiliations

Four-year effects of exercise on fatigue and physical activity in patients with cancer

Lenja Witlox et al. BMC Med. .

Abstract

Background: In the earlier randomized controlled Physical Activity during Cancer Treatment (PACT) study, we found beneficial effects of an 18-week supervised exercise program on fatigue in patients with newly diagnosed breast or colon cancer undergoing adjuvant treatment. The present study assessed long-term effects of the exercise program on levels of fatigue and physical activity 4 years after participation in the PACT study.

Methods: The original study was a two-armed, multicenter randomized controlled trial comparing an 18-week supervised exercise program to usual care among 204 breast cancer patients and 33 colon cancer patients undergoing adjuvant treatment. Of the 237 PACT participants, 197 participants were eligible and approached to participate in the 4-year post-baseline measurements, and 128 patients responded. We assessed fatigue and physical activity levels at 4 years post-baseline and compared this to levels at baseline, post-intervention (18 weeks post-baseline), and at 36 weeks post-baseline.

Results: Intention-to-treat mixed linear effects model analyses showed that cancer patients in the intervention group reported significantly higher moderate-to-vigorous total physical activity levels (141.46 min/week (95% confidence interval (CI) 1.31, 281.61, effect size (ES) = 0.22) after 4 years compared to the usual care group. Furthermore, cancer patients in the intervention group tended to experience less physical fatigue at 4 years post-baseline compared to the usual care group (- 1.13, 95% CI -2.45, 0.20, ES = 0.22), although the result was not statistically significant.

Conclusion: Patients with breast or colon cancer who participated in the 18-week exercise intervention showed significant higher levels of moderate-to-vigorous total physical activity levels and a tendency towards lower physical fatigue levels 4 years post-baseline. Our result indicate that exercising during chemotherapy is a promising strategy for minimizing treatment-related side effects, both short and long term.

Trial registration: Current Controlled Trials ISRCTN43801571 , Dutch Trial Register NTR2138 . Trial registered on 9 December 2009.

Keywords: Cancer; Chemotherapy; Exercise intervention; Fatigue; Long-term effects; Physical activity.

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Conflict of interest statement

Ethics approval and consent to participate

The study was approved by the Medical Ethics Committee of the University Medical Center Utrecht and the local ethical boards of the participating hospitals (i.e., St. Antonius Hospital, Nieuwegein; Diakonessenhuis Hospital, Utrecht; Meander Medical Centre, Amersfoort; Rivierenland Hospital, Tiel; Orbis Medical Center, Sittard; Zuwe Hofpoort Hospital, Woerden). All participants signed informed consent.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Participant flow through the study
Fig. 2
Fig. 2
Effect of the exercise intervention on fatigue and physical activity levels over time. Intention-to-treat mixed linear regression models were used to model absolute changes in a general fatigue, b physical fatigue, c total physical activity, and d sport and leisure-time physical activity from baseline to 18 weeks, 36 weeks, and 4 years for all breast and colon cancer patients
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