Article

Effects of Exercise on Fatigue, Sleep, and Performance: A Randomized Trial

Elizabeth Ann Coleman

Julia A. Goodwin

Robert L. Kennedy

Sharon Coon

Kathy C. Richards

Carol A. Enderlin

Carol B. Stewart

Paula McNatt

Kimberly Lockhart

Elias J. Anaissie

fatigue, exercise therapy, exercise
ONF 2012, 39(5), 468-477. DOI: 10.1188/12.ONF.468-477

Purpose/Objectives: To compare usual care with a home-based individualized exercise program (HBIEP) in patients receiving intensive treatment for multiple myeloma (MM)and epoetin alfa therapy.

Design: Randomized trial with repeated measures of two groups (one experimental and one control) and an approximate 15-week experimental period.

Setting: Outpatient setting of the Myeloma Institute for Research and Therapy at the Rockfellow Cancer Center at the University of Arkansas for Medical Sciences.

Sample: 187 patients with newly diagnosed MM enrolled in a separate study evaluating effectiveness of the Total Therapy regimen, with or without thalidomide.

Methods: Measurements included the Profile of Mood States fatigue scale, Functional Assessment of Cancer Therapy-Fatigue, ActiGraph® recordings, 6-Minute Walk Test, and hemoglobin levels at baseline and before and after stem cell collection. Descriptive statistics were used to compare demographics and treatment effects, and repeated measures analysis of variance was used to determine effects of HBIEP.

Main Research Variables: Fatigue, nighttime sleep, performance (aerobic capacity) as dependent or outcome measures, and HBIEP combining strength building and aerobic exercise as the independent variable.

Findings: Both groups were equivalent for age, gender, race, receipt of thalidomide, hemoglobin levels, and type of treatment regimen for MM. No statistically significant differences existed among the experimental and control groups for fatigue, sleep, or performance (aerobic capacity). Statistically significant differences (p < 0.05) were found in each of the study outcomes for all patients as treatment progressed and patients experienced more fatigue and poorer nighttime sleep and performance (aerobic capacity).

Conclusions: The effect of exercise seemed to be minimal on decreasing fatigue, improving sleep, and improving performance (aerobic capacity).

Implications for Nursing: Exercise is safe and has physiologic benefits for patients undergoing MM treatment; exercise combined with epoetin alfa helped alleviate anemia.

Jump to a section

    References

    Adkins, B. (2009). Maximizing exercise in breast cancer survivors. Clinical Journal of Oncology Nursing, 13, 695-700.
    American College of Sports Medicine. (1991). The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness in healthy adults. Medicine and Science in Sports and Exercise, 22, 265-274.
    Ancoli-Israel, S., Cole, R., Alessi, C., Chambers, M., Moorcroft, W., & Pollak, C. P. (2003). The role of actigraphy in the study of sleep and circadian rhythms. Sleep, 26, 342-392.
    Barlogie, B. (2001). High-dose therapy and innovative approaches to treatment of multiple myeloma. Seminars in Hematology, 38(Suppl. 3), 21-27. doi:10.1016/S0037-1963(01)90091-5
    Barlogie, B., & Beck, T. (1993). Recombinant human erythropoietin and the anemia of multiple myeloma. Stem Cells, 11(2), 88-94. doi:10.1002/stem.5530110203
    Barlogie, B., Zangari, M., Spencer, T., Fassas, A., Anaissie, E., Badros, A., … Tricot, G. (2001). Thalidomide in the management of multiple myeloma. Seminars in Hematology, 38, 250-259. doi:10.1016/S0037-1963(01)90017-4
    Berger, A. M. (2009). Update on the state of the science: Sleep-wake disturbances in adult patients with cancer [Online exclusive]. Oncology Nursing Forum, 36, E165-E177. doi:10.1188/09.ONF.E165-E177
    Berger, A. M., Abernathy, A. P., Atkinson, A., Barsevick, A. M., Breitbart, W. S., Cella, D., … Wagner, L. (2010). Cancer related fatigue. Journal of the National Comprehensive Cancer Network, 8, 904-931.
    Berger, A. M., & Farr, L. (1999). The influence of daytime inactivity and nighttime restlessness on cancer-related fatigue. Oncology Nursing Forum, 26, 1663-1671.
    Blaney, J., Lowe-Strong, A., Rankin, J., Campbell, A., Allen, J., & Gracey, J. (2010). The cancer rehabilitation journey: Barriers to and facilitators of exercise among patients with cancer-related fatigue. Physical Therapy, 90, 1135-1147. doi:10.2522/ptj.20090278
    Booker, R., Olson, K., Pilarski, L. M., Noon, J. P., & Bahlis, N. J. (2009). The relationships among physiologic variables, quality of life, and fatigue in patients with multiple myeloma. Oncology Nursing Forum, 36, 209-216. doi:10.1188/09.ONF.209-216
    Borbely, A. (2000). Sleep homeostasis and models of sleep regulation. In M. Kryer, T. Roth, & W. Dement (Eds.), Principles and practice of sleep medicine (pp. 377-390). Philadelphia, PA: W. B. Saunders.
    Borg, G. (1998). The Borg Scale. Borg's perceived exertion and pain scales. Retrieved from http://www.brianmac.co.uk/borgscale.htm
    Bower, J. E., Ganz, P. A., Desmond, K. A., Rowland, J. H., Meyerowitz, B. E., & Belin, T. R. (2000). Fatigue in breast cancer survivors: Occurrence, correlates, and impact on quality of life. Journal of Clinical Oncology, 18, 743-753.
    Brizel, D. M., Dodge, R. K., Clough, R. W., & Dewhirst, M. W. (1999). Oxygenation of head and neck cancer: Changes during radiotherapy and impact on treatment outcome. Radiotherapy and Oncology, 53, 113-117.
    Cella, D. (1997). The Functional Assessment of Cancer Therapy-Anemia (FACT-An) scale: A new tool for the assessment of outcomes in cancer anemia and fatigue. Seminars in Hematology, 34(3, Suppl. 2), 13-19.
    Cella, D. (2002). The effects of anemia and anemia treatment on quality of life of people with cancer. Oncology, 16(Suppl. 10), 125-132.
    Cella, D., Lai, J. S., Chang, C. H., Peterman, A., & Slavin, M. (2002). Fatigue in cancer patients compared with fatigue in the general United States population. Cancer, 94, 528-538. doi:10.1002/cncr.10245
    Chuang, M. L., Lin, I. F., & Wasserman, K. (2001). The body weight-walking distance product as related to lung function, anaerobic threshold, and peak VO2 in COPD patients. Respiratory Medicine, 95, 618-626. doi:10.1053/rmed.2001.1115
    Clark, T. E., Edom, N., Larson, J., & Lindsey, L. J. (2001). Thalomid (Thalidomide) capsules: A review of the first 18 months of spontaneous post-marketing adverse event surveillance, including off-label prescribing. Drug Safety, 24(2), 87-117.
    Cohen, J. (1992). A power primer. Psychological Bulletin, 112(1), 155-159.
    Coleman, E. A., Coon, S., Hall-Barrow, J., Richards, K., Gaylor, D., & Stewart, B. (2003). Feasibility of exercise during treatment for multiple myeloma. Cancer Nursing, 26, 410-419.
    Coleman, E. A., Coon, S., Kennedy, R., Lockhart, K., Stewart, C. B., Anaissie, E. J., & Barlogie, B. (2008). Effects of exercise in combination with epoetin alfa during high-dose chemotherapy and autologous peripheral blood stem cell transplantation for multiple myeloma [Online exclusive]. Oncology Nursing Forum, 35, E53-E61. doi:10.1188/08.ONF.E53-E61
    Coleman, E. A., Goodwin, J. A., Coon, S. K., Richards, K., Enderlin, C., Kennedy, R., … Barlogie, B. (2010). Fatigue, sleep, pain, mood, and performance status in patients with multiple myeloma. Cancer Nursing, 34, 219-227. doi:10.1097/NCC.0b013e3181f9904d
    Coleman, E. A., Hall-Barrow, J., Coon, S., & Stewart, C. B. (2003). Facilitating exercise adherence for patients with multiple myeloma. Clinical Journal of Oncology Nursing, 7, 529-534. doi:10.1188/03.CJON.529-534
    Cruciani, R., Dvorkin, E., Homel, P., Malamud, S., Culliney, B., Lapin, J., … Esteban-Cruciani, N. (2006). Safety, tolerability, and symptom outcomes associated with L-carnitine supplementation in patients with cancer, fatigue, and carnitine deficiency: A phase I/II study. Journal of Pain Symptom Management, 32, 551-559. doi:10.1016/j.jpainsymman.2006.09.001
    Curt, G. A., Breitbart, W., Cella, D., Groopman, J. E., Horning, S. J., Itri, L. M., … Vogelzang, N. J. (2000). Impact of cancer-related fatigue on the lives of patients: New findings from the Fatigue Coalition. Oncologist, 5, 353-360.
    Czeisler, C., & Khalsa, S. B. S. (2000). The human circadian timing system and sleep-wake regulation. In M. Kryer, T. Roth, & W. Dement (Eds.), Principles and practice of sleep medicine (pp. 353-375). Philadelphia, PA: W. B. Saunders.
    De Backer, I. C., Vreugdenhil, G., Nijziel, M. R., Kester, A. D., van Breda, E., & Schep, G. (2008). Long-term follow up after cancer rehabilitation using high intensity resistance training: Persistent improvement and quality of care. British Journal of Cancer, 99, 30-36. doi:10.1038/sj.bjc.6604433
    Dimeo, F. C. (2001). Effects of exercise on cancer-related fatigue. Cancer, 92(6, Suppl.), 1689-1693.
    Dimeo, F. C., Schwartz, N., Wesel, N., Voigt, A., & Thiel, E. (2008). Effects of an endurance and resistance exercise program on persistent cancer-related fatigue after treatment. Annals of Oncology, 19, 1495-1499. doi:10.1093/annonc/mdn068
    Fiatarone, M. A., O'Neill, E. F., Ryan, N. D., Clements, K. M., Sloares, G. R., Nelson, M. E., … Evans, W. J. (1994). Exercise training and nutritional supplementation for physical frailty in very elderly people. New England Journal of Medicine, 330, 1769-1775.
    Giordano, A., Calvani, M., Petillo, O., Carteni, M., Melone, M. R., & Peluso, G. (2003). Skeletal muscle metabolism in physiology and in cancer disease. Journal of Cellular Biochemistry, 90(1), 170-186. doi:10.1002/jcb.10601
    Glaspy, J., Jadeja, J. S., Justice, G., Kessler, J., Richards, D., Schwartzberg, L., … Colowick, A. B. (2001). A dose-finding and safety study of novel erythropoiesis stimulating protein (NESP) for the treatment of anaemia in patients receiving multicycle chemotherapy. British Journal of Cancer, 84, 17-23.
    Hamilton, D. M., & Haennel, R. G. (2000). Validity and reliability of the 6-Minute Walk Test in a cardiac rehabilitation population. Journal of Cardiopulmonary Rehabilitation, 20, 156-164.
    International Myeloma Foundation. (2011). Understanding anemia and fatigue. Retrieved from http://myeloma.org/pdfs/U-AnemiaFatigue2011_g1web.pdf
    Jacobsen, P. B., Donavan, K. A., Vadaparampil, S. T., & Small, B. J. (2007). Systematic review and meta-analysis of psychological and activity-based interventions for cancer-related fatigue. Health Psychology, 26, 660-667. doi:10.1037/0278-6133.26.6.660
    Kanbayashi, T., Shimizu, T., Takahashi, Y., Kitajima, T., Takahashi, K., Saito, Y., & Hishikawa, Y. (1999). Thalidomide increases both REM and stage 3-4 sleep in human adults: A preliminary study. Sleep, 22, 113-115.
    Knight, K., Wade, S., & Balducci, L. (2004). Prevalence and outcomes of anemia in cancer: A systematic review of the literature. American Journal of Medicine, 116(Suppl. 7), 11-26.
    Kyle, R. (1975). Multiple myeloma: Review of 869 cases. Mayo Clinic Proceedings, 50, 29-40.
    Luctkar-Flude, M., Groll, D., Woodend, K., & Tranmer, J. (2009). Fatigue and physical activity in older patients with cancer: A six month follow-up study. Oncology Nursing Forum, 36, 194-202. doi:10.1188/09.ONF.194-202
    McDonagh, M. J., & Davies, C. T. (1984). Adaptive response of mammalian skeletal muscle to exercise with high loads. European Journal of Applied Physiology, 52, 139-155.
    McNair, C., Lorr, M., & Droppleman, L. F. (1992). EITS manual for the Profile of Mood States. San Diego, CA: Educational and Industrial Testing Service.
    Mock, V., Pickett, M., Ropka, M., Muscari Lin, E., Stewart, K., Rhodes, V., … McCorkle, R. (2001). Fatigue and quality of life outcomes of exercise during cancer treatment. Cancer Practice, 9(3), 119-127. doi:10.1046/j.1523-5394.2001.009003119.x
    Montgomery, P., & Dennis, J. (2003). Cognitive behavioural interventions for sleep problems in adults aged 60+. Cochrane Database of Systemic Reviews, 1, 1-39. doi:10.1002/14651858.CD003161
    Morin, C. (1993). Psychological assessment and management. New York, NY: Guilford Press.
    Mustian, K. M., Peppone, L., Darling, T. V., Palesh, O., Heckler, C. E., & Morrow, G.R (2009). A 4-week home-based aerobic and resistance exercise program during radiation therapy: A pilot randomized clinical trial. Journal of Supportive Oncology, 7(5), 158-167.
    Nair, R., Shirodkar, M., Mallath, M., D'Cruz, A., Shukla, P., & Mistry, R. (2008). Risk factors for poor performance status in cancer patients: A multivariate analysis in 3,585 patients. Journal of Clinical Oncology, 26(15, Suppl.), 9628.
    Petruzzello, S. J., Landers, D. M., Hatfield, B. D., Kubitz, K. A., & Salazar, W. (1991). A meta-analysis on the anxiety-reducing effects of acute and chronic exercise. Outcomes and mechanisms. Sports Medicine, 11, 143-182.
    Pocock, S. J., & Simon, R. (1975). Sequential treatment assignment with balancing for prognostic factors in the controlled clinical trial. Biometrics, 31, 103-115.
    Riley, M., McParland, J., Stanford, C. F., & Nicholls, D. P. (1992). Oxygen consumption during corridor walk testing in chronic cardiac failure. European Heart Journal, 13, 789-793.
    Sadeh, A., Sharkey, K. M., & Carskadon, M. A. (1994). Activity-based sleep-wake identification: An empirical test of methodological issues. Sleep, 17, 201-207.
    Silber, J. H., Fridman, M., DiPaola, R. S., Erder, M. H., Pauly, M. V., & Fox, K. R. (1998). First-cycle blood counts and subsequent neutropenia, dose reduction, or delay in early-stage breast cancer therapy. Journal of Clinical Oncology, 16, 2392-2400.
    Speck, R. M., Courneya, K. S., Mässe, L. C., Duval, S., & Schmitz, K. H. (2010). An update of controlled physical activity trials in cancer survivors: A systematic review and meta-analysis. Journal of Cancer Survivorship, 4(2), 87-100. doi:10.1007/s11764-009-0110-5
    Strong, A., Karavatas, S., & Reicherter, E. A. (2006). Recommended exercise protocol to decrease cancer-related fatigue and muscle wasting in patients with multiple myeloma. Topics in Geriatric Rehabilitation, 22, 172-186.
    Swenson, K. K., Nissen, M. J., & Henly, S. J. (2010). Physical activity in women receiving chemotherapy for breast cancer: Adherence to a walking intervention. Oncology Nursing Forum, 37, 321-330. doi:10.1188/10.ONF.321-330
    Tariman, J. D. (2003). Thalidomide: Current therapeutic uses and management of its toxicities. Clinical Journal of Oncology Nursing, 7, 143-147. doi:10.1188/03.CJON.143-147
    Utter, A. C. (n.d.). Perceived exertion. American College of Sports Medicine Current Comment. Retrieved from http://www.acsm.org/docs/current-comments/perceivedexertion.pdf
    Wallace, L. S., Buckworth, J., Kirby, T. E., & Sherman, W. M. (2000). Characteristics of exercise behavior among college students: Application of social cognitive theory to predicting stage of change. Preventive Medicine, 31, 494-505. doi:10.1006/pmed.2000.0736
    Wielgus, K. K., Berger A. M., & Hertzog, M. (2009). Predictors of fatigue 30 days after completing anthracyline plus taxane adjuvant chemotherapy for breast cancer. Oncology Nursing Forum, 36, 38-48. doi:10.1188/09.ONF.38-48
    Winningham, M. L. (1996). Fatigue. In S. Groenwald, F. Hansen, M. Goodman, & C. Yargro (Eds.), Cancer symptom management (pp. 42-54). Sudbury, MA: Jones and Bartlett.
    Winningham, M. L., Nail, L. M., Burke, M. B., Brophy, L., Cimprich, B., Jones, L. S., … Piper, B. (1994). Fatigue and the cancer experience: The state of the knowledge. Oncology Nursing Forum, 21, 23-36.
    Yellen, S. B., Cella, D. F., Webster, K., Blendowski, C., & Kaplan, E. (1997). Measuring fatigue and other anemia-related symptoms with the Functional Assessment of Cancer Therapy (FACT) measurement system. Journal of Pain Management, 13(2), 63-74.
    Zugck, C., Krüger, C., Dürr, S., Gerber, S. H., Haunstetter, A., Hornig, K., … Haass, M. (2000). Is the 6-Minute Walk Test a reliable substitute for peak oxygen uptake in patients with dilated cardiomyopathy? European Heart Journal, 21, 540-549.