Does excercise help ease fatigue in people with cancer?

sleeping-webMany people with cancer have fatigue.  Fatigue is tiredness that doesn’t get better when you rest. Fatigue is a very difficult thing to study, it may be caused by having cancer (e.g. the cancer itself might disrupt your normal biological process and that makes you feel fatigued) or it may also be caused by cancer treatment, for example the drugs used in chemotherapy.

Researchers have looked to see if exercise can help people with cancer. Some studies show a benefit, some haven’t. Last week a study was published in the British Medical Journal (bmj.com) by a Danish group, investigating the “Effect of a multimodal high intensity exercise intervention in patients undergoing chemotherapy: a randomized control trial”.

The article is open access (so you can read it without paying), the abstract is here and the pdf is here. There is also a short video summary on Insider Medicine (October 14th 2009 Edition).

First things first, it helps if you understand the title! In this paper “multimodal” means different modes (or different types) of exercise. So three times a week the people had to do “high intensity exercise”  (i.e. a workout that makes you breathless) and three times a week they had to do low intensity exercise (things like yoga or Pilates) or massage, relaxation or visualisation.

The people in the study were having chemotherapy at the time they were doing the excercise and it was a randomized control trial.  This is a good type of trial because it means the researchers tried to make sure they didn’t bias the trial (e.g. by putting the “healthier” people in the exercise group).

So in essence, the question they were asking was what happens if we compare people who get chemo with people who get chemo and exercise for 6 weeks?  At the end of 6 weeks the people who didn’t get the exercise were allowed to join the exercise program if they wanted (and about 60% of them did).

Why is this study interesting?

  1. For a start the studied 269 people, so it is relatively big. There were 73 men and 196 that took part. Of this 12 % dropped out. When looking at research studies it’s good to know how many people dropped out, 12 % is about normal, if loads of people dropped out you have to start wondering if your intervention is worth it, in this case, most people stuck with it, which is good.
  2. They also included people with lots of different types of cancer, often these studies only include people with one particular type of cancer or having one particular treatment. This study included people with ovarian, testicular, esophageal, cervical, voicebox, pancreatic and stomach cancer (which are all “solid” tumours i.e. they form lumps). They also had people with Hodgkin’s and Non-Hodgkin’s Lymphoma. These people were getting lots (59) different types of chemotherapy, most commonly cyclophosphamide, epirubicin and 5-flurouaracil.  Half of the participants had evidence of disease and half didn’t. Some people had advanced disease but people with brain and bone metastasis were excluded from the study (that meant they weren’t allowed to take part, probably because the high intensity exercise may have done them more harm than good).

What sort of excercise did they have to do?

The high intensity exercise included cycling on stationary bikes, they also did weight training, leg presses, abdominal crunches etc. The low intensity exercises included yoga and Pilates.

Did it work?

Yes, a bit. The people in the study were given a questionnaire to fill in.  At the end, the people who did the exercise were less fatigued than those who didn’t do the exercise. Overall this was thought to have a “small to medium” clinical effect.  A Cochrane review earlier this year showed that exercise did  have a clinical effect, and so backs up this result (Exercise for the managment of cancer related fatigue in adults).

The excercise in this study didn’t improve other symptoms like pain or nausea. Overall the excercise didn’t improve patients “quality of life”, but the authors argue that when you have cancer a 6 week exercise program is unlikely to make a major impact on your life and that exercise can help you feel less fatigued when you are having chemo.

Adamsen L, Quist M, Andersen C, Møller T, Herrstedt J, Kronborg D, Baadsgaard MT, Vistisen K, Midtgaard J, Christiansen B, Stage M, Kronborg MT, & Rørth M (2009). Effect of a multimodal high intensity exercise intervention in cancer patients undergoing chemotherapy: randomised controlled trial. BMJ (Clinical research ed.), 339 PMID: 19826172

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Cancer fatigue – Why am I so tired?

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