Effects of supervised exercise intervention in patients with colorectal cancer undergoing chemotherapy

Purpose: This study aimed to investigate the effects of supervised exercise intervention on physical fitness, fatigue, emotional distress, sleep quality, and quality of life (QOL) in patients with colorectal cancer (CRC) undergoing chemotherapy. Relevance: CRC is the third leading cause of cancer mortality in Taiwan. Although improved surgical techniques and chemotherapeutics result in higher cure rates, cancer and its treatment sequelae are associated with significant morbidity that may impair function and cause disability. Exercise is a safe, feasible, and promising therapy to help alleviate many of the common side effects from cancer and its treatments. Participants: Twenty six patients with CRC (stage I‐III) aged 42‐76 years were recruited after operation from Department of Surgery of National Taiwan University Hospital if they had an Eastern Cooperative Oncology Group Performance Status of 0‐2 and were admitted for adjuvant chemotherapy. Methods: This is a prospective clinical controlled trial. Subjects who consented to participate in this study were allocated to either a supervised exercise group that received a 12‐ week combined aerobic and resistance exercise program or a control group that received home‐based exercise after baseline assessment. The participants were assessed at baseline and post‐intervention. Assessments included cardiorespiratory fitness (6‐minute walk test), muscle strength (hand‐held dynamometer), QOL (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, EORTC QLQ‐C30), emotional distress (Hospital Anxiety and Depression Scale), physical activity (Index of Physical Activity Questionnaire‐Short Form), fatigue (Fatigue Symptom Inventory), and sleep quality (Medical Outcomes Study Sleep Scale). Analysis: Analyses were performed with SPSS version 13.0. Descriptive statistics and test of normality using Shapiro‐Wilk tests were provided for each variable. Baseline data of the two groups were compared with independent t‐test for normally distributed variables and Mann‐Whitney U test for variables not normally distributed. A 2x2 twoway repeated measures analysis of variance or Friedman test was used to compare between supervised exercise and homebased exercise group in changes in the outcome variables between baseline and the 12‐week assessments. Results: No significant difference was found between both groups at baseline. Significant interaction between intervention and time was observed for knee extensor strength (F(1,24) = 6.576, p = 0.017). Knee extensor strength of subjects in the supervised exercise group increased from 32.93+/‐7.33 to 37.81+/‐7.71, whereas that of the home‐based exercise group decreased from 32.58+/‐6.54 to 31.19+/‐8.65 over time. There were statistically significant differences between supervised exercise group and home‐based exercise group in cardiorespiratory fitness (chi2 (1) = 10.667, p = 0.001), fatigue (chi2 (1) = 6.545, p = 0.011), and two subscales of EORTC QLQ‐C30, role functioning (chi2 (1) = 4.571, p = 0.033) and pain (chi2 (1) = 8.067, p = 0.005). Conclusions: The results of this study with a limited number of subjects indicate that, for patients with CRC who were receiving adjuvant chemotherapy, supervised exercise program may improve physical fitness, fatigue, and QOL more than home‐based exercise. Larger randomized controlled trials are needed to confirm these findings. Implications: Supervised exercise program is suggested to be incorporated to promote the physical fitness, fatigue, and QOL of patients with CRC undergoing chemotherapy.