A randomized trial of exercise and quality of life in colorectal cancer survivors
Corresponding Author
K. S. COURNEYA PHD
University of Alberta, Edmonton, Alberta, Calgary, Canada
Kerry S. Courneya, Faculty of Physical Education, University of Alberta, E-424 Van Vliet Center, Edmonton, Alberta, Canada, T6G 2H9 (e-mail: [email protected]).Search for more papers by this authorH. A. QUINNEY PHD
University of Alberta, Edmonton, Alberta, Calgary, Canada
Search for more papers by this authorL. W. JONES PHD
University of Alberta, Edmonton, Alberta, Calgary, Canada
Search for more papers by this authorA. S. FAIREY MS
University of Alberta, Edmonton, Alberta, Calgary, Canada
Search for more papers by this authorCorresponding Author
K. S. COURNEYA PHD
University of Alberta, Edmonton, Alberta, Calgary, Canada
Kerry S. Courneya, Faculty of Physical Education, University of Alberta, E-424 Van Vliet Center, Edmonton, Alberta, Canada, T6G 2H9 (e-mail: [email protected]).Search for more papers by this authorH. A. QUINNEY PHD
University of Alberta, Edmonton, Alberta, Calgary, Canada
Search for more papers by this authorL. W. JONES PHD
University of Alberta, Edmonton, Alberta, Calgary, Canada
Search for more papers by this authorA. S. FAIREY MS
University of Alberta, Edmonton, Alberta, Calgary, Canada
Search for more papers by this authorAbstract
We conducted a randomized controlled trial to determine the effects of a home-based exercise intervention on change in quality of life (QOL) in recently resected colorectal cancer survivors, most of whom were receiving adjuvant therapy. Participants were randomly assigned in a 2 : 1 ratio to either an exercise (n = 69) or control (n = 33) group. The exercise group was asked to perform moderate intensity exercise 3–5 times per week for 20–30 min each time. The primary outcome was change in QOL as measured by the Functional Assessment of Cancer Therapy-Colorectal (FACT-C) scale. Adherence in the exercise group was good (75.8%) but contamination in the control group was problematic (51.6%). Intention-to-treat analysis revealed no significant differences between groups for change in the FACT-C (mean difference, −1.3; 95% CI, −7.8 to 5.1; P = 0.679). In an ‘on-treatment’ ancillary analysis, we compared participants who decreased versus increased their cardiovascular fitness over the course of the intervention. This analysis revealed significant differences in favour of the increased fitness group for the FACT-C (mean difference, 6.5; 95% CI, 0.4–12.6; P = 0.038). These data suggest that increased cardiovascular fitness is associated with improvements in QOL in colorectal cancer survivors but better controlled trials are needed.
REFERENCES
- American Cancer Society (2002) Cancer Facts and Figures 2002. American Cancer Society, Atlanta, GA.
- American College of Sports Medicine (1991) Guidelines for Exercise Testing and Prescription. Lea & Febiger, Philadelphia, PA.
- American College of Sports Medicine (1998) Position stand on exercise and physical for older adults. Medicine and Science in Sports and Exercise 30, 992–1008.
- Baumgartner T.A. & Jackson A.S. (1995) Measurement for Evaluation in Physical Education and Exercise Science. W.C. Brown, Dubuque, IA.
- Cella D., Eton D.T., Lai J.S., Peterman A.H. & Merkel D.E. (2002) Combining anchor and distribution based methods to derive minimal clinically important differences on the Functional Assessment of Cancer Therapy (FACT) anemia and fatigue scales. Journal of Pain and Symptom Management 24, 547–561.
- Cella D.F., Tulsky D.S., Gray G., Sarafian B., Linn E., Bonomi A., Silberman M., Yellen S.B., Winicour P., Brannon J., Eckberg J., Lloyd S., Purl S., Blendowski C., Goodman M., Barnicle M., Stewart I., McHale M., Bonomi P., Kaplan E., Taylor S., Thomas C.R. & Harris J. (1993) The functional assessment of cancer therapy scale: development and validation of the general measure. Journal of Clinical Oncology 11, 570–579.
- Courneya K.S. (2001) Exercise interventions during cancer treatment: biopsychosocial outcomes. Exercise and Sport Science Reviews 29, 60–64.
- Courneya K.S. & Friedenreich C.M. (1997) Relationship between exercise pattern across the cancer experience and current quality of life in colorectal cancer survivors. Journal of Alternative and Complimentary Medicine 3, 215–226.
-
Courneya K.S.,
Friedenreich C.M.,
Arthur K. &
Bobick T.M. (1999) Physical exercise and quality of life in postsurgical colorectal cancer patients.
Psychology, Health and Medicine
4, 181–187.
10.1080/135485099106315 Google Scholar
- Courneya K.S., Friedenreich C.M., Sela R., Quinney H.A. & Rhodes R.E. (2002) Correlates of adherence and contamination in a randomized trial of exercise in cancer survivors: an application of the theory of planned behavior and the five factor model of personality. Annals of Behavioral Medicine 24, 257–268.
- Courneya K.S., Friedenreich C.M., Sela R., Quinney H.A., Rhodes R.E. & Handman M. (2003a) The group psychotherapy and home-based physical exercise (GROUP-HOPE) trial in cancer survivors: physical fitness and quality of life outcomes. Psycho-Oncology 12, 357–374.
- Courneya K.S., Mackey J.R., Bell G.J., Jones L.W., Field C.J. & Fairey A.S. (2003b) Randomized controlled trial of exercise training in postmenopausal breast cancer survivors: cardiopulmonary and quality of life outcomes. Journal of Clinical Oncology 21, 1660–1668.
- Courneya K.S., Mackey J.R. & Fairey A.S. (2003c) Managing the symptoms of cancer and its treatments with exercise. American Journal of Medicine and Sports 5, 132–136.
-
Demark-Wahnefried W.,
Peterson B.,
McBride C.,
Lipkus I. &
Clipp E. (2000) Current health behaviors and readiness to pursue life-style changes among man and women diagnosed with early stage prostate and breast carcinomas.
Cancer
88, 674–684.
10.1002/(SICI)1097-0142(20000201)88:3<674::AID-CNCR26>3.0.CO;2-R CAS PubMed Web of Science® Google Scholar
- Diener E., Emmons R.A., Larsen R.J. & Griffin S. (1985) The satisfaction with life scale. Journal of Personality Assessment 49, 71–75.
- Godin G., Jobin J. & Bouillon J. (1986) Assessment of leisure time exercise behavior by self-report: a concurrent validity study. Canadian Journal of Public Health 77, 359–361.
- Godin G. & Shephard R.J. (1985) A simple method to assess exercise behavior in the community. Canadian Journal of Applied Sport Sciences 10, 141–146.
- Jacobs D.R., Ainsworth B.E., Hartman T.J. & Leon A.S. (1993) A simultaneous evaluation of ten commonly used physical activity questionnaires. Medicine and Science in Sports and Exercise 25, 81–91.
- Jones L.W. & Courneya K.S. (2002) Exercise counselling and programming preferences of cancer survivors. Cancer Practice 10, 208–215.
- McArdle W.D., Katch F.I. & Katch V.L. (1991) Exercise Physiology, Energy, Nutrition, and Human Performance. Lea & Febiger, Philadelphia, PA.
- Martin K.A. & Sinden A.R. (2001) Who will stay and who will go? A review of older adults’ adherence to randomized controlled trials of exercise. Journal of Aging and Physical Activity 9, 91–114.
- Mock V., Pickett M., Ropka M.E., Muscari E., Stewart K.J., Rhodes V.A., McDaniel R., Grimm P.M., Krumm S. & McCorkle R. (2001) Fatigue and quality of life outcomes of exercise during cancer treatment. Cancer Practice 9, 119–127.
-
Pavot W. &
Diener E. (1993) Review of the satisfaction with life scale.
Psychology Assessment
3, 164–172.
10.1037/1040-3590.5.2.164 Google Scholar
- Radloff L.S. (1991) The use of the center for epidemiologic studies depression scale in adolescents and young adults. Journal of Adolescence 20, 149–166.
- Schwartz A.L. (1999) Fatigue mediates the effects of exercise on quality of life. Quality of Life Research 8, 529–538.
- Schwartz A.L., Mori M., Gao R., Nail L.M. & King M.E. (2001) Exercise reduces daily fatigue in women with breast cancer receiving chemotherapy. Medicine and Science in Sports and Exercise 33, 718–723.
- Segal R.J., Reid R.D., Courneya K.S., Malone S.C., Parliament M.B., Scott C.G., Venner P.M., Quinney H.A., Jones L.W., D’Angelo M.E.S. & Wells G.A. (2003) Resistance exercise in men receiving androgen deprivation therapy for prostate cancer. Journal of Clinical Oncology 21, 1653–1659.
- Shapiro C.L. & Recht A. (2001) Side effects of adjuvant treatment of breast cancer. New England Journal of Medicine 344, 1997–2008.
- Shumaker S.A., Dugan E. & Bowen D.J. (2000) Enhancing adherence in randomized controlled trials. Controlled Clinical Trials 21, 226S–232S.
- Skibber J.M., Hoff P.M. & Minisky B.D. (2001a) Cancer of the rectum. In: Cancer: Principles and Practice of Oncology, 6th edn (eds V.T. DeVita, S. Hellman & S.A. Rosenberg), pp. 1271–1312. Lippincott Williams & Wilkins, Philadelphia, PA.
- Skibber J.M., Minsky B.D. & Hoff P.M. (2001b) Cancer of the colon. In: Cancer: Principles and Practice of Oncology, 6th edn (eds V.T. DeVita, S. Hellman & S.A. Rosenberg), pp. 1216–1262. Lippincott Williams & Wilkins, Philadelphia, PA.
-
Spielberger C.D.,
Gorusch R.L. &
Lushene R.F. (1970) Manual for the State-Trait Anxiety Inventory. Consulting Psychologists Press, Palo-Alto, CA.
10.1037/013734 Google Scholar
- Thomas S., Reading J. & Shephard R.J. (1992) Revision of the physical activity readiness questionnaire (PAR-Q). Canadian Journal of Sport Sciences 17, 338–345.
- Ward W.L., Hahn E.A., Mo F., Hernandez L., Tulsky D.S. & Cella D. (1999) Reliability and validity of the Functional Assessment of Cancer Therapy-Colorectal (FACT-C) quality of life instrument. Quality of Life Research 8, 181–195.
- 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 and Symptom Management 13, 63–74.