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I am off to celebrate Thanksgiving in S Padre by doing some kiteboarding. I leave in a few hours and I can't wait. Whooooo ha.
This week I have a summary/critique I did of a study looking at the perception of fatigue in cancer patients before and after an exercise program. Pretty amazing study to see how their perception of fatigue was altered by exercise.
This is a qualitative study, so you most of you in the hard core science world are use to reading quantitative studies (think lots of numbers, highly controlled). The bad part is that not all of life fits so neatly in that box, so qualitative studies can be extremely useful. A different question many times needs a different method. Enjoy!
Summary
The object of this study (Adamsen et al., 2004) was to explore the nature of fatigue in advanced stage cancer patients undergoing chemotherapy and also participating in an exercise program. The exercise program lasted 6 weeks with multidimensional exercise consisting of physical exercise (1.5 hours three times weekly), relaxation (0.5 hours four times weekly), massage (0.5 hours twice weekly), and body-awareness training (1.5 hours once weekly. A qualitative process using interviews that were conducting at three different times (start, during, and termination) of the program. 23 patients (age 18 to 65 years old) participated. The type of cancer, stage of progression and treatment all varied. They concluded that patients experienced exercise-induced fatigue which they related to a new sense of increased strength, improvement in overall energy and physical well being instead of a negative, flu-like induced chemotherapy fatigue. The transformation of fatigue supports the theory that exercise is a beneficial strategy in the treatment of cancer related fatigue (Adamsen et al., 2004).
Critique/analysis
Research Design
The theoretical perspective was appropriate since it works to answer their question about the impact of exercise on changing perceptions of fatigue. There are a few studies on the impact of exercise and cancer, one by Markes, Brockow, and Resch (2006) stated, “Exercise during adjuvant treatment for breast cancer can be regarded as a supportive self-care intervention which results in improved physical fitness and thus the capacity for performing activities of daily life, which may otherwise be impaired due to inactivity during treatment. Improvements in fatigue were ambiguous and there was a lack of evidence for improvement with exercise for other treatment-related side effects.” (Markes, Brockow, & Resch, 2006)
69 total interviews of 23 participants were conducted. The interviews were conducted at three different time points during the study: prior to (as a baseline), 6 weeks into the exercise program and at the completion of the intervention. Three weeks should have been enough time for the participants to judge the change in their fatigue levels due to the exercise intervention. Adamsen L et al. (2006) stated, “Clinical controlled trials and more follow-up studies are needed to establish the optimal program length and content for sustained exercise adherence in cancer patients.” (Midtgaard, Tveteras, Rorth, Stelter, & Adamsen, 2006) There was not a control group, so you can’t rule out the added attention that the participants received as altering their feelings of fatigue, especially since they were receiving custom exercise, massage, relaxation treatments for many hours a week.
The researchers role in the study was design and analysis, but they did not conduct the interviews themselves, stating “Interviewing was chosen as the research method in order to ensure that the physical exercise was performed at lowest risk by using the patients’ information as the basis for making adjustments to the program and subsequently evaluating the program.” (Adamsen et al., 2004) This helps to remove the bias that the research may add during the interview process. Investigator triangulation was also applied to further reduce bias (Ramprogus, 2005).
There is little to no background on the authors described in the text. A simple literature search under the main author Adamsen L. reveals many studies in relation to exercise and cancer, so it would be great to see this highlighted more in this study.
Sampling
According to literature by Endacott and Botti (2005), calculating sample size in qualitative research depends on a number of factors. These include: 1) research design 2) sampling method 3) the degree of precision required 4) the variability of the factors being investigated 5) the incidence of a particular variable in the population (Endacott & Botti, 2005). Twenty-seven patients gave their consent, but two withdrew and twenty-five completed the 6-week intervention; so a small number were in the study and 6-weeks is short for an exercise study. To the researcher’s credit, they were not looking at a functional outcome from the study, but at how the participants viewed fatigue. The authors also acknowledge the small population as a study limitation and there was not a previous study looking at the changing perception of fatigue with exercise in cancer patients, so a smaller sample size may be appropriate for this study (although a larger number is always nice to see).
Participants were attracted by posters and pamphlets at the outpatient clinic or in the ward; so not all patients were notified of the study in a systematic fashion. The participants were also categorized as highly motivated, relatively young and physically active pre illness. This is the type of group you would expect to attract from this type of study, so it is skewed towards an active, motivated population that may obtain different results than an unmotivated, less active group.
The participants were not alike in many ways such as age, sex, diagnosis, treatment, etc. Other studies of cancer and exercise (Barnard, Leung, Aronson, Cohen, & Golding, 2007; Heim, v d Malsburg, & Niklas, 2007; Markes et al., 2006; Monga et al., 2007) normally focus on one particular type of cancer, but even that research is limited in volume. The biggest flaw of this study is lumping all types of cancer and treatment methods into one big group.Practical
Applications
This study shows that an intervention of an exercise program may alter cancer patients perception of fatigue. This could have a great impact in future cancer treatments programs to help patients deal with the sense of flu like fatigue that normally accompanies chemotherapy treatment causing the patients to move even less and continue to have their health spiral downward. While there is little know about the mind/body connection and its ramifications, it can be argued that if patients feel better about themselves and maintain a more positive outlook, they may have a better prognosis.
ConclusionThe object of this study (Adamsen et al., 2004) was to explore the nature of fatigue in advanced stage cancer patients undergoing chemotherapy and also participating in an exercise program. The exercise program lasted 6 weeks using multidimensional exercise. A qualitative process (interview method) was conducting with 23 patients (age 18 to 65 years old). The type of cancer, stage of progression and treatment all varied. Despite this, they concluded that patients experienced exercise-induced fatigue which they related to a new sense of increased strength, improvement in overall energy and physical well being instead of a negative, flu-like induced chemotherapy fatigue. The transformation of fatigue supports the theory that exercise is a beneficial strategy in the treatment of cancer related fatigue (Adamsen et al., 2004) and may have further implications for including an exercise program in cancer treatment programs.
References
Adamsen, L., Midtgaard, J., Andersen, C., Quist, M., Moeller, T., & Roerth, M. (2004). Transforming the nature of fatigue through exercise: Qualitative findings from a multidimensional exercise programme in cancer patients undergoing chemotherapy. European journal of cancer care, 13(4), 362-370.
Barnard, R. J., Leung, P. S., Aronson, W. J., Cohen, P., & Golding, L. A. (2007). A mechanism to explain how regular exercise might reduce the risk for clinical prostate cancer. European journal of cancer prevention : the official journal of the European Cancer Prevention Organisation (ECP), 16(5), 415-421.
Endacott, R., & Botti, M. (2005). Clinical research 3: Sample selection. Intensive & critical care nursing : the official journal of the British Association of Critical Care Nurses, 21(1), 51-55.
Heim, M. E., v d Malsburg, M. L., & Niklas, A. (2007). Randomized controlled trial of a structured training program in breast cancer patients with tumor-related chronic fatigue. Onkologie, 30(8-9), 429-434.
Markes, M., Brockow, T., & Resch, K. L. (2006). Exercise for women receiving adjuvant therapy for breast cancer. Cochrane database of systematic reviews (Online), (4)(4), CD005001.
Midtgaard, J., Tveteras, A., Rorth, M., Stelter, R., & Adamsen, L. (2006). The impact of supervised exercise intervention on short-term postprogram leisure time physical activity level in cancer patients undergoing chemotherapy: 1- and 3-month follow-up on the body & cancer project. Palliative & supportive care, 4(1), 25-35.
Monga, U., Garber, S. L., Thornby, J., Vallbona, C., Kerrigan, A. J., Monga, T. N., et al. (2007). Exercise prevents fatigue and improves quality of life in prostate cancer patients undergoing radiotherapy. Archives of Physical Medicine and Rehabilitation, 88(11), 1416-1422.
Ramprogus, V. (2005). Triangulation. Nurse researcher, 12(4), 4-6.
