Document Detail

The development of an evidence-based physical self-management rehabilitation programme for cancer survivors.
MedLine Citation:
PMID:  18255249     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: This paper describes the development of a physical training programme for cancer patients. Four related but conceptually and empirically distinct physical problems are described: decreased aerobic capacity, decreased muscle strength, fatigue and impaired role physical functioning. The study aimed to identify the optimal content for an exercise programme that addresses these four physical problems, based on the highest level of evidence available. The study further aimed to review the evidence available on the delivery of the programmes. The final goal was to develop a programme in which content and delivery are based on the best available evidence. METHODS: Literature searches (PUBMED and MEDLINE, to July 2006) on content looked for evidence about the efficacy of exercise on aerobic capacity, muscle strength, fatigue and impaired role physical functioning. Literature searches on delivery looked for self-management and/or self-efficacy enhancing techniques in relation to outcome, adherence to and/or adoption of a physically active lifestyle. RESULTS: Evidence on the effectiveness of exercise in cancer patients varies and increases when moving from muscle strength (RCT level), fatigue and physical role functioning to aerobic capacity (all at the meta-analysis level). Effect sizes for aerobic capacity were moderate, while effect sizes for fatigue and physical role functioning were zero and/or small. Many of the studies have significant methodological shortcomings. There was some evidence (meta-analyses) that self-management programmes and self-efficacy enhancing programmes have beneficial effects on health outcomes in a variety of chronic diseases, on the quality of life in cancer patients, and on exercise adherence and later exercise behaviour. CONCLUSION: Limited data are available on the effectiveness of exercise for cancer patients. Although evidence supports the positive effects of exercise on exercise capacity during and after completion of cancer treatment, the effects for fatigue and role functioning are ambiguous. Evidence on the effectiveness of progressive exercise training on muscle strength is promising. In addition, some evidence supports the positive effects of self-management programmes and self-efficacy enhancing programmes on health outcomes, exercise adherence and later exercise behaviour. PRACTICE IMPLICATIONS: The resulting programme was developed on the basis of the highest quality of evidence available regarding content and delivery. The content is based on information obtained from the present review, and on the recommendations of the American College of Sports Medicine. Potential advantages of the programme include: (a) tailored physical training towards focusing on the patient's established problems and (b) delivery of the training as a self-management programme that might have beneficial effects on health outcome, exercise adherence and a long-term physically active lifestyle.
Ellen van Weert; Josette E H M Hoekstra-Weebers; Anne M May; Irene Korstjens; Wynand J G Ros; Cees P van der Schans
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review     Date:  2008-02-05
Journal Detail:
Title:  Patient education and counseling     Volume:  71     ISSN:  0738-3991     ISO Abbreviation:  Patient Educ Couns     Publication Date:  2008 May 
Date Detail:
Created Date:  2008-04-02     Completed Date:  2008-07-03     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8406280     Medline TA:  Patient Educ Couns     Country:  Ireland    
Other Details:
Languages:  eng     Pagination:  169-90     Citation Subset:  N    
Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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MeSH Terms
Activities of Daily Living
Adaptation, Psychological
Evidence-Based Medicine / organization & administration*
Exercise Therapy / organization & administration*
Exercise Tolerance
Fatigue / etiology,  prevention & control
Life Style
Meta-Analysis as Topic
Muscle Weakness / etiology,  prevention & control
Needs Assessment
Neoplasms / complications,  psychology,  rehabilitation*
Patient Compliance / psychology
Program Development
Quality of Life / psychology
Randomized Controlled Trials as Topic
Research Design
Self Care / methods*,  psychology
Self Efficacy
Survivors* / psychology
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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