In this quasi-experimental study, adult patients with colorectal cancer referred to Shefa Hospital of Ahwaz in 2005 were included. The sample size was 36 and the researcher presented in the research environment during the working hours to select the hospitalized patients who had the entry criteria and were willing to participate in the study. The entry criteria included having colorectal cancer, under-going chemotherapy with special protocol, being 18 to 65 years old, being diagnosed with colorectal cancer at least 3 months ago and being able to do exercise.

Patients with heart diseases, diabetes mellitus, hypertension, anemia, decreased white blood cells, asthma, imbalance, severe pain, and bone metastases were excluded from the study. Selection and exclusion of the patients were based on their medical files and approval of their physicians.

At the beginning, after explaining the effects of exercise on body and the method and receiving permission from the patients, each of them completed a questionnaire including demographic data and a fatigue assessment form to determine the severity of their primary fatigue. Demographic and disease data questionnaire included 21 questions about height, weight, age, gender, education, job, income, disease level, disease duration, treatments received so far, type and amount of medications in chemotherapy, number of chemotherapy periods, other medications, other diseases such as diabetes mellitus, heart diseases etc., their previous exercises before and during the disease, and the type of exercise and its amount. The fatigue assessment form also included 10 questions assessing current fatigue, usual fatigue in past 24 hours and the most severe fatigue that patients had experienced in past 24 hours, as well as the effect of fatigue on their general activity, mood, walking ability, communicating with others, and enjoying life in past 24 hours. Each of these questions was scored based on a scale of 0 to 10. Reliability of this instrument was approved with 98% correction coefficient in a study in Canada by Groenwald.¹⁴

Also, in the study of Rad in 2001, the correlation coefficient was found to be as r = 85.¹⁵

The exercise included the soft motions of the body organs and head and neck for 40 minutes. Before starting the exercise, the stage of warming body was practiced for 5 minutes and then flexion and extension of the head and neck and extremity joints was performed for 30 minutes. At the end stage, body cooling was carried out for 5 minutes. Exercise was done 3 times a week for a month between the chemotherapy sessions. The patients participating in the study were divided into 3 groups of 11 to 13 people, one group for women and two other groups for men. Exercises were done by a physical trainer working at Shahid Chamran University of Ahwaz. It was hold in the gym of the Medical University.

Right before the exercise, the patients’ blood pressure and pulse were controlled as the basic vital signs and after the exercise also, their blood pressure and pulse was recorded so that in case of any problem, they would be excluded from the study. The questionnaire on fatigue was recorded at the time of sample selection, after starting exercise, at the end of each week and finally at the end of the exercise program to assess their fatigue.

The data which collected by the questionnaires were analyzed using Friedman test via SPSS version 13 software.

The patients in the study consisted of 69% men and 31% women. Of all, 77.8% had no exercise before the disease and 47.2% had often fatigue. Twelve patients (33.3%) were in the grade 3 of the disease and 9 (25%) were diagnosed 6 months ago.

The findings of the study showed that the mean of fatigue severity during the exercise weeks were different from the week before the exercise. The mean of the fatigue decreased from week 0 (before the exercise) to week 4 during the exercise. Friedman test showed a significant difference between all weeks from the first to the fourth (p < 0.01) (Table 1).

According to the findings of this study, most subjects had not exercised before their disease. Exercising increases the physical ability and tolerance by improving cardiovascular and musculoskeletal conditions. Those who do not exercise show less strength against the diseases and their complications.¹⁶ Also, almost half of the patients in this study had sometimes felt fatigue before the intervention. Fatigue in patients suffering from cancer is a prevalent and annoying symptom during the disease or its treatment.¹¹

One third of the subjects in the study were in grade 3 of their disease and the rest were in grades 1 and 2. Six months were passed from the disease diagnosis of 25% of the patients. Various studies showed that the more time passed from the disease, the more patients would feel fatigue.^{3, 17}

According to the objective of this study, comparing the severity of fatigue before and after an exercising program, the findings showed that the mean of the fatigue on the third and fourth weeks were significantly different from the beginning and the first and second weeks; also the fourth week was significantly different from the third week. Dimeo et al found that aerobic exercise program improves physical activity of the patients during the recovery from tumor surgery.¹⁸ Also, Windsor et al revealed that mild walking improves physical condition of patients undergoing physiotherapy without significant increase in their fatigue; the improvement of the physical condition is necessary to recover from fatigue due to radiotherapy.¹⁹

The results showed that exercising reduced fatigue in patients. Dimeo et al also said that a daily exercising program in accordance with the individual tolerance can reduce lack of physical functioning related to the treatments in patients with blood malignancy undergoing chemotherapy.²⁰ The present study can help nurses to solve one of the main problems of their patients by providing a method to prevent and control fatigue in colorectal cancer patients. Also, exercise as a care program can be a great help to nursing management by reducing treatment costs.

Considering the conducted studies and experiences of the researchers during this study, it is recommended that clinical nurses working in oncology wards receive explanations about the necessity of using exercising programs so that they include such programs in their caring activities for their patients and by giving pamphlets to the patients, in order to perform the exercises.

The authors declare no conflict of interest in this study.

Special thanks go to the faculty members of the Scool of Nursing and Midwifery, Ahwaz Jondi Shapour University of Medical Sciences, Mr. Abdolali Shariati the supervisor and Ms. Seddighe Fayyazi the assistant supervisor and Mr Hamed Tabesh the statistical supervisor, who helped conduction of this thesis. Also, thanks go to Ms. Elahe Elahi the head of Shefa Library and all the staff and patients of the chemotherapy and adult hematology wards in Shefa Hospital of Ahwaz.