The development of an evidence-based physical self-management rehabilitation programme for cancer survivors.
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.


CONCLUSIONS
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.


CONCLUSIONS
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.
van Weert
Ellen
E
Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. e.van.weert@rev.umcg.nl
Hoekstra-Weebers
Josette E H M
JE
May
Anne M
AM
Korstjens
Irene
I
Ros
Wynand J G
WJ
van der Schans
Cees P
CP
D000203:Activities of Daily Living; D000223:Adaptation, Psychological; D019317:Evidence-Based Medicine / Q000458:organization & administration*; D005081:Exercise Therapy / Q000458:organization & administration*; D017079:Exercise Tolerance; D005221:Fatigue / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D008019:Life Style; D015201:Meta-Analysis as Topic; D018908:Muscle Weakness / Q000209:etiology / Q000517:prevention & control; D020380:Needs Assessment; D009369:Neoplasms / Q000150:complications / Q000523:psychology / Q000534:rehabilitation*; D010349:Patient Compliance / Q000523:psychology; D016730:Program Development; D011788:Quality of Life / Q000523:psychology; D016032:Randomized Controlled Trials as Topic; D012107:Research Design; D012380:Role; D012648:Self Care / Q000379:methods* / Q000523:psychology; D020377:Self Efficacy; D017741:Survivors / Q000523:psychology; D016896:Treatment Outcome