title: Home-based functional walking program for advanced cancer patients receiving palliative care: a case series.
abstract: BACKGROUND
  Although meta-analyses have demonstrated that physical activity can positively impact quality of life outcomes in early stage cancer patients, it is not yet known whether these benefits can be extended to patients with advanced cancer. In a previous pilot survey of patients with advanced cancer with a median survival of 104 days, participants felt willing and able to participate in a physical activity intervention, and reported a strong preference for walking and home-based programming. Here, we report on the initial development and feasibility of a home-based functional walking program in patients with advanced cancer receiving palliative care.
  
  
  METHODS
  Nine adult patients were recruited from outpatient palliative care clinics and palliative home care. A pilot intervention trial was conducted over a 6-week period. The McGill Quality of Life Questionnaire (MQOL), Late Life Function and Disability Instrument (LLFDI), Edmonton Symptom Assessment System (ESAS), Seniors Fitness Test, four-test balance scale, and grip strength, were performed pre- and post-intervention. Participants wore activPAL™ accelerometers to monitor ambulatory activity levels.
  
  
  RESULTS
  Of the nine recruited participants, three participants dropped out prior to baseline testing due to hospital admission and feeling overwhelmed, and three participants dropped out during the intervention due to severe symptoms. Only three participants completed the intervention program, pre- and post-intervention assessments: two reported improvements in total MQOL scores, yet all three shared an overall trend towards worsening symptom and total fatigue scores post-intervention. Two participants passed away within 90 days of completing the intervention.
  
  
  CONCLUSIONS
  This case series demonstrates the challenges of a physical activity intervention in patients with advanced cancer receiving palliative care. Further feasibility research is required in this patient population.
  
  
  BACKGROUND
  This study is registered under ClinicalTrials.gov as NCT00438620.
authors.affiliation: Department of Symptom Control and Palliative Care, Cross Cancer Institute, 11560 University Avenue, Edmonton, Alberta, T6G 1Z2, Canada.
authors.forename: Sonya S
authors.initials: SS
authors.lastname: Lowe
authors.affiliation: Department of Symptom Control and Palliative Care, Cross Cancer Institute, 11560 University Avenue, Edmonton, Alberta, T6G 1Z2, Canada ; Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Alberta, Canada.
authors.forename: Sharon M
authors.initials: SM
authors.lastname: Watanabe
authors.affiliation: Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Alberta, Canada.
authors.forename: Vickie E
authors.initials: VE
authors.lastname: Baracos
authors.affiliation: Physical Activity and Cancer, Physical Education & Recreation, University of Alberta, E-488 Van Vliet Centre, Edmonton, Alberta, T6G 2H9, Canada.
authors.forename: Kerry S
authors.initials: KS
authors.lastname: Courneya
keywords: Cancer; Palliative care; Physical activity; Quality of life; Walking