title: Implementing a home-based exercise program for patients with advanced, incurable diseases after discharge and their caregivers: lessons we have learned.
abstract: BACKGROUND
  Palliative care (PC) patients experience loss of physical function which usually impedes mobility, autonomy and quality of life. We aimed at examining the feasibility of a home-based exercise program for patients with advanced, incurable diseases after discharge.
  
  
  RESULTS
  This was a single-arm pilot study (WHO-ICTRP: DRKS00005048). The 12-week home-based program comprised strength, balance, flexibility and endurance components. Patients with a presumed life expectancy of 6-12 months were recruited during a 6-months period on a specialized PC and a radiation therapy ward. We chose the De Morton Mobility Index as primary outcome. Secondary outcomes were quality of life, 6-min walk test and others. A total of 145 patients were screened, 103 (98%) out of 105 patients on the specialized PC ward could not be included, mostly because of a low performance status [n = 94; 90%; Eastern Cooperative Oncology Group (ECOG) >2]. The only two eligible patients declined to participate. Eleven out of 40 patients (28%) were eligible on the radiation therapy ward. However, only one patient (9%) participated but dropped out 2 days later (upcoming surgery). Distance to the hospital (n = 3; 30%) and considering additional tasks as "too much" (n = 3; 30%) were most common reasons for non-participation.
  
  
  CONCLUSIONS
  Establishing a home-based exercise program for inpatients after discharge was not feasible mainly due to non-eligibility and lack of demand. For future trials, we suggest that choosing (1) outpatients with (2) an ECOG of ≤2 and (3) an estimated survival of ≥9 months could enhance participation in home-based exercise programs.
authors.affiliation: Department of Palliative Care, University Medical Center Freiburg, Robert-Koch-Straße 3, 79106, Freiburg, Germany. waldemar.siemens@uniklinik-freiburg.de.
authors.forename: Waldemar
authors.initials: W
authors.lastname: Siemens
authors.affiliation: Department of Internal Medicine, Institute for Exercise- and Occupational Medicine, University Medical Center Freiburg, Hugstetter Str. 49, 79106, Freiburg, Germany. anja.wehrle@uniklinik-freiburg.de.
authors.forename: Anja
authors.initials: A
authors.lastname: Wehrle
authors.affiliation: Department of Palliative Care, University Medical Center Freiburg, Robert-Koch-Straße 3, 79106, Freiburg, Germany. jan.gaertner@uniklinik-freiburg.de.
authors.forename: Jan
authors.initials: J
authors.lastname: Gaertner
authors.affiliation: Department of Radiation Oncology, University Medical Center Freiburg, Robert-Koch-Straße 3, 79106, Freiburg, Germany. michael.henke@uniklinik-freiburg.de.
authors.forename: Michael
authors.initials: M
authors.lastname: Henke
authors.affiliation: Department of Internal Medicine, Institute for Exercise- and Occupational Medicine, University Medical Center Freiburg, Hugstetter Str. 49, 79106, Freiburg, Germany. peter.deibert@uniklinik-freiburg.de.
authors.forename: Peter
authors.initials: P
authors.lastname: Deibert
authors.affiliation: Department of Palliative Care, University Medical Center Freiburg, Robert-Koch-Straße 3, 79106, Freiburg, Germany. gerhild.becker@uniklinik-freiburg.de.
authors.forename: Gerhild
authors.initials: G
authors.lastname: Becker
mesh_terms: D017028:Caregivers; D005081:Exercise Therapy; D006699:Home Care Services; D006801:Humans; D010166:Palliative Care; D010351:Patient Discharge; D011878:Radiotherapy