Too Sick Not to Exercise
Too Sick Not to Exercise
The results of this feasibility study demonstrate that a home-based, light-intensity walking and balance exercise intervention for patients immediately following discharge from the hospital after surgery for NSCLC is feasible, safe, well tolerated, and highly acceptable. Likewise, the results indicated that the intervention positively impacted end points such as CRF severity; PSE for fatigue self-management, walking, and balance; CRF self-management behaviors (walking and balance exercise); and functional performance (number of steps taken per day). Relative to functional performance, there was some speculation that the number of steps taken each day by study participants may decrease with increased intervention walking durations. That was not the case in this feasibility study as participants increased their daily walking activity at the same time they were increasing their intervention walking duration. This is consistent with the expectation that increased functional capacity through exercise would increase functional performance. Likewise, there was speculation that the initiation of adjuvant chemotherapy and/or radiation therapy would trigger the cessation from the exercise intervention. However, this was not the case as participants continued the exercise intervention. Likewise, the question of whether participants would continue to want to exercise after phase 1 was answered as all 7 participants elected to participate in phase 2 of the study, which extended the intervention an additional 10 weeks. Also, because CRF is one of the most frequently reported and distressing symptoms for persons with NSCLC, the findings that PSEFSM and CRF severity improved to levels better than presurgical levels with the incorporation of a safe, well-tolerated and highly acceptable PSEFSM-enhancing intervention are promising. Moreover, being able to provide an intervention to a highly vulnerable population (postsurgical NSCLC participants) within days of discharge from the hospital could provide a means for rehabilitation that does not currently exist.
To date, postsurgical exercise interventions for the cancer population have been initiated much later in the recovery period; consisted of moderate to vigorous intensity; were longer in duration (>10 weeks); were structured, inpatient or facility based; and have not incorporated transitional plans from hospital to home to address fatigue. The literature indicates that adoption of exercise even in healthy populations is difficult and requires PSE to engage in exercise. Consequently, this exercise intervention was designed mindful of the challenges that both healthy persons and those recovering from NSCLC surgery would face in an effort to enhance PSE for CRF self-management to augment their rehabilitation. Thus, the exercise intervention in this study was designed to span 6 weeks starting promptly after hospital discharge extending to a critical juncture where patients may transition to initiation of adjuvant therapy (eg, chemotherapy, radiation therapy) and/or can increase to more demanding physical activity levels (eg, greater lifting, pushing, pulling). In addition, the exercise intervention was initiated promptly after discharge from the hospital, knowing that CRF can be induced by many factors including becoming less active, which knowingly occurs when a person is hospitalized after undergoing surgery for NSCLC. Our pressing rehabilitation concern was driven by the follow-up results of the renowned Dallas Bedrest and Training Study conducted in 1966. In the follow-up study conducted by McGuire et al, the short-term effects of 3 weeks of bed rest in 5 healthy young men at age 20 years in 1966 were found to be more profound than 30 years of aging, highlighting the deleterious effects that inactivity can have on a patient. In this current study, with participants having a mean hospital stay of 7.8 days, the immediacy of the intervention for NSCLC patients is deemed critical. Also, to promote the initiation of exercise for participants after surgery, we used a light-intensity, less-than-3.0 metabolic equivalents, rather than a moderate- to vigorous-intensity walking and balance exercise, which corresponds to usual activities of daily living. The American College of Sports Medicine, the American Heart Association, and the American Cancer Society recommend that persons who are sedentary, deconditioned, recovering from surgery, and with multiple comorbid conditions first focus on developing a habit of regular exercise including walking in order to complete usual activities of daily living. Likewise, balance exercises were combined with walking because balance exercises when combined with walking have been found to have a positive effect on balance as well as walking confidence and speed.
Discussion
The results of this feasibility study demonstrate that a home-based, light-intensity walking and balance exercise intervention for patients immediately following discharge from the hospital after surgery for NSCLC is feasible, safe, well tolerated, and highly acceptable. Likewise, the results indicated that the intervention positively impacted end points such as CRF severity; PSE for fatigue self-management, walking, and balance; CRF self-management behaviors (walking and balance exercise); and functional performance (number of steps taken per day). Relative to functional performance, there was some speculation that the number of steps taken each day by study participants may decrease with increased intervention walking durations. That was not the case in this feasibility study as participants increased their daily walking activity at the same time they were increasing their intervention walking duration. This is consistent with the expectation that increased functional capacity through exercise would increase functional performance. Likewise, there was speculation that the initiation of adjuvant chemotherapy and/or radiation therapy would trigger the cessation from the exercise intervention. However, this was not the case as participants continued the exercise intervention. Likewise, the question of whether participants would continue to want to exercise after phase 1 was answered as all 7 participants elected to participate in phase 2 of the study, which extended the intervention an additional 10 weeks. Also, because CRF is one of the most frequently reported and distressing symptoms for persons with NSCLC, the findings that PSEFSM and CRF severity improved to levels better than presurgical levels with the incorporation of a safe, well-tolerated and highly acceptable PSEFSM-enhancing intervention are promising. Moreover, being able to provide an intervention to a highly vulnerable population (postsurgical NSCLC participants) within days of discharge from the hospital could provide a means for rehabilitation that does not currently exist.
To date, postsurgical exercise interventions for the cancer population have been initiated much later in the recovery period; consisted of moderate to vigorous intensity; were longer in duration (>10 weeks); were structured, inpatient or facility based; and have not incorporated transitional plans from hospital to home to address fatigue. The literature indicates that adoption of exercise even in healthy populations is difficult and requires PSE to engage in exercise. Consequently, this exercise intervention was designed mindful of the challenges that both healthy persons and those recovering from NSCLC surgery would face in an effort to enhance PSE for CRF self-management to augment their rehabilitation. Thus, the exercise intervention in this study was designed to span 6 weeks starting promptly after hospital discharge extending to a critical juncture where patients may transition to initiation of adjuvant therapy (eg, chemotherapy, radiation therapy) and/or can increase to more demanding physical activity levels (eg, greater lifting, pushing, pulling). In addition, the exercise intervention was initiated promptly after discharge from the hospital, knowing that CRF can be induced by many factors including becoming less active, which knowingly occurs when a person is hospitalized after undergoing surgery for NSCLC. Our pressing rehabilitation concern was driven by the follow-up results of the renowned Dallas Bedrest and Training Study conducted in 1966. In the follow-up study conducted by McGuire et al, the short-term effects of 3 weeks of bed rest in 5 healthy young men at age 20 years in 1966 were found to be more profound than 30 years of aging, highlighting the deleterious effects that inactivity can have on a patient. In this current study, with participants having a mean hospital stay of 7.8 days, the immediacy of the intervention for NSCLC patients is deemed critical. Also, to promote the initiation of exercise for participants after surgery, we used a light-intensity, less-than-3.0 metabolic equivalents, rather than a moderate- to vigorous-intensity walking and balance exercise, which corresponds to usual activities of daily living. The American College of Sports Medicine, the American Heart Association, and the American Cancer Society recommend that persons who are sedentary, deconditioned, recovering from surgery, and with multiple comorbid conditions first focus on developing a habit of regular exercise including walking in order to complete usual activities of daily living. Likewise, balance exercises were combined with walking because balance exercises when combined with walking have been found to have a positive effect on balance as well as walking confidence and speed.
