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Am Fam Physician. 1998;57(8):1942

Fatigue and impaired physical performance are common side effects of cancer treatment, affecting up to 70 percent of all patients undergoing radiation treatment or chemotherapy. These problems are due, in part, to inactivity during hospitalization and the acute phase of treatment. Dimeo and colleagues evaluated the effects of aerobic exercise on the loss of physical performance in patients undergoing high-dose chemotherapy followed by autologous peripheral blood stem cell transplant. The impact of aerobic activity on the incidence and severity of complications during this treatment was also reviewed.

Eighty patients between the ages of 18 and 60 years with solid cancerous tumors were considered for enrollment in the study. Of that group, 70 were randomly assigned to one of two groups. Thirty-three patients were assigned to a regular exercise protocol during treatment, while the remaining 37 were assigned to the control group with no intervention. One week before starting chemotherapy, all patients underwent a treadmill stress test to determine baseline physical performance.

Patients in the training group followed a daily regimen in which they “biked” on a bed ergometer for one minute in order to reach at least 50 percent of their cardiac reserve, then rested for one minute. This exercise-rest regimen was performed 15 times, so patients were training for 30 minutes a day. In addition, complete blood cell counts and serum chemistry measurements were obtained each day 12 hours after training. On the day of discharge, patients in both groups underwent resting electrocardiography, echocardiography and a treadmill stress test. Hematologic and nonhematologic toxicities also were assessed at this time.

At the beginning of the study, the baseline physical performance of both groups was the same. After hospitalization with no exercise, patients in the control group had a 27 percent higher loss of physical function than those in the exercise group. Hemoglobin and hematocrit levels were similar for both groups at the beginning and end of the study, but the training group had a shorter duration of neutropenia and thrombocytopenia. In addition, patients in the treatment group reported less severe pain and diarrhea, less need for analgesics and a shorter average hospital stay than those in the control group. During the exercise program no injuries to the patients were reported.

The authors conclude that initiation of an aerobic exercise program immediately after high-dose chemotherapy is safe and may prevent severe loss of physical performance. Exercise may also decrease some of the toxic side effects associated with chemotherapy.

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Copyright © 1998 by the American Academy of Family Physicians.

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