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The development of an evidence-based physical self-management rehabilitation programme for cancer survivors.
Patient Educ Couns 2008; 71(2):169-90PE

Abstract

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.

CONCLUSION

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.

PRACTICE IMPLICATIONS

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.

Authors+Show Affiliations

Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. e.van.weert@rev.umcg.nlNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

18255249

Citation

van Weert, Ellen, et al. "The Development of an Evidence-based Physical Self-management Rehabilitation Programme for Cancer Survivors." Patient Education and Counseling, vol. 71, no. 2, 2008, pp. 169-90.
van Weert E, Hoekstra-Weebers JE, May AM, et al. The development of an evidence-based physical self-management rehabilitation programme for cancer survivors. Patient Educ Couns. 2008;71(2):169-90.
van Weert, E., Hoekstra-Weebers, J. E., May, A. M., Korstjens, I., Ros, W. J., & van der Schans, C. P. (2008). The development of an evidence-based physical self-management rehabilitation programme for cancer survivors. Patient Education and Counseling, 71(2), pp. 169-90. doi:10.1016/j.pec.2007.11.027.
van Weert E, et al. The Development of an Evidence-based Physical Self-management Rehabilitation Programme for Cancer Survivors. Patient Educ Couns. 2008;71(2):169-90. PubMed PMID: 18255249.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The development of an evidence-based physical self-management rehabilitation programme for cancer survivors. AU - van Weert,Ellen, AU - Hoekstra-Weebers,Josette E H M, AU - May,Anne M, AU - Korstjens,Irene, AU - Ros,Wynand J G, AU - van der Schans,Cees P, Y1 - 2008/02/05/ PY - 2007/03/19/received PY - 2007/11/28/revised PY - 2007/11/28/accepted PY - 2008/2/8/pubmed PY - 2008/7/4/medline PY - 2008/2/8/entrez SP - 169 EP - 90 JF - Patient education and counseling JO - Patient Educ Couns VL - 71 IS - 2 N2 - 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. CONCLUSION: 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. PRACTICE IMPLICATIONS: 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. SN - 0738-3991 UR - https://www.unboundmedicine.com/medline/citation/18255249/The_development_of_an_evidence_based_physical_self_management_rehabilitation_programme_for_cancer_survivors_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0738-3991(07)00485-5 DB - PRIME DP - Unbound Medicine ER -