Excellence in Research Writing/Best Paper Award

Research focuses on benefits of exercise among cancer patients

Andrea L. Cheville, M.D., a physiatrist at Mayo Clinic in Rochester, Minn., received the Excellence in Research Writing/Best Paper Award at the 2011 annual meeting of the Association of Academic Physiatrists (AAP). Dr. Cheville's article, "Therapeutic Exercise During Outpatient Radiation Therapy for Advanced Cancer: Feasibility and Impact on Physical Well-Being," appeared in the August 2010 issue of the American Journal of Physical Medicine & Rehabilitation.

According to the AAP, this award is given for scientific articles submitted to the American Journal of Physical Medicine & Rehabilitation during the year. The selection is made by a committee from the editorial board, appointed by the editor.

"My research team and I were thrilled by this unexpected honor," says Dr. Cheville. "Cancer has not historically been a focus of the rehabilitation medicine community's interest. We are hopeful that this may be changing as the societal burden of cancer-related disability continues to grow."

According to Dr. Cheville and co-authors, plenty of data support the idea that therapeutic exercise directed by rehabilitation specialists may reduce disability among patients with advanced cancer. "Resistive exercise enhances skeletal muscle anabolic processes and limits the cachexia often associated with cancer and chronic disease," explains Dr. Cheville. "We also know that exercise reduces immobility-associated morbidities such as venous thrombi and bone loss that are prevalent in advanced cancers."

Despite patient enthusiasm for therapeutic exercise and its demonstrated efficacy, Mayo researchers note that appropriate programs are seldom offered or delivered to patients with advanced cancer. Lack of availability and other logistical barriers revealed in patient surveys and qualitative research may contribute to underutilization of rehabilitative services by cancer patients.

"Survey data underscore the need to examine treatment models that coordinate rehabilitative therapies with the delivery of cancer treatments," says Dr. Cheville.

The Mayo Clinic research outlined in Dr. Cheville's paper examines the benefits and feasibility of delivering a physical therapy-based exercise program as an integrated part of a multidisciplinary intervention designed to maintain and improve the quality of life for outpatients receiving radiation therapy for advanced cancer.

In designing the study, Dr. Cheville's team posed two questions:

• Can these patients tolerate or benefit from such a program?
• Can the exercise program be delivered in a way that integrates fluidly with other care provided?

Study design

The multidisciplinary intervention was tested in a randomized controlled trial, enrolling 103 adult patients undergoing radiation therapy for advanced cancer with prognoses of six months or longer and five-year survival estimates of up to 50 percent. Study participants were randomly assigned to usual care or participation in eight 90-minute, multidisciplinary interventional sessions, with 30 minutes of each session devoted to physical therapy (PT).

PT consisted of truncal and limb isodynamic strengthening targeting major upper and lower limb muscle groups as well as education and provision with instructional materials. Physical well-being and fatigue were assessed with Linear Analogue Self-Assessment. The Profile of Mood States-Short form, including Fatigue-Inertia and Vigor-Activity subscales, was also administered.

Results and conclusions

This trial yielded several striking results. PT session attendance was 89.3 percent. Relative to baseline, mean physical well-being Linear Analogue Self-Assessment scores at week four improved in the intervention group and declined significantly in the control group.

"The participants' baseline functional status (reflected in their Tinetti Scale scores, intact physical examinations and normal walking speeds), their attendance rate at the PT sessions, and their self-assessment scores suggest that patients with advanced cancer who are undergoing radiation can engage in and benefit from regular exercise," explains Dr. Cheville. Acknowledging that intergroup differences were not preserved after completion of the PT intervention, Dr. Cheville points out that future work must examine the capacity of telephone, Internet or in-person follow-up to extend gains beyond the study interval.