Exercise and Quality of Life Outcomes in Patients With Cancer

https://doi.org/10.1016/j.soncn.2007.08.007Get rights and content

Objective

To review the evidence of the effects of exercise interventions in patients with cancer in each of four quality-of-life domains: physical, psychological, social, and spiritual.

Data Sources

Research articles, abstracts, literature review.

Conclusion

There is strong evidence to support positive effects of exercise on physical and psychological well-being. Exercise improves physical function, muscle strength, emotional well-being, self esteem, decreases fatigue, anxiety, and depression, and helps maintain weight. Data suggest exercise fosters social functioning and more research is needed on the relationship of exercise and spiritual well-being.

Implications for Nursing Practice

There is sufficient evidence to support exercise as an intervention to enhance a cancer patient's physical functioning and psychological well-being. Nurses should be encouraged to integrate physical activity recommendations into practice, tailored to the individual's health condition and mutual goal setting.

Section snippets

Exercise and Health-Related Quality of Life in Cancer Patients

Health-related QOL is a multi-dimensional construct that commonly includes four common domains: physical, social, psychological, and spiritual aspects of one's life. QOL represents an individual's subjective perspective. Multiple instruments are available for QOL assessments but they reflect varying conceptualizations and thus differ in what they measure.11, 12 It is critical to understand what instruments measure to interpret the findings. Well-being and functional ability or status are

Exercise and the Physical Domain of QOL

The strongest evidence of the effect of exercise is on the symptom of fatigue7, 42, 43 and physical functioning (eg, cardiovascular fitness, subjective physical well-being, strength).6, 8, 10 Evidence to support the benefits of exercise on the physical QOL domain for cancer survivors are described in several articles in this issue.44, 45, 46

Exercise and Psychological Domain of QOL

Psychological distress is common following a cancer diagnosis and is characterized by vulnerability, uncertainty, loss of control, and existential concerns. Exercise interventions in patients with cancer over the past decade support that PA can decrease psychological distress, enhance emotional well-being, and promote adaptation.8, 47, 48, 49, 50, 51

Anxiety and depression have been the most common psychological responses assessed in exercise studies with cancer patients. Evidence from

Exercise and Social Domain of QOL

The impact of exercise on the social domain of QOL for cancer survivors has been reported in a few studies related to social well-being or role performance (Table 1). Data suggest that exercise can improve social well-being, functional ability in work and family roles, and may increase feelings of happiness and life satisfaction. The role of social support has not been explicitly addressed, which may have a very important role in exercise adherence, feelings of confidence to participate in

Exercise and Spirituality Domain of Quality of Life

The spirituality domain includes the meaning of illness, transcendence, hope, uncertainty, and inner strength.66 No studies were identified that specifically addressed spirituality in the context of exercise and QOL outcomes. This may be explained in part by the lack of spirituality as a QOL domain in many of the common instruments used. Yet, there are some data that suggest a linkage. Increased confidence to participate in exercise,29 less uncertainty,40 and feelings of empowerment36, 67 may

Conclusion

There is sufficient evidence for nurses to promote exercise in patients diagnosed with cancer. Following careful assessment and tailoring an exercise prescription based on the health status of the individual,46 exercise has established physical and psychological benefits for those at risk or diagnosed with cancer. Research to date also suggests that exercise improves overall QOL but there is a need to further explore the role of exercise in more depth within each of the QOL domains, to identify

Acknowledgment

The authors thank Stacey Young-McCaughan, PhD for her review and critique of the manuscript.

M. Tish Knobf, RN, PhD, FAAN: American Cancer Society Professor of Oncology Nursing, Yale University School of Nursing, New Haven, CT.

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    M. Tish Knobf, RN, PhD, FAAN: American Cancer Society Professor of Oncology Nursing, Yale University School of Nursing, New Haven, CT.

    Rita Musanti, RN, PhD, APN-C: Adult Nurse Practitioner, Cancer Institute of New Jersey, New Brunswick, NJ.

    Jennifer Dorward, RN, MSN, ACNP: Acute Care Nurse Practitioner, Team Health Inc, Emergency Department, Long Beach Veterans Administration Hospital, Long Beach, CA.

    Dr. Knobf was supported in part by the American Cancer Society Professor of Oncology Nursing grant and Dr. Musanti was supported in part by an award from the Greater NYC Affiliate of the Susan G. Komen Breast Cancer Foundation, Inc.

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