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Intervention

    Table 2. Centrally Acting Stimulants for Adult Cancer Patients continued...

    In a study of 545 breast cancer survivors who were, on average, 6 months postdiagnosis, increased physical activity was consistently related to both improved physical functioning and reduced fatigue and bodily pain. Prediagnosis physical activity was associated with better physical functioning at 39 months but generally unrelated to symptoms. Increased physical activity after cancer was related to less fatigue and pain and better physical functioning. Significant positive associations were found with moderate to vigorous recreational physical activity but not household activity. This study suggests that breast cancer survivors may be able to decrease fatigue and bodily pain and be better able to pursue daily activities by increasing their recreational physical activities after cancer.[48][Level of evidence: II]

    Exercise for patients with advanced or terminal disease is difficult to study but may yield similar benefits. The ability of patients with advanced cancer who are in hospice care and on a physical therapy regimen to carry out activities of daily living has been reported to improve in one study.[49][Level of evidence: III] Improved satisfaction with the physical therapy regimen was reported when family involvement in the program increased. A randomized study suggested that exercise improved fatigue during breast cancer treatment.[50][Level of evidence: I]

    When educating patients about activity with respect to CRF, one important goal to consider is inclusion of 3 to 5 hours per week of moderate activity. It is critical that:

    • Patients choose a type of exercise they enjoy.
    • Providers discuss specific implementation strategies (type of exercise, time of day, days of the week, location of activity) to enable patients to make frequent activity a reality.

    Beginning with lighter activity for shorter periods of time and building in intensity and length of time may be required. Studies have confirmed this can be safely done both during active treatment and after treatment is completed.[40]

    Variations of exercise that have a mind-body component include complementary modalities such as qigong, tai chi, and yoga, popular interventions that are being studied for their effects on CRF. These modalities are unique in that they incorporate cognitive and spiritual elements with movement, stretching, and balance. One fairly large study evaluated medical qigong for CRF.[51] This study reported significant improvements in fatigue and several other aspects of quality of life for the intervention group versus usual care. The major weakness limiting interpretation and integration of these results is that there was no attempt to control for attention or any of the social aspects of the intervention.

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