|
Beating Fatigue > Diet & Lifestyle, Vitamins & Supplements, Staying
Fit
Exercise may beat fatigue from prostate
radiation
 Men randomized to a moderate intensity exercise intervention during
their course of radiotherapy for localized prostate cancer reported less
fatigue than men in the control arm of a study recently published in
Cancer (2004;101:550–557).
Though fatigue is a commonly recognized consequence of radiotherapy,
there is little evidence regarding the best way to prevent or minimize
this side effect. Clinicians often advise patients to continue their
usual activities when possible and rest if they become tired. Although
exercise interventions have been reported to improve fatigue in patients
receiving radiotherapy or chemotherapy, this strategy had not been studied
in any randomized controlled clinical trials. For this reason, Phyllis
M. Windsor, MSc, MD, and colleagues from Ninewells Hospital and Medical
School in Dundee, Scotland, studied 66 men receiving external beam radiation
for early stage prostate cancer. Half were assigned to walk for about
30 minutes several days a week, while the rest were told to go about
their normal activities, but rest if they felt tired. Fatigue was measured
with the Brief Fatigue Inventory, a nine-item questionnaire that was
self-administered before beginning radiation, after receiving 5, 10,
15 and 20 fractions of conformal radiotherapy, and four weeks after the
end of treatment.
Before starting radiation, there were no differences between the two
groups in levels of fatigue. After completing the 20-fraction course
of radiation, men in the control group reported feeling more tired than
before treatment (p=0.013), while those who were assigned to walking
regularly reported no change in their fatigue level. Four weeks after
the end of treatment, fatigue scores in the control group had not yet
returned to their pretreatment values, although the difference was not
quite statistically significant (p=0.053), whereas the scores of men
who were exercising showed a slight (albeit nonsignificant) improvement
over their pretreatment reports. A standardized measure of physical performance,
the "shuttle test," found that the walkers were able to walk
24% farther (p=0.0025) during the specified interval of time than the
control group at the end of their radiotherapy regimen.
Those findings aren’t surprising, said Anna Schwartz, FNP, PhD,
FAAN, an expert in physical activity during cancer treatment who was
not involved with the research. Radiation tends to cause fatigue that
gets worse over time as the effects of treatment accumulate. Exercising
can help counteract that trend, she said.
"Almost all patients feel better if they get up and move around
a little bit," said Schwartz, who is Research Associate Professor
in Biobehavioral Nursing and Health Systems at the University of Washington
in Seattle. "People who exercise stay stronger, fitter, and actually
get faster and stronger during treatment. So they are more physically
fit and don’t experience the physical decline and debilitation
that most patients suffer through."
Windsor and her colleagues, in fact, speculated that men who did not
exercise during treatment may have actually lost muscular conditioning,
making everyday activities more difficult and causing greater fatigue.
Encouraging men with prostate cancer to exercise may not only help them
cope with the fatigue of radiation, they say, but also could have long-term
health benefits.
Schwartz agreed. "It should be the advice that all cancer patients
receive," she said, predicting that the prescription will one day
become as routine as physical rehabilitation for cardiac patients.
Exercise may be particularly helpful to men receiving hormone therapy
for prostate cancer, she added, because it can help counteract the muscle
loss and bone thinning hormone therapy can cause. Walking is a good choice
because it is good for the heart and the bones and helps patients maintain
mobility.
Even small amounts of exercise can help, Schwartz said. Someone who
is unable to walk for 10 minutes straight can try walking five minutes
in the morning and five in the evening. Even walking around the living
room is a start. Bedridden patients can ask a physical therapist or other
professional for exercises to do in bed that can help them retain some
muscle tone.
The important thing is to do something, Schwartz said, even when fatigue
sets in. Exercise not only reduces fatigue, but appears to have an indirect
impact on other quality of life domains. Prior studies have reported
that fatigue is correlated with other self-reported side effects of radiotherapy
(for example, urinary and bowel symptoms in men with prostate cancer)
and with depression.
"Patients tell me all the time the most important time for them
to exercise is when they feel their worst," Schwartz said, "but
it’s a balancing act. If someone feels worse when they exercise,
they should rest. But if you keep saying I’m too tired to exercise
today, and tomorrow, over time you start to get the
debilitating effects of not using your body."
> Diet & Lifestyle, Vitamins & Supplements, Staying
Fit
Top
|
