Although research has long shown that exercise can improve fatigue symptoms among cancer patients, some 84 percent of oncologists do not advise their patients to increase activity. There are a variety of reasons for this omission, ranging from a lack of time during appointments to too few modified exercise resources available for patients.
With this in mind, an OHSU cancer researcher launched a study to increase exercise among cancer patients receiving care at OHSU. She began by asking one simple question: Would adding a free exercise DVD to an oncologist’s recommendation for exercise lead to better outcomes than an oncologist’s recommendation alone?
Kerri Winters-Stone, Ph.D., the study’s principal investigator, is a co-leader of the Knight Cancer Institute Cancer Prevention and Control Program and a research professor in the OHSU School of Nursing. Winters-Stone and colleagues created a free, yoga-based and cancer-specific DVD designed to accompany an oncologist’s advice to exercise and better motivate patients.
“We thought if patients can engage in even a modest amount of exercise matched to what they are able to do, they’d be much more likely to stick with it, and we might be able to start to change the culture around exercise and cancer,” said Winters-Stone.
Creating the study
To create the research protocol, Winters-Stone worked with a number of oncologists, including Arpana Naik, M.D., breast surgical oncologist for the OHSU Knight Cancer Institute and associate professor of surgery in the OHSU School of Medicine.
Winters-Stone, Naik and team randomly assigned 90 study participants with breast cancer to receive either a verbal recommendation from an oncologist to exercise or the same recommendation plus the free DVD. Researchers checked in with participants regarding their exercise and symptoms, including fatigue, at weeks 4 and 8.
Throughout the study, participants who received the DVD reported using it an average of twice a week. Participants in both groups reported a reduction in their fatigue over time, but the group that received the DVD experienced a greater reduction overall, compared with the group that only received a verbal recommendation.
In addition, participants who received the DVD reported feeling more prepared to engage in exercise and better maintained their overall physical activity levels.
“We learned that cancer patients appreciated the exercise advice from their oncologist,” said Winters-Stone. “But that recommendation translated to better outcomes for patients if they were also given a tool to follow their oncologist’s advice.”
Their findings are published in the journal Supportive Care in Cancer.
Creating the DVD
The research team noted that an important factor in determining the DVD’s success was the ability to match the intensity of exercise to a participant’s exercise abilities. Based on her previous research and exercise studies, Winters-Stone knew that patients have good days and bad days, high energy levels energy levels. The DVD offered three levels of difficulty for yoga exercises, allowing participants to select the level that best matched their energy level that day.
“A lot of patients working through or recovering from cancer aren’t comfortable jumping into community exercise centers,” said Winters-Stone. “This DVD gives them the flexibility to engage in physical activity to their comfort level that day, in the comfort of their home.”
Laurie Iverson is one of the featured instructors on the DVD. As a former patient and clinical trial participant, she understands the power of exercise to manage symptoms during and after treatment. She was eager to become an instructor, and Winters-Stone and team recruited her to lead patients through yoga workouts for the DVD.
Iverson introduces herself on the DVD as follows: “Believe me, cancer treatment can affect you in ways you never thought possible. Pull this video out on days when maybe you’re feeling depressed or you are really tired and do this. This will help you have a much quicker recovery in the long run and will help you emotionally recover from cancer. I wish I had had something like this when I was first diagnosed — I think it will be very beneficial to patients at all stages of diagnosis and recovery.”
Instructor Rachel Wood also has a personal connection to the project. In addition to being a member of Winters-Stone’s research team, Wood was a personal trainer with a strong interest in the effects of exercise on recovery. Shortly after the DVD was made, Wood was accepted to medical school, where she can put the knowledge she gained about exercise as medicine into practice.
Study implications
Winters-Stone and team hope this research will start to change the discussion oncologists have with their patients about exercise.
“In an ideal world, we would start with this routine and phase the patient into other types of exercise, like aerobic and resistance training, activities that help manage other symptoms, improve functioning and maybe even change the course of their cancer. This DVD and type of workout could be that bridge,” she said. “The clinician starts this conversation and points out the importance of exercise. If they were able to also provide a tool for patients to start with, it could make a significant impact for patients to have some control over their symptoms and recovery from cancer.”