Health & Medical Cancer & Oncology

Too Sick Not to Exercise

Too Sick Not to Exercise

Implications


To date, postsurgical NSCLC patients with multiple comorbid conditions have been left with no standard rehabilitation options. The findings from this home-based exercise intervention feasibility study indicate that it is not only feasible and safe for these very sick patients to exercise immediately upon discharge from the hospital, but it is also acceptable to the patients, and they will adhere to the exercise for up to 6 weeks even through the initiation of adjuvant chemotherapy and/or radiation therapy. Likewise, when given the option, all participants opted to extend the intervention for an additional 10 weeks, indicating their enthusiasm for the intervention. As such, postsurgical NSCLC patients can be equipped with a light-intensity, self-paced walking and balance program that may have a long-lasting impact on the reduction of CRF and the prevention of further development of CRF. Having an intervention that is readily available in the home and can be implemented within days of returning home from the hospital provides patients with empowerment that they can do something to directly impact the quality of their health. The intervention's utilization of a nurse to assess the participant's readiness to start exercise and assist the participant in addressing his/her symptoms (should they preclude the participant from initiating exercise) is critical to the success of the intervention. Participants within this feasibility study reported a feeling of being alone and sad after returning home, and the nurse was able to fill this void and provide a continuum of care to help initiate the intervention and to provide support (eg, advise participant to call physician) if any symptoms or clinical problems were unmanaged. The nurse's weekly calls providing self-efficacy–enhancing support to the participant also proved valuable for participants not knowing what to expect relative to their symptoms and their exercise progress. Because NSCLC participants are among the most vulnerable and may be further compromised by comorbidities, should this intervention prove efficacious, it could also be generalizable across similar vulnerable populations that currently have few or no rehabilitation options. Moreover, a home-based program with a light-intensity exercise program during the initial weeks upon discharge from the hospital is practical because the intensity of the program falls within their current prescribed physical activity level. Likewise, participants within this feasibility study continued the home-based program through the initiation of their adjuvant chemotherapy and/or radiation therapy without any issues as the intensity of the program continued to fall within their prescribed physical activity level. Additionally, patients report that traveling outside the home is often physically challenging and wrought with difficulty in finding someone to assist in helping them to make appointments. Last, further research should focus on a 2-arm study comparing the effects of this exercise intervention to a usual care group with a larger sample size. This feasibility study was valuable in progressing toward this goal by allowing our team to assess the key processes, procedures, resources, and research information (eg, that performance status was more critical than stage of cancer when assessing for readiness to start the exercise intervention) relative to the specific aims.

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