Al-Majid, S., Wilson, L.D., Rakovski, C., & Coburn, J.W. (2015). Effects of exercise on biobehavioral outcomes of fatigue during cancer treatment: Results of a feasibility study. Biological Research for Nursing, 17, 40–48.

DOI Link

Study Purpose

To determine the feasibility of an exercise intervention among women receiving treatment for breast cancer and to examine the effects of exercise on hemoglobin (Hb) and maximum oxygen volume (VO2MAX) and their association with changes in cancer-related fatigue (CRF) and quality of life (QOL) while investigating changes in selected inflammatory markers

Intervention Characteristics/Basic Study Process

The intervention consisted of a supervised, progressive treadmill exercise program two to three times times per week delivered in a rehabilitation center for the duration of chemotherapy (9–12 weeks).

Sample Characteristics

  • N = 14  
  • AGE = Aged 21 years and greater
  • FEMALE: 100%
  • KEY DISEASE CHARACTERISTICS: Stages I–II breast cancer
  • OTHER KEY SAMPLE CHARACTERISTICS: No history of depression, arthritis, or joint pain in the prior three months; engaged in regular exercise for five days per week in past three months; other uncontrolled conditions 


  • SITE: Multi-site    
  • SETTING TYPE: Outpatient    
  • LOCATION: Southern California and Virginia

Phase of Care and Clinical Applications

  • PHASE OF CARE: Active antitumor treatment
  • APPLICATIONS: Elder care  

Study Design

Random assignment with repeated measures

Measurement Instruments/Methods

  • Feasibility: Measured by recruitment, retention, adherence to exercise protocol, tolerance of exercise testing, and the completion of data collection
  • Efficacy: Measured by Hb concentration (venous blood), VO2MAX (using the Trackmaster TM500/S® by JAS Fitness Systems in Carrollton, TX), CRF (Piper Fatigue Scale [PFS]), QOL (Functional Assessment of Cancer Treatment - Breast [FACT-Breast]), and inflammatory markers (IL6, IL10, cortisol, and myeloperoxidase) using laboratory kits


Feasibility: The recruitment rate was 45.7%, the retention rate was 87.5%, the adherence rate was 95%–97%, and the tolerance rate was 93%.  

Efficacy: There were no differences in VO2MAX at baseline between the groups. The exercise group maintained pretreatment VO2MAX levels throughout chemotherapy, and the usual-care group showed a significant decline of as much as 6.3 ml/kg per minute that continued three to four weeks after treatment. CRF outcomes favored the exercise group, and QOL, physical well-being, and functional well-being declined significantly in both the experimental and usual-care groups.


Recruitment to exercise interventions is difficult. The type of exercise, location, and the choice of a self-lead or a supervised intervention may influence the decision to participate. Retention may be influenced by flexibility in scheduling and the allowance of make-up sessions. Exercise did not have a significant effect on CRF or QOL. Changes in the inflammatory markers favored the exercise group. Exercise may protect against a decline in VO2MAX but not Hb concentrations.


  • Small sample (< 30)
  • Risk of bias (no blinding)
  • Risk of bias(sample characteristics)
  • Unintended interventions or applicable interventions not described that would influence results 
  • Findings not generalizable
  • Intervention expensive, impractical, or training needs

Nursing Implications

This study addressed exercise dose in terms of intensity, duration, and frequency when prescribing exercise as an intervention. The inclusion of inflammatory markers is a potential benefit that future research could use to quantify the effects of an exercise intervention.