Gokal, K., Wallis, D., Ahmed, S., Boiangiu, I., Kancherla, K., & Munir, F. (2016). Effects of a self-managed home-based walking intervention on psychosocial health outcomes for breast cancer patients receiving chemotherapy: A randomised controlled trial. Supportive Care in Cancer, 24, 1139–1166.

DOI Link

Study Purpose

To evaluate the effectiveness of a self-managed, home-based walking program of moderate intensity

Intervention Characteristics/Basic Study Process

Prior to randomization, patients completed baseline questionnaires before beginning chemotherapy and after completing two of six cycles of chemotherapy. Patients were then randomized to usual care control or usual care plus exercise groups. Patients in the exercise group were given an intervention booklet with recommendations to ensure adherence, tips, guidance, and a diary to keep a log of walking duration and intensity. Self-management strategies used for guidance were based on the theory of planned behavior, including setting weekly goals, reflecting by writing achievements and shortfalls, and modifying goals. Pedometers were provided to the walking group. The intervention lasted 12 weeks.

Sample Characteristics

  • N = 50   
  • MEAN AGE = 53.7 years
  • FEMALES: 100%
  • CURRENT TREATMENT: Chemotherapy
  • KEY DISEASE CHARACTERISTICS: All had breast cancer, and most were grade 2 or 3; 72% were postmenopausal.
  • OTHER KEY SAMPLE CHARACTERISTICS: Sixty percent were reported to be inactive at baseline.


  • SITE: Single site   
  • SETTING TYPE: Home    
  • LOCATION: United Kingdom

Phase of Care and Clinical Applications

PHASE OF CARE: Active antitumor treatment

Study Design

Randomized, controlled trial

Measurement Instruments/Methods

  • Hospital Anxiety and Depression Scale (HADS)
  • Functional Assessment of Cancer Therapy (FACT)-Fatigue scale
  • Self-Esteem Scale
  • Profile of Mood States (POMS) short form
  • Borg Rating of Perceived Exertion (RPE) scale
  • Pedometer measures of steps taken each day
  • General Practice Physical Activity Questionnaire


Eighty percent adhered to the intervention based on walking diaries. Group by time analysis showed that the intervention had a positive effect on fatigue (p = 0.02). No effects on anxiety or depression as measured by HADS were reported.


The self-managed, home-based walking program had a positive effect on fatigue.


  • Small sample (< 100)
  • Risk of bias (no blinding)


Nursing Implications

This study adds to the body of evidence showing that exercise has a positive effect on fatigue. A self-managed, home-based walking program is a practical approach to incorporating activity during active treatment.