Hoffman, A. J., Brintnall, R. A., Brown, J. K., von Eye, A., Jones, L. W., Alderink, G., . . . Vanotteren, G. M. (2014). Virtual reality bringing a new reality to postthoracotomy lung cancer patients via a home-based exercise intervention targeting fatigue while undergoing adjuvant treatment. Cancer Nursing, 37, 23–33.

DOI Link

Study Purpose

To explore the efficacy of a virtual reality home-based exercise program for managing fatigue during adjuvant therapy in patients with postthoracotomy lung cancer.

Intervention Characteristics/Basic Study Process

Patients were initially provided self-management education for fatigue and a Nintendo Wii system for walking and balance exercise in the home. Nurses initiated the program in a home visit, performed follow-up at two weeks, and contacted patients via telephone for reinforcement at three and six weeks in the initial study. This report involved extension of the initial study for an additional 10 weeks while patients were receiving adjuvant therapy. Patients wore a pedometer to record the number of steps per day and were to use the program five days per week.

Sample Characteristics

  • Seven participants (28.6% male, 71.4% female) were included in the study.
  • Mean age was 64.4 years (range 53–73).
  • All participants were postthoracotomy for non-small cell lung cancer. 
  • Five patients began chemotherapy at five weeks postsurgery.


  • Multisite 
  • Home 
  • Michigan

Phase of Care and Clinical Applications

Patients were undergoing the active antitumor treatment phase of care.

Study Design

This was a prospective trial.

Measurement Instruments/Methods

  • Acceptability questionnaire
  • Brief Fatigue Inventory (BFI)
  • Fatigue Self-Management Instrument
  • Self-efficacy for walking instrument
  • Walking duration instruments
  • Activities-Specific Balance Confidence (ABC) scale
  • Daily diary to record fatigue and exercise use


Adherence to the exercise protocol declined slightly from the previous six-week study to an overall adherence of 87.6% (range 59%–100%). All patients reported unmanaged symptoms unrelated to the exercise at some point in the 10 weeks. Fatigue scores increased slightly from weeks 6 to 14 and then declined further. Self-efficacy for walking and self-management were relatively stable. There was high variability in the average walking steps per day from the pedometers.


Results suggested continued feasibility and overall efficacy of the virtual reality home-based exercise and balance program tested. Findings showed that, over longer periods of time, program adherence declined and was more variable. Some of this variability in exercise adherence and fatigue scores may be associated with periods of adjuvant chemotherapy and radiation therapy.


  • The study had a small sample size, with less than 30 participants.
  • The study had risks of bias due to no control group, no blinding, no random assignment, and no appropriate attentional control condition.
  • The intervention was expensive, impractical, or had training needs.
  • The Nintendo Wii system had associated costs.

Nursing Implications

The use of a home virtual reality–based approach to facilitate exercise among patients with cancer is a promising approach for self-management of fatigue.  Larger well-designed research using this approach is warranted.