Hoffman, A.J., Brintnall, R.A., Given, B.A., von Eye, A., Jones, L.W., & Brown, J.K. (2016). Using perceived self-efficacy to improve fatigue and fatigability in postsurgical lung cancer patients: A pilot randomized controlled trial. Cancer Nursing, 40, 1–12. 

DOI Link

Study Purpose

To design and test the feasibility and acceptability of a postsurgical intervention with exercise for patients with non-small cell lung cancer to promote perceived self-efficacy for fatigue self-management targeting cancer-related fatigue (CRF) severity and its associated fatigability

Intervention Characteristics/Basic Study Process

Participants performed warm-up exercises designed for the patient population. Wii walking was self-paced and comfortable for participants with the Wii exercise equipment, creating a virtual environment in a town of happy people providing encouragement to continue. Patients started walking five minutes each day for five days during week 1 and increased by five-minute intervals per day until a goal of 30 minutes per day of Wii walking was reached by week 6. The nurse assessed each participant’s readiness to advance the walking prescription. Participants also completed balance exercises five days a week from weeks 1 to 6 from a menu of predetermined Wii balance exercises, which used a gaming format. Data were recorded in the participants' daily diaries and confirmed by research staff as recorded in the Wii Fit Plus.

Sample Characteristics

  • N = 72   
  • AGE RANGE = 37–89 years
  • MEAN AGE = 67 years
  • MALES: 44%, FEMALES: 56%
  • CURRENT TREATMENT: Not applicable
  • KEY DISEASE CHARACTERISTICS: Early to late stage suspected non-small cell lung cancer receiving a surgical intervention
  • OTHER KEY SAMPLE CHARACTERISTICS: Participants had to be at least 21 years of age; have a Karnofsky Performance Status of 70% or greater; have medically stable comorbid conditions presurgery; get the approval of a surgeon prior to and after surgery; have phone access; be able to speak and write English; own a television; have no severe sensory impairment that would increase the risks of exercise; have no metastatic disease requiring portable oxygen for activities of daily living; weigh equal to or less than 330 pounds; and have no history of photosensitive seizures or dementia, which would limit safety or full participation.


  • SITE: Multi-site   
  • SETTING TYPE: Home    
  • LOCATION: Michigan

Phase of Care and Clinical Applications

  • PHASE OF CARE: Transition phase after active treatment
  • APPLICATIONS: Elder care

Study Design

Two-arm, randomized, controlled trial to compare the impact of a six-week rehabilitative CRF self-management exercise intervention post-surgical hospital discharge. The control group used a Wii-based walking and balance home program at home.

Measurement Instruments/Methods

Feasibility: Rates of recruitment, adherence, retention, and monitoring of adverse events

Acceptability: 15-item acceptability questionnaire developed by the researchers


  • Brief Fatigue Inventory (BFI)
  • Perceived Self-Efficacy for Fatigue Self-Management
  • Perceived Self-Eefficacy for Walking Duration
  • Activities-Specific Balance Confidence Scale
  • Cancer-related fatigue self-management behaviors diary

Functional status:

  • Capacity-fatigability six-minute walk test (6MWT) (fatigue reported during the 6MWT and distance walked in six minutes)
  • Performance: Modified Borg Scale (fatigue severity during the 6MWT) and Medical Outcomes Study Short Form 36, version 2, Acute Recall
  • Demographic questionnaire
  • Modified version of the Comorbidity Questionnaire
  • Smoking-Behavioral Risk Factor Survey
  • Karnofsky Performance Status Score


Feasibility and acceptability: Recruitment, vulnerable population, adherence, and acceptability goals were exceeded. No adverse events were reported.

Efficacy: At week 6, interval scores for CRF, CRF self-management, walking, balance, and fatigability were significantly different (p < 0.001) between the intervention group and control group. Participants exceeded minimum walking-balance exercise behaviors during the six-week study period. Functional performance decreased postsurgery in both the control and intervention groups. Improvement occurred in weeks 1–6 for both groups but improved more slowly in the control group versus the intervention group.


A home- and Wii-based exercise and balance program for patients with lung cancer postsurgery is a feasible, acceptable, safe, and effective method to improve fatigue and fatigability in this patient population.


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


Nursing Implications

Early rehabilitation exercise and balance interventions for patients undergoing surgery for non-small cell lung cancer are feasible, acceptable, and safe. Additional research is needed to determine factors to enhance adherence to exercise and balance interventions beyond the immediate postsurgical period (six weeks) and to determine their effects on prognosis and functional (physical and mental) capacity.