Jensen, W., Baumann, F.T., Stein, A., Bloch, W., Bokemeyer, C., de Wit, M., & Oechsle, K. (2014). Exercise training in patients with advanced gastrointestinal cancer undergoing palliative chemotherapy: A pilot study. Supportive Care in Cancer, 22, 1797–1806.

DOI Link

Study Purpose

To investigate the feasibility of two different training programs including resistance and aerobic exercise in a small cohort of patients with advanced gastrointestinal cancer undergoing palliative chemotherapy; the study aimed to investigate potential effects of these programs on quality of life according to the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) as well as on physical performance, biological parameters, and activities of daily living

Intervention Characteristics/Basic Study Process

The resistance exercise training (RET) group of large muscles received supervised training sessions over 45 minutes, including warm-up and cool-down periods, twice per week until a total of 24 sessions over a period of 12 weeks was achieved/completed. The aerobic exercise training (AET) group received supervised sessions lasting 45 minutes on a bicycle ergometer twice a week for 12 weeks. Starting at 60% of patients' predetermined pulse rate in weeks one through four, the work load was intensified to 70%–80% in weeks 5–12. The exercise duration started with 10 minutes in week one and was increased up to 30 minutes in week 12.

Sample Characteristics

  • N = 26 randomized (21 completed)  
  • AVERAGE AGE = 55 years
  • MALES: 10, FEMALES: 11
  • KEY DISEASE CHARACTERISTICS: Gastrointestinal (GI) tumors with advanced disease; 48% new diagnosis; varied treatment modalities
  • OTHER KEY SAMPLE CHARACTERISTICS: Some patients had a history of operation or radio-chemotherapy at initial diagnosis and were undergoing palliative chemotherapy.


  • SITE: Single-site    
  • SETTING TYPE: Not specified    
  • LOCATION: Supervised exercise (does not specify)

Phase of Care and Clinical Applications

  • PHASE OF CARE: End-of-life care
  • APPLICATIONS: Palliative care 

Study Design

Two-group randomized trial

Measurement Instruments/Methods

  • Quality of Life (QOL): European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30)
  • Physical Performance: Muscular strength and cardiorespiratory fitness
  • Daily Physical Activity: Wearing a SenseWear® wristband; Freiburg Questionnaire of Physical Activity
  • Biologic Parameters: Peripheral venous blood parameters
  • Exercise preference


Relevant to fatigue and QOL: In the AET arm, relevant improvements of the EORTC scores could be observed for global health status (58 preintervention to 71 postintervention, p = 0.045) and role functioning (from 53 to 75). The fatigue score decreased in both subgroups from 66 to 43 in the pre/postintervention analysis (p < 0.05). All other scores showed no change from baseline assessment to postintervention. A greater number of steps in daily living after the training intervention measured by the SenseWear® wristband seemed to be associated with higher physical (r = 0.51) and social functioning levels (r = 0.56) as well as lower scores for pain (r = −0.53) and fatigue (r = −0.54) after 12 weeks. Higher levels of physical (r = 0.70) and role functioning (r = 0.46), as well as lower scores for pain (r = −0.47) and fatigue (r = −0.59), were observed in patients with a higher level of postinterventional total activity per week.


The postinterventional fatigue level decreased in both subgroups, suggesting that both programs seem to have positive effects on fatigue in patients undergoing palliative chemotherapy.


  • Small sample (< 30)
  • Risk of bias (no control group)
  • Risk of bias (no blinding)


Nursing Implications

Further prospective, controlled trials with larger sample sizes are needed to adequately analyze the efficacy of these programs in patients with advanced gastrointestinal cancer currently undergoing palliative chemotherapy.