Litterini, A. J., & Fieler, V. K. (2008). The change in fatigue, strength, and quality of life following a physical therapist prescribed exercise program for cancer survivors. Rehabilitation Oncology, 26, 11–17.

Study Purpose

To determine if there was an improvement in fatigue, strength, and quality of life (QOL) in individuals within one year of treatment for an individualized physical therapist–prescribed exercise intervention.

Intervention Characteristics/Basic Study Process

Cancer survivors participated in an exercise class (one hour two times weekly) that included instruction and supervision in cardiovascular, strength training, and flexibility exercises. Measurement of fatigue, strength, and repetition of prescribed exercises occurred. The individualized exercise program was prescribed by a single therapist and was based on the patient’s medical history, diagnosis, age-related changes, treatment stage, and goals. Flexibility, strength, and balance assessments were conducted, and participants were retested at the conclusion of the program. Patients were encouraged to exercise two times weekly.

Sample Characteristics

  • Two hundred patients (91 females and 41 males) were enrolled; 132 (66%) completed the program.
  • Mean age was 57.48 years. One patient was younger than 21 years and five patients were between 81 and 90 years; the majority (n = 36) were between 61 and 70 years.
  • Stages of cancer were I through IV.
  • Diagnoses included breast, colorectal, lung, ovarian, non-Hodgkin lymphoma, prostate, and other cancers.
  • Most patients were undergoing active treatment, and most had undergone surgery, chemotherapy/hormonal, and radiation therapy.


  • Single site
  • Cancer Well-Fit Exercise Program at Synergy Health and Fitness Center on the campus of Exeter Hospital, Exeter, New Hampshire

Study Design

This study included a pre- and posttest and a two-tailed t test. 

Measurement Instruments/Methods

  • Visual analog scale (VASF) to measure fatigue (Glaus reported validity and reliability but did not report the actual number)
  • Jamar dynamometer to measure upper extremity strength (Bohannan reported as valid and predictive of postoperative complications and related to functional loss but did not report the actual number)
  • Cybex VR2 seated leg press machine to measure lower extremity strength
  • Segal tested lower-extremity muscular fitness with repetitions to fatigue for prediction, and Sale and MacDougall published data regarding repetitions to fatigue. The amount of weight lifted and the total number of repetitions performed were used to estimate a predicted one repetition maximum according to Brzycki’s regression equation.
  • Short Form 36 Health Survey (SF-36) was used to measure QOL. This total score and eight subscales were analyzed pre- and post exercise intervention. They included physical functioning, physical role, bodily pain, general health, vitality, social functioning, emotional role, mental health, and reported health transition.


Overall fatigue improved significantly (p = 0.004). Overall lower-extremity anaerobic endurance increased significantly (p = 0.000). Overall nondominant grip strength increased significantly (p = 0.000). Overall QOL improved significantly (p < 0.01). The intervention was well tolerated in all of the diagnostic, stage, and age groups with no adverse events. The 81- to 90-year-old group had the highest completion rate, followed by the 71- to 80-year-old group. Survivors with stage IV disease had statistically significant improvement in lower extremity anaerobic endurance and QOL, whereas survivors of lung cancer had statistically significant reductions in their fatigue.


Virtually all patients with various cancer diagnoses and stages of disease, as well as a wide age range and both genders, can safely participate in and will benefit from a strength training program in terms of less fatigue, improved QOL, and increased strength. Oncology rehabilitation is necessary for survivors of cancer.


  • The study lacked an appropriate control group.
  • The population was primarily Caucasian, and there was limited cultural diversity.
  • The study lacked randomization and control group.
  • Combination exercise was used; the authors were unable to determine the most effective type of exercise for this population.

Nursing Implications

Exercise can be performed safely with careful planning. Exercise programs do not need to be restricted to those who are relatively well. Oncology rehabilitation is as necessary for survivors as cardiac rehabilitation. This study is supportive of a comprehensive exercise program.