Litterini, A.J., Fieler, V.K., Cavanaugh, J.T., & Lee, J.Q. (2013). Differential effects of cardiovascular and resistance exercise on functional mobility in individuals with advanced cancer: A randomized trial. Archives of Physical Medicine and Rehabilitation, 94, 2329–2335. 

DOI Link

Study Purpose

To compare effects of cardiovascular and resistance exercise on functional mobility in people with advanced cancer

Intervention Characteristics/Basic Study Process

Individuals were randomly assigned to either resistance or cardiovascular exercise groups. Exercise sessions were held in a hospital-based fitness facility twice weekly for 10 weeks. Both groups  participated in flexibility exercises. Sessions lasted 30–60 minutes and were supervised by oncology-trained exercise specialists. Participants completed the study assessments at baseline and one week after study completion.

Sample Characteristics

  • N = 52    
  • MEAN AGE = 62.35 years (SD = 13.49)
  • MALES: 45%, FEMALES: 55%
  • KEY DISEASE CHARACTERISTICS: Multiple tumor types. All had advanced cancer determined by an oncologist to be in a terminal stage.
  • OTHER KEY SAMPLE CHARACTERISTICS: More than 90% of the patients were currently receiving chemotherapy, radiation therapy, or a combination of these. Baseline mean fatigue was 37.02 on a 0–100 scale.


  • SITE: Single site
  • SETTING TYPE: Outpatient
  • LOCATION: New England

Phase of Care and Clinical Applications

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

Study Design

  • Randomized, parallel group trial

Measurement Instruments/Methods

  • Short Physical Performance Battery (SPPB)
  • 100 mm visual analog scale for fatigue and pain


On average, participants attended 70% of exercise sessions. SPPB scores improved in all over time (p < .001), but improved slightly more in the cardiovascular group (p = .045). Intent-to-treat analysis did not confirm this difference between groups. Fatigue declined over time in all (p = .05), with no difference between groups. There were no significant changes in pain by group or by time.


Findings show improved functional mobility and reduced fatigue over time. This study did not show a difference associated with the type of exercise provided.


  • Small sample (< 100)
  • Risk of bias (no control group)
  • Risk of bias (no blinding)
  • Measurement validity/reliability questionable
  • Other limitations/explanation: VAS score was only for fatigue. There was a 21% dropout rate and reasons for this are not described. Relatively low levels of fatigue at baseline, suggesting possible measurement floor effect.

Nursing Implications

This study suggests that both cardiovascular and resistance exercise can be used in appropriate patients with advanced disease, and findings showed that there were no significant changes in pain or fatigue with these interventions.