Yang, C. Y., Tsai, J. C., Huang, Y. C., & Lin, C. C. (2011). Effects of a home-based walking program on perceived symptom and mood status in postoperative breast cancer women receiving adjuvant chemotherapy. Journal of Advanced Nursing, 67, 158–168.

DOI Link

Study Purpose

To test the effect of a home-based walking program on symptom distress and mood status in women undergoing breast cancer treatment.

Intervention Characteristics/Basic Study Process

Women referred by their oncologists were randomly assigned to the exercise or control group. Patients in the control group were instructed to maintain their usual lifestyles. Those in the exercise group were given individualized home-based exercise instructions based on American College of Sports Medicine guidelines. Participants were asked to walk briskly three times per week for 12 weeks during chemotherapy treatment, beginning two to three days after starting each chemotherapy cycle. Exercise sessions included a five-minute warm-up, 30 minutes of walking at  60% to 80% of the age-adjusted maximal heart rate, and a five-minute cool-down. Patients were asked to wear a heart rate monitor during exercise sessions and to monitor their own heart rates during exercise. Investigators read the heart rate monitor data weekly. Outcome data were collected at baseline and at six and 12 weeks. All patients received weekly telephone calls over the 12 weeks to identify any relevant health problems among participants.

Sample Characteristics

  • The sample was comprised of 40 participants.
  • Mean age was 51.8 years (range 31–67).
  • All participants were female.
  • Most participants had stage I or II breast cancer and were receiving adjuvant chemotherapy.  
  • All participants had undergone surgery, and most had undergone modified radical mastectomy.


  • Single site
  • Outpatient
  • Taiwan

Phase of Care and Clinical Applications

Patients were undergoing the active treatment phase of care.

Study Design

This was a randomized, controlled trial.

Measurement Instruments/Methods

  • Seven-day physical-activity recall:  self-reported physical activity and intensity (prior validation and reliability provided)
  • MD Anderson Symptom Inventory (MDASI)
  • Profile of Mood States (POMS), Taiwanese version


Adherence to the exercise prescription was 77% for the number of sessions and 100% for intensity. Mean physical activity levels from self-reports were not different between the groups at baseline. However, over time, a significant effect developed, for time and group assignment, regarding weekly energy expenditure (p = 0.02). Over time, symptoms declined in both groups, and the authors noted a significant group-by-time interaction on symptom severity (p < 0.01), indicating a greater decline in the exercise group. The authors also noted, compared to baseline in the exercise group, a significantly lower symptom severity overall, lower symptom interference, and less mood disturbance (p < 0.01) at 12 weeks. During the same period, the severity of symptoms increased in the control group. The sample size was determined by power analysis and met the size requirements.


Findings suggested that an individually prescribed home-based exercise program can reduce symptom severity and mood disturbance in women with breast cancer during adjuvant chemotherapy treatment.


  • The study had a small sample size, with less than 100 participants.
  • The authors provided no information regarding medications provided to patients that could have influenced differences in symptoms.
  • Patients had relatively low symptom severity at baseline (<3), and individuals with more advanced disease were excluded from the sample.
  • The authors did not clarify how critical the weekly telephone calls were to patient adherence to the exercise regimen, and the authors did not detail the nature of these calls.
  • This was a single-site study of relatively short duration.

Nursing Implications

Use of a prescribed individualized exercise regimen consisting mainly of brisk walking, three days per week, was shown to have a positive effect on the symptoms and mood of women with breast cancer during chemotherapy treatments. Although the study did not show the effect on single symptoms, overall symptom severity decreased. This study showed that this type of simple exercise intervention for patients during cancer treatment can have a positive effect for overall well-being.