Yeh, C. H., Man Wai, J. P., Lin, U. S., & Chiang, Y. C. (2011). A pilot study to examine the feasibility and effects of a home-based aerobic program on reducing fatigue in children with acute lymphoblastic leukemia. Cancer Nursing, 34, 3–12.

DOI Link

Study Purpose

To examine the feasibility of a home-based aerobic exercise intervention on reducing fatigue in children with acute lymphoblastic leukemia (ALL).

Intervention Characteristics/Basic Study Process

Institutional review board approval, parental consent and child assent, verbal and written explanations, and baseline assessments were completed. Maximal exercise tests were completed for all, and those in the intervention group were provided with a video and instructions on achieving target heart rate. Parents and patients were instructed on exercise guidelines, safety and health condition assessment, and monitoring. Heart rate monitors were worn and documented.  

The home-based aerobic exercise intervention consisted of following the steps in an exercise video three days a week, for 30 minutes each session, for six weeks. The content of the intervention included three sections:  a warm-up for five minutes, aerobic exercise for 25 minutes, and a cool-down for five minutes. The warm-up and cool-down were aimed to increase 10% to 30% of the heart rate reserve. This was recommended by the American College of Sports Physicians. The aerobic section was designed to increase the heart rate reserve to 40% to 60%. The exercise prescription was individualized after baseline assessment, and the duration ranged from 10 to 30 minutes, gradually increasing to 30 minutes by the third week and after. Patients were instructed to complete the exercise three times per week for six weeks.

Sample Characteristics

  • Twenty-two children were included in the study (12 in the intervention group [six boys and six girls; average age = 11.01 years] and 10 in the control group [six boys and four girls; average age = 12.48 years]).  
  • They were matched by age and sex.  
  • All patients received maintenance chemotherapy for 20 weeks, and they were recruited after completing the dexamethasone.  
  • Ten patients (five boys and five girls) in the intervention group adhered to the exercise prescription.
  • In the control group, five children (three boys and two girls) reported any exercise with their logs, and they were used for per-protocol (PP) analysis.  
  • Of the patients, 54.% were female and 45.5% were male.
  • Patients had ALL.
  • All patients were receiving maintenance chemotherapy regimens of standard or high-dose chemotherapy.


  • Single site
  • Home
  • Taiwan

Phase of Care and Clinical Applications

  • Patients were undergoing the active treatment phase of care.
  • The study has clinical applicability for pediatrics and late effects and survivorship.

Study Design

This was a quasiexperimental control study with multivariate analysis on self-reported levels of fatigue at posttest and one-month follow-up.

Measurement Instruments/Methods

  • Pediatric Quality of Life Inventory (PedsQL) Multidimensional Fatigue Scale 
  • Physical activity log
  • Children’s OMNI-Walk/Run Scale
  • Stage of change-exercise behavior
  • Maximal exercise test for assessing cardiorespiratory fitness
  • Only subjective data were reported.
  • Hemoglobin was measured to assess for confounding variables, but it was not related to fatigue change patterns.


For the PP analysis, children who received the exercise intervention reported lower general fatigue subscale scores than those in the control group at one-month follow-up (p = 0.03). There were no significant differences between groups at any other study timepoint. For intent-to-treat (ITT) analysis, there was no intervention and time effect for any of the three fatigue subscales at posttest or one-month follow-up. Descriptive statistics were collected, and the intervention effects of the home exercise and data were measured using the mixed-effects model (mixed procedure in SAS). This included fixed-effects for time and group. ITT (for all patients) and PP (for those who adhered to exercise) analyses were used. The mean adherence rate for the six-week intervention was 76% in the ITT analysis and 90% in the PP analysis.


This exercise program was feasible. Children who received the home-based aerobic exercise intervention reported lower “general fatigue” than those in control group at one-month follow-up. There was structured parental involvement, which might have played a role in adherence. Motivating children with cancer to exercise will require additional study.


  • The study had a small sample size, with less than 30 participants. 
  • The study had potential risks of bias due to no random group assignment and no blinding.

Nursing Implications

A home-based aerobic intervention program might reduce fatigue in children with ALL who are undergoing maintenance chemotherapy. This study demonstrated a high level of adherence, which the authors attributed to parental involvement. Larger, well-designed clinical trials should be performed to further examine the role of exercise in managing fatigue in these patients, as well as the importance and degree of parental involvement needed for success.