Yeo, T. P., Burrell, S. A., Sauter, P. K., Kennedy, E. P., Lavu, H., Leiby, B. E., & Yeo, C. J. (2012). A progressive postresection walking program significantly improves fatigue and health-related quality of life in pancreas and periampullary cancer patients. Journal of the American College of Surgeons, 214, 463–475.

DOI Link

Study Purpose

To evaluate the effects of a home-based walking program in postresection patients on cancer-related fatigue, physical function, and quality of life.

Intervention Characteristics/Basic Study Process

Consenting patients were randomly assigned to the walking group or usual care group while in the hospital after surgery. Baseline measures were obtained either in the physician's office prior to surgery or in the hospital. Patients in the intervention group were given a prescription for a graduated walking program and were asked to record the number of minutes or approximate distance walked and any adverse symptoms in a weekly diary. They also received monthly telephone calls to assess their current status and adherence to walking and remind them to mail in their diary information. The intervention group was given a modified “Every Step Counts” booklet, modified to cover a six-month period recommending increasing brisk walking time to 20 minutes in the second month and to 25 to 30 minutes in the third month. Patients in the usual care control group did not receive monthly calls but received one follow-up call at three months. Outcome measures were assessed via the follow-up telephone calls in all groups.

Sample Characteristics

  • One hundred two patients (50% male, 50% female) were included.
  • Seventy-nine patients completed the final six-month postoperative follow-up.
  • Mean age was 66.5 years (range 38–91). 
  • All patients had pancreatic, bile duct, or duodenal cancer, and 93% had undergone pancreaticoduodenectomy with pyloru preservation.
  • Of the patients, 73% underwent adjuvant therapy with chemotherapy, radiation, or both.
  • Patients with stage IV disease were excluded.


  • Single site
  • Home
  • Philadelphia, PA

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

  • Fatigue visual analog scale (VAS)
  • Pain VAS
  • Medical Outcomes Study (MOS)
  • Short Form 36 Health Survey (SF-36), version 2
  • Eastern Cooperative Oncology Group (ECOG) Performance Status
  • Functional Assessment of Chronic Illness (FACIT) Fatigue subscale


Patients in the exercise group had improved fatigue scores by both VAS and FACIT measures (p < 0.05). Mean change in VAS fatigue score was 1.2, and mean change in the FACIT subscale was 9 points. FACIT scores tended to correlate with disease stage. All patients had a significant reduction in pain. Physical function score changes on the SF-36 were mixed, with the individual subscale score improving more in the exercise group but the composite score improving more in the usual care group. There were no differences between groups in other symptoms observed. Analysis demonstrated a fatigue-related symptom cluster of fatigue, bodily pain, depression, weakness, and anxiety at an average of three months.


Findings supported the benefits of a home-based progressive walking program for patients postsurgical resection.


  • The study had risks of bias due to no appropriate control group and no attentional control. 
  • It is unclear if some patients had baseline measures performed pre- or postoperatively; the timeframe of these measures related to the surgical procedure is also unclear.
  • The study report appeared to provide some conflicting information in this area. There was no subgroup analysis between those who received various adjuvant therapies, although the study groups were similar in terms of percentages that had any adjuvant treatment. There was no stratification based on baseline activity levels and physical functioning. There was no information regarding walking adherence or the activity levels of the control group, so it is not really known if there was a difference in actual exercise between groups.

Nursing Implications

Findings suggested that a self-managed home-based walking prescription can be helpful to patients with cancer postoperatively. This study adds to the body of evidence related to exercise and fatigue by using a sample of patients who had diagnoses and treatments not previously studied in this area.