Basis of inquiry: During cancer treatment, children are significantly less active than their healthy peers. Inactivity persists into survivorship, negatively influencing health and quality of life. Children with cancer report that fatigue is one of the most distressing, treatment-related symptom impacting their quality of life; yet children with increased physical activity (PA) have less fatigue. In this study, we sought to evaluate if children could decrease their level of fatigue over the trajectory of treatment by increasing their physical activity.
Purpose/Objectives: The purpose of this study was to evaluate the impact of an exercise coaching on fatigue and PA in children undergoing cancer treatment when delivered by pediatric oncology nurse practitioners (NPs) during routine clinic visits.
Methods: In this quasi-experimental, repeated measures study, NPs learned to adapt concepts from the American College of Sport Medicine’s Exercise is Medicine program as part of usual care during routine clinic visits. Using motivational interviewing, children with acute lymphocytic leukemia (ALL), lymphoma, or solid tumors, and their families were coached on strategies to increase PA at home. Self-report measures of PA and fatigue using validated instruments were completed at months 2, 4, and 6 of treatment. PA was also measured over 5 days using actigraphy.
Findings or Outcomes: Thirty children ages 6 to 18 years participated in the study measurements. Seven had ALL, 11 lymphoma, and 12 solid tumors. Patterns of fatigue were different by disease group with trend to fatigue decreasing during treatment in the patients with ALL (p = .09) and lymphoma (p = .13) while it trended toward an increase in those with a solid tumor (p = .06). PA by self-report was unchanged during treatment; sedentary bouts measured by actigraphy increased in patients with solid tumors (p < .01) but were stable in those with ALL & lymphoma. NP’s reported challenges in having time to include coaching as part of the clinic visit and in providing continuity of coaching. Children with solid tumors experience repeating cycles of intensive chemotherapy which may contribute to fatigue increasing during the 6 month study time period. The intensity of treatment for ALL and lymphoma decreases during the first 6 months of treatment which may play a role in fatigue decreasing. It is not known if PA levels were maintained by the NP coaching and would have significantly decreased without it. Future research is needed to evaluate more “dose-intensive” PA interventions in larger samples of specific disease groups.
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- Mary C. Hooke, PhD APRN PCNS CPON®