Exercise reduces fatigue in chronic fatigued Hodgkins disease survivors—results from a pilot study
Introduction
The prevalence of chronic fatigue among Hodgkin's disease survivors (HDS) is 25–30% compared with 11% in the general population [1]. Fatigue seems to be more prevalent in HDS than in other cancer survivors [2]. Chronic fatigue in this particular group of cancer survivors is relatively poorly understood, but an association between fatigue and pulmonary dysfunction has recently been demonstrated [3].
Fatigue is a normal and passing experience after physical and mental exertions, and contributes to regulate the balance between rest and activity, resulting in restoration when needed. For example, some days of rest are a normal and effective strategy in the restitution after an acute infectious disease. Patients undergoing treatment for cancer are often advised to limit their activity and get enough rest. These strategies may be effective in acute situations of fatigue. However, for patients suffering from chronic fatigue, rest will result in physical deconditioning and probably increased fatigue. Most individuals with chronic disease or disability become less physically active, and this may lead to a cycle of deconditioning of multiple physiological systems [4]. Many chronic diseases such as cognitive heart failure, multiple sclerosis, systemic lupus erythematosus and patients with psychiatric disorders are accompanied by fatigue 5, 6, 7, 8. Like in chronic pain, the experience of fatigue in chronic disease may provoke psychological and biological reactions that maintain or exacerbate fatigue in a vicious circle. Furthermore, prolonged rest or inactivity can lead to skeletal muscle atrophy and further reduction in exercise tolerance. Today, however, there is increasing consensus among professionals that persistent rest may worsen fatigue in sufferers of the chronic fatigue syndrome (CFS) [9].
There is no consensus on how to prevent or alleviate fatigue. In a randomised clinical trial (RCT), graded aerobic exercise significantly improved fatigue, functional capacity and fitness in CFS patients without psychiatric or sleep disorders compared with flexibility exercises and relaxation therapy [10].
Exercise is one of the few interventions suggested to prevent or decrease fatigue among cancer patients, but the research supporting this is limited 11, 12, 13. Dimeo and colleagues concluded that an aerobic exercise programme improved maximal physical performance and reduced fatigue in fatigued cancer patients. However, these studies mainly included cancer patients during and immediately after chemotherapy or radiotherapy 13, 14.
To our knowledge, no published study has so far tested exercise capacity among chronic fatigued HDS or the effects of physical exercise in chronic fatigued cancer survivors. On this basis, the present quasi-experimental pilot study was conducted to examine the level of aerobic capacity among chronic fatigued HDS compared with HDS without chronic fatigue. Further aims were to assess the effects of an aerobic training programme upon fatigue, physical functioning and aerobic capacity in chronic fatigued HDS and to evaluate the feasibility of the programme as a preparative step for a larger randomised study.
Section snippets
Sampling
Fig. 1 shows the flowchart of the study and the patient selection. The study included three phases; phase 1 is a survey; phase 2 is an exercise testing and medical examination and phase 3 is an intervention study. 62 patients (aged 19–74 years) were treated for Hodgkin's disease at the University Hospital in Trondheim in the period 1987–1997 and were alive without active disease in 1999. They were approached by mail, and 53 patients completed the questionnaires after one written reminder (85%).
Fatigued versus non-fatigued HDS
Results from physiological comparisons of the fatigued and the non-fatigued HDS are presented in Table 2. No statistically significant differences were seen between the two groups in physiological measures: body mass index (BMI), VO2 peak, resting heart rate, maximal heart rate or resting blood pressure. Spirometric variables did not differ significantly between the two groups, except for FVC (P=0.04). The FVC mean value of the chronic fatigued HDS was 4% above the mean normal value, while the
Discussion
Exercise capacity (VO2max) did not differ between the chronic fatigued HDS and HDS without chronic fatigue. Therefore, aerobic exercise capacity does not seem to play an important role in the pathophysiology of chronic fatigue in HDS. The reduction of fatigue after 20 weeks of aerobic exercise indicate that home-based physical exercise may be an alternative treatment for chronic fatigued HDS. Furthermore, the feasibility and adherence rate compare with well to similar exercise intervention
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