Implications for practice

Fatigue assessment and prescriptions for managing fatigue should be a vital aspect of care for cancer patients and survivors during treatment and follow-up care. Exercise and physical activity should be considered as an important fatigue management strategy. Prescription of exercise or physical activities should consider individual health status, exercise type, intensity, duration, frequency, and progression. Table 14.4 lists suggested considerations when prescribing exercise and physical activities (Winningham 1999).

It should be noted that exercise and physical activity are one of several possible inter-ventional strategies for managing fatigue. The multidimensionality of cancer-related

Table 14.4 Prescriptions of physical exercise and activity

Prescription

Rationale/explanation

Status of the

Exercise should be tailored to age, gender, condition, risk factors, disease,

individual

and treatment

Type of exercise Should encourage rhythmic, repetitive movement of large muscle groups such as walking, swimming, cycling, dancing, or stretching. Walking and cycling are the most appropriate because they are safe and easily tolerated by cancer patients and survivors. Exercise should be modified based on treatment modalities and disease progression

Intensity of exercise Low to moderate exercise should be encouraged depending on patient's current fitness level and treatment modalities. Exercise or physical activities should never be so hard that the person is out of breath. Winningham's (1991) half rule of thumb can be an excellent reference, especially for individuals with cancer who are under active treatment and evident disease progression. The half rule of thumb involves finding out how much activity the patient can comfortably tolerate and then instructing them to begin with half that much several times daily, with rest periods between. Instead of a single type, a variety of exercise or physical activities should be prescribed

Frequency of exercise For moderate exercise or activity (walking or cycling), three to five times per week is sufficient. For low-intensity and shorter-duration exercise and physical activities (stretching or marching in the room), a few minutes two or three times a day is beneficial

Duration of exercise For cancer survivors and patients with stable conditions, 20-30 min of continuous exercise should be encouraged. For patients who are undergoing treatment and evident disease progression, 3-5 min short exercise bouts with rest intervals are preferable

Progression of exercise Cancer patients and survivors should be instructed to increase exercise intensity until they meet the frequency and duration prescribed. Long-term exercise from months to a lifetime should be encouraged. A general rule of thumb is starting with what the person can do comfortably and working up very gradually from there fatigue needs an integrative approach. Exercise and physical activity should be integrated with other fatigue management strategies, including modifying dietary needs, relieving other symptoms, practicing progressive muscle relaxation, and assessing/ meeting emotional and spiritual needs. Cognitive therapy focusing on increasing individuals' self-efficacy can be an effective motivational intervention to encourage individuals with cancer to participate in exercise and physical activity (Haas 2000). It can be assumed that an integrative approach to fatigue management will improve the ability of cancer patients and survivors to manage their fatigue.

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