Effects of a Home‐based Exercise Program on Anxiety and Mood Disturbances in Older Adults with Cancer Receiving Chemotherapy

Abstract

BACKGROUND/OBJECTIVE Exercise interventions improve anxiety and mood disturbances in patients with cancer. However, studies are limited in older adults with cancer. We assessed the effects of exercise on anxiety, mood, and social and emotional well‐being in older patients with cancer during their first 6 weeks of chemotherapy. DESIGN Exploratory secondary analysis of a randomized controlled trial (RCT). SETTING Community oncology practices. PARTICIPANTS Older patients (aged 60 years or older) undergoing chemotherapy (N = 252). INTERVENTION Patients were randomized to Exercise for Cancer Patients (EXCAP) or usual care (control) for the first 6 weeks of chemotherapy. EXCAP is a home‐based, low‐ to moderate‐intensity progressive walking and resistance training program. MEASUREMENTS Analysis of covariance, with study arm as the factor, baseline value as the covariate, and study arm × baseline interaction, was used to evaluate arm effects on postintervention anxiety (State Trait Anxiety Inventory [STAI]), mood (Profile of Mood States [POMS]), and social and emotional well‐being (Functional Assessment of Cancer Therapy–General subscales) after 6 weeks. RESULTS Median age was 67 years; 77% had breast cancer. Statistically significant group differences were observed in the STAI score (P = .001), POMS score (P = .022), social well‐being (P = .002), and emotional well‐being (P = .048). For each outcome, EXCAP patients with worse baseline scores had larger improvements at 6 weeks; these improvements were clinically significant for STAI score and social well‐being. CONCLUSIONS Among older cancer patients receiving chemotherapy, a 6‐week structured exercise program improved anxiety and mood, especially among those participants with worse baseline symptoms. Additional RCTs are needed to confirm these findings and evaluate the appropriate exercise prescription for managing anxiety, mood, and well‐being in this patient population. J Am Geriatr Soc 67:1005–1011, 2019.

Physical activity and nutrition interventions for older adults with cancer: a systematic review

“…This review included 14 papers [47][48][49][50][51][52][53][54][55][56][57][58][59][60]. A further eight related papers were referenced to provide more detail when unable to find information in the primary paper (e.g.…”

“…Seven studies took place in the USA [49,50,55,56,59,60], two in Canada [47,51] and one each in China [52], Japan [54], Korea [57], Sweden [58] and UK [48]. Five studies recruited patients with prostate cancer only [47,48,55,57,60], one each recruited bladder [58], lung [52] and breast cancer only [51], with the remaining recruiting a mixed sample of cancer types [49,50,53,54,56,59].…”

“…Based on assessments from two reviewers, no studies received overall risk of bias judgements of low, ten were judged to have some concerns and four had high risk of bias. Twelve studies were low [47-51, 53, 54, 56-60] and two some concerns [52,55] for allocation; ten were low [47,49,[52][53][54][56][57][58][59][60], two some concerns [48,50] and two high [51,55] for intervention deviations; nine rated low [47-50, 52-54, 56, 59], three some concerns [55,57,60] and two high [51,58] for missing data; one ranked low [52] and 13 some concerns [47][48][49][50][51][53][54][55][56][57][58][59][60] for outcome measurement; and finally, 11 rated low [47][48][49][50][51][52][53][54][55][56]…”

“…Most interventions focused on PA behaviour only [47,[51][52][53][54][55][57][58][59][60] and three on both nutrition and activity behaviour [48,49,56]. One study reported improving nutrition as its main objective; however, this was a gardening intervention which could also be considered activity [50].…”

“…The studies ranged in duration from 7 days to 1 year, six studies [48-50, 56, 58] collected followup measures beyond post-study though only three studies reported this data in the included articles [48,49,58]. Intervention settings included hospital [52][53][54][55]58], community [57,59,60], home [49,50,56] or a mixture of settings [47,48,51]. Detailed characteristics of the included studies can be found in Table 1.…”