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Title: Evaluation of a home-based walking exercise program on fatigue and health related quality of life in prostate cancer patients undergoing radiation therapy : a pilot study
Author: Doyle, Ciarán
ISNI:       0000 0004 5924 1976
Awarding Body: London School of Hygiene & Tropical Medicine
Current Institution: London School of Hygiene and Tropical Medicine (University of London)
Date of Award: 2016
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Background: Exercise could have a role in ameliorating some of the adverse effects of External Beam Radiotherapy and Androgen Deprivation Therapy (EBRT+ADT) in men with prostate cancer. The primary aim of this study was to assess the feasibility (process, resource and management) and efficacy (scientific) of a home-based moderate-to-vigorous physical activity (MVPA) walking exercise intervention for patients with localised prostate cancer (PCa) undergoing EBRT+ADT in anticipation of a future confirmatory RCT. Methods: PCa patients receiving EBRT+ADT were randomized to a home-based MVPA walking intervention (n=12) or standard care (n=12) for the duration of their EBRT. Intervention patients were prescribed 3000 steps in 30 minutes on 5 days each week, i.e. a cadence of 100 steps/minute. These 3000 steps/day were prescribed in addition to their pre-determined habitual step/day. Fatigue, health related quality of life (HRQoL), anthropometric measures and physical performance were assessed at baseline (planning CT), mid EBRT, end of EBRT, and at 1 month post EBRT. Intervention participants’ satisfaction with the intervention and barriers/facilitators to exercise during EBRT were also assessed. Control group participants’ exercise knowledge, attitudes and practices were assessed post EBRT. The feasibility of the intervention’s processes, resources and management were assessed using quantitative and qualitative methods. Results: The exercise intervention group showed greater improvements in fatigue, quality of life, anthropometric measures and physical performance compared to standard care controls. These improvements were sustained beyond the intervention period. Exercise convenience and treatment centre environment emerged as exercise facilitators. Intervention participants’ average exercise convenience and satisfaction ratings were 4.8/5 (SD=0.4) i.e. “extremely convenient” and 4.8/5 (SD=0.4) i.e. “extremely satisfied” respectively. A lack of time and poor weather emerged as exercise barriers. Standard care controls had poor exercise knowledge, attitudes and practices (KAP) post EBRT, for example only 42% of the control group were aware of the correct recommended weekly MVPA guidelines. Conclusions: This preliminary evidence suggests that a pragmatic home-based MVPA walking exercise intervention is feasible and has the potential to evoke improvements in fatigue, in addition to other important health outcomes in men with PCa undergoing EBRT+ADT. This pilot study has achieved its six feasibility criteria and should proceed to a future confirmatory RCT. Impact: This study shows for the first time that a pragmatic home-based MVPA walking exercise intervention using evidence based tailored exercise prescriptions is feasible and could have a positive impact on fatigue and other key outcomes in men with PCa receiving EBRT+ADT.
Supervisor: Curtis, V. Sponsor: Not available
Qualification Name: Thesis (D.P.H.) Qualification Level: Doctoral