RECENT ADVANCES IN EXERCISE INTERVENTION FOR FATIGUE MANAGEMENT IN PATIENTS WITH GYNAECOLOGIC CANCER @Dr.Muskan Rastogi (PT) BPT,MPT(OBG)
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This document summarizes recent advances in exercise interventions for managing fatigue in patients with gynecologic cancer. It reviews 3 studies that investigated the effects of different types of exercise on fatigue. A randomized controlled trial found that a 12-week resistance exercise program significantly improved quality of life and reduced fatigue in patients with gynecologic cancer compared to a control group. Another study found that relaxation breathing exercises conducted 4 times daily for 30 minutes significantly reduced fatigue in women receiving chemotherapy, more so than exercises conducted 2 times daily. A systematic review concluded that resistance, aerobic, flexibility, and breathing exercises can all help alleviate fatigue in this patient population, but noted limited evidence and called for additional research.
RECENT ADVANCES IN EXERCISE INTERVENTION FOR FATIGUE MANAGEMENT IN PATIENTS WITH GYNAECOLOGIC CANCER @Dr.Muskan Rastogi (PT) BPT,MPT(OBG)
- 1. RECENT ADVANCES IN EXERCI INTERVENTION FOR FATIGUE MANAGEMENT IN PATIENTS WI GYNAECOLOGIC CANCER MUSKAN RASTOGI 222139001 MPT(OBG)-GYNAECOLOGICAL PHYSIOTHERAPY
- 2. Contents 2 1.Introduction 2.Need for recent advance 3.Search strategy 4.Inclusion criteria 5.Exclusion criteria 6.Total included articles 7.Clinical implication 8.Future Scope 9.References
- 3. INTRODUCTION • Gynaecological cancer is an umbrella term for cancer of women’s reproductive organs, which includes ovarian, endometrial(corpus uteri), vaginal, vulval and cervical cancer(cervix uteri). • Globally, 1.4 million females were estimated to be newly diagnosed with gynaecological cancers in 2020, with 6.8 lakh deaths. (CDC National Centre for Health Statistics, Jan 2022) 3
- 4. • In India, 2 lakh new gynecological cancer cases were diagnosed in 2020, and 1.2 lakh deaths occurred among females. Every 1 in 30 Indian women develops gynecological cancer in their lifetime, and one in 48 women dies from it. (Sung H et al. 2021) • Among Indian females, cancer was observed mainly in the age group of 35–64 years, which is also the most productive age group. (ICMR-NCDIR, Bengaluru, India 2020) 4
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- 6. • Most epidemiological studies indicate that the fatigue caused by cancer and its treatment occurs more pervasively, persistently, and profoundly than any other symptom. (Mendoza et al. 1999) • For patients with gynecological cancer, cancer-related fatigue (CRF) has been well documented as an adverse event by clinicians in clinical trials of new drugs and during standard intraperitoneal chemotherapy. (Wang & Woodruff 2015) 6
- 7. • In a qualitative examination of ovarian cancer patients, CRF emerged as the most common symptom, with 93% of patients reporting its presence. • Additionally, the validation study for the MD Anderson Symptom Inventory ovarian cancer module revealed that 20% of patients experienced severe fatigue. (Wang & Woodruff 2015) 7
- 8. • In the past, cancer patients were encouraged to rest if they felt fatigued. Physical exercise has been suggested as helpful in reducing the fatigue associated with cancer by counteracting the tumors and toxic therapy’s adverse effects on the capacity for physical performance. • However, the benefits of exercise on fatigue were explicitly observed for people with breast cancer and prostate cancer. (Kessels and Ellen et. Al. 2018) 8
- 9. NEED FOR RECENT ADVANCE 9 • Studies have proven that exercise is an effective tool for reducing cancer- related fatigue. • However, these investigations have been restricted to groups of individuals affected by breast and prostate cancer. • The appropriate exercise type and dosage for gynaecological cancer patients to alleviate fatigue remains uncertain. • Hence, this RA aims to gain insight into the efficacy of each exercise intervention given to gynecological cancer patients to reduce fatigue levels.
- 10. SEARCH STRATEGY DATABASES • EMBASE - 7 • SCOPUS- 19 • PUBMED – 11 • GOOGLE SCHOLAR- 15 • Total Results - 42 • Removal of duplicates- 36 • Title and abstract screening- 3 Keywords used- “exercise,” “gynecologic cancer,” “Fatigue” “ovarian” “vulval,” “endometrial” “cervical” “aerobic exercise,” “breathing exercise,” “resistance exercise” Boolean operators- “AND” and “OR” Timeline- 2018 to 2023 10
- 11. INCLUSION CRITERIA 11 1. Participants diagnosed/ undergoing chemotherapy for any type of Gynecologic Cancers. 2. Exercise intervention specific to gynecologic cancer patients. 3. Exercise given at any stage of diagnosis or treatment. 4. Studies published in the English language. 5. Studies with the highest level of evidence 6. Studies performed on human subjects
- 12. EXCLUSION CRITERIA • Studies in languages other than English. • Full-text articles not available, Case series, Case reports. 12
- 13. Recent Advances
- 14. Articles Included Title Level of Evidence PEDro score The effect of resistance exercise on quality of life and fatigue in patients with gynecological cancer 1b 8/11 Effect of Relaxation Breathing Exercise on Fatigue for Women with Gynecological Cancer Receiving Chemotherapy 1b 9/11 Exercise Interventions to Manage Fatigue in Women With Gynecologic Cancer: A Systematic Review 1a 14
- 15. TURKISH JOURNAL OF SPORTS MEDICINE 2022;57(1):44-50
- 16. • AIM To investigate the effect of resistance exercises on quality of life and fatigue in patients with gynecological cancer. • PARTICIPANTS 160 endometrial, cervical, or ovarian cancer patients participated in the study. Participants were divided into two groups the exercise and control groups, with 80 individuals in each group. Single centred randomized controlled trial 16
- 17. • OUTCOME MEASURES TAKEN Primary outcome measurements. Functional Assessment of Cancer Therapy-General Functional Assessment of Chronic Illness Therapy-Fatigue Secondary outcome measurements. Body mass index (BMI) Body fat ratio Hand grip strength Hip and back extensor group muscle strength 17
- 18. • INTERVENTION (EXERCISE GROUP) 12 weeks of intervention were given. (1-2 sets x 8-12 repetitions for 2 days/week) Exercises for the upper extremity: • Abduction, extension, and external rotation of the shoulder against resistance, • Horizontal adduction and protraction against resistance, • Flexion of the elbow against resistance. Exercises for the lower extremity : • Flexion-extension of the hip against resistance, • Abduction and adduction of the hip against resistance, • Flexion and extension of the knee against resistance, • Flexion and extension of the ankle against resistance. • A total of five different levels of resistance bands were used. The patients were asked to choose the resistance band so that they would perform the last repetitions with a compelling effort. The participants 18
- 19. • INTERVENTION (CONTROL GROUP) Usual oncological care. (intervention not defined) 19
- 20. • RESULTS At the end of the study, significant improvements were observed in the quality of life (p<0.001) and fatigue (p<0.001), as well as body composition and strength values (p<0.001) in the exercise group compared to the control group. The levels of change in the values were more significant in the exercise group (p<0.001). A significant correlation was found between the changes in physical parameters (body fat ratio, BMI) and the changes in quality of life and fatigue levels (p<0.001) • CONCLUSION Resistance exercises could significantly reduce cancer-related fatigue and improve quality of life in patients with gynecological cancer. It can be concluded that resistance exercises can contribute to the treatment process and the patient’s quality of life 20
- 21. EGYPTIAN JOURNAL OF HEALTHCARE, 2020
- 22. • AIM To evaluate the effect of relaxation breathing exercises on fatigue for women with gynecological cancer receiving chemotherapy. • PARTICIPANTS Simple random sample were recruited to participate in this study. Subjects: Subjects of this study included 183 women Inclusion criteria: Women who had gynaecological cancer, received chemotherapy in the inpatient units, endured cancer-related fatigue, alert, and knew writing and reading. Exclusion criteria: Women with chronic medical conditions such as diabetes mellitus, heart disease, and chronic kidney disease were excluded from the study because fatigue experience can be affected by these conditions.
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- 24. • OUTCOME MEASURES TAKEN PFS- PIPER FATIGUE SCALE WOMEN’S DIARY NOTES • INTERVENTION 7-day intervention Subjects of the two times relaxation breathing exercise group were taught how to perform a 3-step relaxation breathing exercise. Step1.Preliminary exercise: In which women sit on the bed in a comfortable position and focus their attention on the lower abdomen. Step2.Relaxation breathing: This step focuses on performing relaxation breathing exercises through which the women relax and inhale deep breath and exhale them loudly. Step 3. Ending Exercise: In this step the exercise instruction was to extend both arms and legs and keep their minds clear. Each participant exercises twice; once in the morning/8 am and the other in the afternoon/8 pm Four-time relaxation breathing exercise group received the same care as 2 times group except that they were instructed to perform RBE four times instead. This group were instructed on 3-step relaxation breathing exercises 4 times daily for 30 minutes each time, at this time;(morning/8 am, midday/12 pm, afternoon/4pmandnight/8 pm) for seven days. 24
- 25. Results: • There was a highly significant difference in fatigue scores between intervention and control. Also, fatigue scores were statistically significantly reduced between two weeks and four weeks groups. • There was also a considerable difference concerning four fatigue domains between intervention and control groups. • Moreover, there was a significant difference in mean fatigue score concerning daily activities on the seventh day of the study among interventions (two times group). At the same time, there was a high significance difference between the four times groups and the control group. 25
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- 30. Conclusion: • Relaxation breathing exercise is a cost-effective, non-invasive, easy, and safe practice to alleviate cancer related-fatigue, mainly when conducted four times daily. • Moreover, relaxation breathing exercise positively improves the performance of daily activities and associated symptoms of chemotherapy. 30
- 32. 32 AIM and PROBLEM IDENTIFICATION: Fatigue has a negative impact on the quality of life of patients with cancer. This review aims to evaluate studies on the effectiveness of exercise interventions in reducing fatigue in women with gynecologic cancer. LITERATURE SEARCH: The review was conducted according to the PRISMA guidelines using the CINAHL, MEDLINE, EMBASE, PsycINFO, and Cochrane Library databases. The Critical Appraisal Skills Programme was used for quality assessment. DATA EVALUATION: Five studies met the inclusion criteria: three randomized controlled trials and two single-arm trials. CONCLUSION: Evidence suggests that exercise interventions significantly reduce fatigue in women with gynecologic cancer. However, the current evidence is limited. Additional studies are required to address the dose-dependent outcomes of exercise interventions on fatigue in women with gynecologic cancer.
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- 37. CLINICAL IMPLICATION • Relaxation breathing exercises improve all four domains of fatigue.{Repetition of four is more effective than two times for 30 minutes daily} • Resistance exercise can be given as 1-2 sets x 8-12 repetitions for 2 days/week with the help of resistance bands. • Superiority of any exercise intervention is not established. • Resistance, aerobic, flexibility, and breathing exercises alleviate fatigue in patients with gynecological cancer, hence, they should be a part of the exercise protocol to relieve fatigue. 37
- 38. FUTURE SCOPE • Standardized parameters for all the types of exercise to reduce fatigue in gynecologic cancer patients. • Effect of application of exercise intervention on fatigue within the different types of gyanecologic cancer should be studied. 38
- 39. REFERENCES • Mendoza TR, Wang XS, Cleeland CS, Morrissey M, Johnson BA, Wendt JK, Huber SL. The rapid assessment of fatigue severity in cancer patients: use of the Brief Fatigue Inventory. Cancer. 1999 Mar 1;85(5):1186-96. • Wang XS, Woodruff JF. Cancer-related and treatment-related fatigue. Gynecologic oncology. 2015 Mar 1;136(3):446-52. • Kessels, Ellen et al. “The effect of exercise on cancer-related fatigue in cancer survivors: a systematic review and meta-analysis.” Neuropsychiatric disease and treatment vol. 14 479-494. 9 Feb. 2018, doi:10.2147/NDT.S150464 39
- 40. Thank you