Beidas, R.S., Paciotti, B., Barg, F., Branas, A.R., Brown, J.C., Glanz, K., . . . Schmitz, K.H. (2014). A hybrid effectiveness-implementation trial of an evidence-based exercise intervention for breast cancer survivors. JNCI Monographs, 2014, 338-345. 

DOI Link

Study Purpose

To determine whether an exercise-based intervention was safe and effective for breast cancer survivors

Intervention Characteristics/Basic Study Process

The Physical Activity After Lymphedema (PAL) exercise intervention was revised for the intervention of this study based on feedback from health care providers who work with patients with cancer and feedback from patients who participated in the PAL intervention study. Enrollment was open to all breast cancer survivors regardless of a diagnosis of lymphedema. Patients were referred to the Strength After Breast Cancer (SABC) program by a health care provider or were self-referred. Physicians referred all women to a physical therapist for assessment. Patients received a lymphedema education session based on information provided by the National Lymphedema Network. Physical therapists provided small group exercises for four sessions over one to two months with twice-weekly home exercises conducted by participants between sessions for 52 weeks. Symptoms were monitored by study staff members, and data were collected at baseline and at three, six, and 12 months. Patients were provided power blocks and adjustable dumbbells for home exercise.
 
Women with lymphedema were required to wear a well-fitted compression sleeve and glove or gauntlet during the intervention exercise sessions. In addition, women were told to follow up with the physical therapist if they noticed a change in symptoms lasting longer than one week or if measurements at three or six months indicated a change in arm volume ≥ 5% or a ≥ 5% interlimb difference.

Sample Characteristics

  • N = 67  
  • AVERAGE AGE = 55.1 years
  • FEMALES: 100%
  • KEY DISEASE CHARACTERISTICS: Breast cancer 

Setting

  • SITE: Single-site    
  • SETTING TYPE: Home    
  • LOCATION: United States

Phase of Care and Clinical Applications

  • PHASE OF CARE: Late effects and survivorship

Study Design

Quasiexperimental

Measurement Instruments/Methods

  • Height and weight
  • Physical activity outside of weight lifting
  • Perometry
  • National Cancer Institute's Common Terminology Criteria for Adverse Events–Lymphedema (NCI-CTCAE-L) version 3
  • Muscular strength 
  • Semistructured interviews 

Results

The number of lymphedema symptoms reduced from baseline to the 12-month follow-up visit (2.6 [SD = 2.6] to 1.7 [SD = 2.1], p = .002), but there was no statistically significant reduction in the severity of lymphedema symptoms from baseline to the 12-month follow up visit (p = .58). In addition, there was no difference in arm volume, measured as a percent of interlimb difference, at the 12-month follow-up visit (p = .98). Within this sample, four patients (8%) had new-onset lymphedema at the 12-month measurement and five (19%) had a flare-up of existing lymphedema.

Conclusions

The PAL intervention reduced the number of lymphedema symptoms but not the severity of symptoms experienced by participants. In addition, the intervention did not reduce the limb volume of participants. Participants were able, however, to complete the intervention, which took place mostly in the home setting, making it a feasible intervention for women with breast cancer.

Limitations

  • Small sample (< 100)
  • Risk of bias (no control group)
  • Risk of bias (no blinding)
  • Risk of bias (no random assignment)
  • Unintended interventions or applicable interventions not described that would influence results
  • Other limitations/explanation: It is unclear what other exercises participants were doing at home.

Nursing Implications

When available, home-based exercise interventions like the ones described here may be beneficial for patients who are motivated to participate in and complete exercises at home. Nurses should assess patients for readiness to participate in a home exercise program and help patients find resources for planning an appropriate home-based program.