More about Phys-Can

Background

Physical exercise has beneficial effects on physical and mental health. People undergoing cancer treatment may improve healt-related quality of life and decrease treatment-related side-effects like fatigue and nausea. In addition, the chances of completing oncological treatment according to the treatment plan seem to increase with increased physical fitness. However, we do not know which exercise intensity is optimal to gain the best health gains, and we do not know which behavior change strategies should be used to facilitate the actual performance of exercise.

Read scientific Study protocol för Phys-Can här

Aims

1) To compare the effects of aerobic and resistance exercise on high and low/moderate intensity levels on cancer-related fatigue and health-related quality of life  2) To compare the effect of additional behavior change support in terms of e.g. planning and follow-up of performing the exercise. 3) To explore possible physiological mechanisms explaining the effect of physical exercise on fatigue. 4) To describe a health aconomic evaluation of the Phys-Can study.

Design

Phys-Can is a randomized controlled trial with allocation to one out of four conditions; 1) high intensity 2) high intensity with extra behavior change support 3) low/moderate intensity 4) low/moderate intensity with extra behavior change support.

The design is longitudinal with assessments before, during and after the 6-month exercise program and  at 1, 2 and 5 years follow-up. At 10-year follow-up data is collected from medical records and registries. 

Participants

600 patients undergoing adjuvant treatment (chemotherapy, radiation and/or antihormoe tratment) for breast cancer, prostate cancer or colorectal cancer at Uppsala, Linköping or Lund/Malmö university hospitals. All potential participants are assessed by physicians to rule out any medical risks for the patients to participate.

Exercise program

Exercise is performed during 6 months. The resistance exercise is supervised and performed twice a week at a public gym (Friskis & Svettis). The resistance is tested out for every participant: higher loads enphasizing muscular strength in the high intensity group and lower loads emphasizing muscular endurance in the low/moderate intensity group. Aerobic exercise is home-based after introduction by a project instructor. The high intensity group performs interval sessions twice a week on individually adjusted intensity. The low/moderate intensity group perform walking and biking on individually adjusted levels at least 150 minutes per week.

Behavior change support

Groups with extra behavior change support are guided in planning and follow-up of their exercise sessions, focusing on the homebased aerobic exercise. At the end of the 6-month exercise program thay are also guided to develop a plan for maintenance of exercise of own choice, with follow-up at 3 and 9 months.

Assessments

Physical capacity tests of maximum oxygene uptake, muscle strength and body composition. Questionnaires with self-reports of e.g. cancer-related fatigue, health-realted quality of life with validated instruments. Exercise diaries and heart rate monitors are used to assess exercisse adherence. Blood samples are drawn to assess physiological mechanisms related to exercise and fatigue. Medical records and register data are used for the health economy analyses.

Time plan and significance

The exercise intervention started March 2015 and will end November 2018. The results will increase the evidence base for physical exercise recommendations to people undergoing adjuvant cancer treatment, both regarding intensity and behavior change support to facilitate performance of exercise. Healthcare will get a better health economy foundation to make decisions about the role of physical exercise as part of cancer care.