Exercise training in patients with locally advanced stage rectal cancer: Pain, fatigue, insomnia, and health perceptions outcomes


The wait period between the completion of neoadjuvant-chemoradiation therapy (NACRT) and surgery can be challenging for patients with advanced rectal cancer who experience debilitating side effects. This can depreciate patients' perceptions of their health status. Thus, identifying strategies to reduce side effects and maintain patients' perceptions of their health status is a priority in the treatment of advanced stage rectal cancer. In this study, the effectiveness of a 6-week, in-hospital exercise intervention for promoting physical and mental health perceptions and reducing pain, fatigue, and insomnia in patients with locally advanced rectal cancer (n=24, Mage=63 years, SD = 9.7; 58% male) was examined. The intervention was delivered immediately after patients completed NACRT and prior to surgery. Participants completed questionnaires at three time points: pre-NACRT, post-NACRT/pre-exercise intervention, and post-exercise intervention. Data were analyzed using Wilcoxon matched-pairs signed-rank tests, and the Simes procedure was used to correct for multiple comparisons. Fatigue decreased (p=.01) and physical health perceptions increased (p=.004) pre- to post-exercise intervention. Pain also decreased during this time, albeit not significantly based on the corrected critical p-value (p=.03). There were no significant differences in insomnia or mental health perceptions across assessments (ps=.11-.73). Based on these findings, pre-operative exercise training appears to effectively reduce fatigue and improve physical health perceptions in patients awaiting surgery for locally advanced stage rectal cancer. Including pre-surgical exercise within patients' cancer plan of care post-NACRT may be a critical strategy to reduce certain side effects, improve perceptions of physical health status, and ultimately promote recovery.

Acknowledgments: This study was conducted while the first author was supported by a Canadian Cancer Society Career Development Award in Prevention.