Too Sick Not to Exercise

Using a 6-Week, Home-Based Exercise Intervention for Cancer-Related Fatigue Self-management for Postsurgical Non-Small Cell Lung Cancer Patients

Amy J. Hoffman, PhD, RN; Ruth Ann Brintnall, PhD, AOCN, APRN-BC; Jean K. Brown, PhD, RN, FAAN; Alexander von Eye, PhD; Lee W. Jones, PhD; Gordon Alderink, PhD, PT; Debbie Ritz-Holland, BSN, RN, OCN; Mark Enter, RN, OCN; Lawrence H. Patzelt, MD; Glenn M. VanOtteren, MD


Cancer Nurs. 2013;36(3):175-188. 

In This Article

Abstract and Introduction


Background: Two prevalent unmet supportive care needs reported by the non–small cell lung cancer (NSCLC) population include the need to manage fatigue and attain adequate exercise to meet the physical demands of daily living. Yet, there are no guidelines for routine rehabilitative support to address fatigue and exercise for persons with NSCLC during the critical transition from hospital to home after thoracotomy.

Objective: The objective of this study was to evaluate the feasibility, acceptability, safety, and changes in study end points of a home-based exercise intervention to enhance perceived self-efficacy for cancer-related fatigue (CRF) self-management for persons after thoracotomy for NSCLC transitioning from hospital to home.

Interventions/Methods: Guided by the principles of the Transitional Care Model and the Theory of Symptom Self-management, a single-arm design composed of 7 participants with early-stage NSCLC performed light-intensity walking and balance exercises in a virtual reality environment with the Nintendo Wii Fit Plus. Exercise started the first week after hospitalization for thoracotomy and continued for 6 weeks.

Results: The intervention positively impacted end points such as CRF severity; perceived self-efficacy for fatigue self-management, walking, and balance; CRF self-management behaviors (walking and balance exercises); and functional performance (number of steps taken per day).

Conclusions: A home-based, light-intensity exercise intervention for patients after thoracotomy for NSCLC is feasible, safe, well tolerated, and highly acceptable showing positive changes in CRF self-management.

Implications for Practice: Beginning evidence suggests that a light-intensity in-home walking and balance intervention after hospitalization for thoracotomy for NSCLC is a potentially effective rehabilitative CRF self-management intervention. Next steps include testing of this health-promoting self-management intervention in a larger-scale randomized controlled trial.


Fatigue is an unresolved problem for many cancer survivors, and this is particularly true for persons with lung cancer.[1,2] Likewise, persons with lung cancer report that 2 of their most prevalent unmet supportive care needs include the inability to self-manage fatigue and attain adequate exercise to preserve independence in activities of daily living.[3–5] Lung cancer is one of the most common solid tumors, and it remains one of the most deadly cancers in the world.[6] Yet, it remains woefully understudied with little information regarding the early postoperative recovery period for those persons with early-stage non–small cell lung cancer (NSCLC).[7] This study focuses on the post–hospital discharge recovery period and describes the incorporation of an intervention designed to meet the immediate known needs of this patient population—fatigue, fatigue self-management, and exercise.