Abstract
Objective. As a result of recent advances in diagnosis and treatment, the number of people surviving cancer is increasing. A subgroup of cancer survivors report long-lasting physical and psychological complaints including decreased cardiorespiratory capacity, decreased physical functioning, and decreased quality of life (QoL). Physical and psychological rehabilitation had beneficial effects
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on cancer survivors' physical fitness and QoL. Physical training appeared to have a primarily positive effect on the physical and functional aspects of QoL, whereas cognitive-behavioural therapy was shown to be beneficial for the psychosocial aspects. Therefore, compared to a single intervention, combining physical training with cognitive-behavioural therapy may lead to greater improvements in QoL by having benefits on both physical and psychosocial functioning. Therefore, the aim of the present study was to determine the effects of a group-based combined self-management physical and cognitive-behavioural intervention (PT+CBT) on the physical fitness and quality of life of cancer survivors compared to group-based self-management physical training (PT) and a waiting list control group (WLC). Methods. Between February 2004 and January 2007, a total of 209 cancer survivors (all cancer types, medical treatment completed at least three months ago) were recruited and were randomly assigned to 12-week PT+CBT (n=76) or 12-week PT (n=71), or participated in WLC (n=62). The WLC group consisted of cancer survivors on a waiting-list using the same inclusion criteria. QoL was measured using the EORTC-QLQ-C30 and the RAND-36. Physical fitness was assessed by means of an exhaustive exercise test and muscle strength testing. Physical activity levels were determined using the Physical Activity Scale for the Elderly. The intervention groups were measured at baseline and post-intervention. QoL was also assessed at three and nine months post-intervention. The WLC group was measured at baseline and 12 weeks later. Results. The sample compromised 179 women and 30 men. The age of participants ranged from 18 to 74 years with a mean of 49.9 years. 57.4% survivors were diagnosed with breast cancer, 15.8% with haematological cancer, 11.5% with gynaecological cancer and 15.3% with other types of cancer. In terms of treatment, 84.7% had surgery, 67.5% received chemotherapy and 58.9% received radiation therapy. There was no difference in changes of QoL, physical fitness and physical activity between PT and PT+CBT at the short-term as well as, concerning QoL, at the long-term. Compared to control, participants in both intervention groups exhibited significant and clinically relevant improvements in role limitations due to physical problems, physical functioning, vitality and health change. Furthermore, peak exercise capacity and muscle strength of the lower limb of PT+CBT and PT participants were increased after the intervention compared to the control subjects. Conlusion. The intensive, supervised, group-based physical training programme that integrated principles of self-management and the advantages of peer contact improved cancer survivors' physical fitness and QoL. Combining the physical training with a cognitive-behavioural intervention did not add to these beneficial effects of physical training neither in the short-term nor in the long-term.
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