We appraised seven articles examining the effects of a walking program on quality of life (QOL), fatigue, and aerobic functional capacity in individuals receiving chemotherapy or radiotherapy for cancer. Five of the reviewed studies had moderate to good methodological quality and contributed to our overall clinical bottom line. In these studies, individuals who walked (total of 3 to ¡Ý24 hours) clinically improved their QOL and decreased their cancer-related fatigue, and statistically improved their aerobic functional capacity (or effectively mitigated significant decreases in aerobic functional capacity) compared to individuals who received usual cancer care. Three of the five articles specified that the aerobic walking program was performed at moderate intensity (50-70% of max heart rate). In one study with a population of women one to three years post breast cancer treatment, a two-month moderate intensity aerobic exercise program increased fatigue levels compared to the usual care group. This may have been because the intensity was too vigorous and exercise-related fatigue may have been misinterpreted as cancer-related fatigue. Therefore, we recommend close monitoring of exercise intensity and post-exercise fatigue levels to minimize the potential of causing exercise-induced fatigue in previously inactive individuals. Based on this evidence, we recommend an average of ¡Ý60 minutes per week of light to moderate intensity walking during cancer treatment to increase QOL, decrease cancer-related fatigue, and improve overall aerobic functional capacity. These recommendations can apply to adults undergoing chemotherapy or radiotherapy for cancer (with treatment regimens and courses similar to those prescribed to study participants for each respective type of cancer) for whom safe exercise intensities can be established. Since the interventions were walking programs, we cannot generalize our recommendations to a non-ambulatory population or to those who have other co-morbidities that prevent walking at the required heart rates. Physical therapists can effectively screen patients for safe aerobic exercise by using an assessment or screening tool such as the Duke Activity Status Index. Future studies need to investigate the role of the intensity component aerobic of exercise to determine the appropriate aerobic exercise intensity to best improve QOL, fatigue, and aerobic functioning during cancer treatment.
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