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WASHINGTON -- Cancer patients receiving chemotherapy randomized to follow a prescribed walking program for 6 months had lower glycemic levels and improved treatment symptoms, compared to a control group receiving information about exercise benefits, according to a small study presented here.

Patients who followed a prescribed walking program for 6 months reduced their HbA1c by 16% (P=0.002), reported Marilyn Hammer, PhD, RN, of Mount Sinai Hospital in New York City, at the Oncology Nursing Society's annual conference.

The intervention group also had significantly lower depression and sleep disturbance symptoms, compared to the control group.

Patients in the intervention group also saw nonsignificant trends towards improvements in scores for fatigue, energy, current pain, and weekly pain compared to the control group during the 6-month period:

• Fatigue: -1.48 versus -1.11
• Energy: +1.03 versus +0.45
• Current pain: -0.06 versus +0.98
• Weekly pain: -0.75 versus -0.07

"While there are a lot of studies about exercise for cancer-related fatigue, this is the first study that I know of that actually looked at both managing blood sugar and other treatment-related symptoms," said Hammer.

"Patients undergoing chemotherapy can have increased blood sugar levels, due to steroid use, stress-induced hyperglycemia, and other treatment side effects," she said. "We designed the study to exclude those patients previously diagnosed with diabetes because we wanted to study those patients who might have hidden glucose problems. They may have hyperglycemic episodes and are creeping to a diabetes diagnosis."

"Similarly, when patients have a high symptom burden then it really impairs their quality of life. On top of that, we know that quality of life is directly related to survivability," Hammer added.

The prospective pilot study involved 33 cancer patients without pre-existing diabetes, of which 32 were women and 24 were treated for breast cancer.

Fifteen patients were randomized to the intervention -- a prescribed walking program overseen in collaboration with physical therapists -- and 18 to a control group who received exercise information alone. There were no demographic or medication differences found between the intervention and control groups.

Mean body mass index (BMI) at baseline in the control group was 24.7; it was 26 for the intervention group.

"We understand that patient enrollment in an exercise study typically motivates those who are interested in exercise, so participants were actually a healthy group," said Hammer.

Both groups had A1c measured at enrollment and 6-months. Patients completed symptom surveys at the time of enrollment, and at 3- and 6-month follow-up. Movement and sleep habits were monitored via actigraphy.

"The prescribed exercise program in this study encourages patients to be involved in their care by collaborating with physical therapists to find the right exercise plan for their own needs," commented Roseann Tucci, ANP, CPNP, a nurse practitioner at Memorial Sloan Kettering Cancer Center in New York City, who was not involved with the study. "It also increases better adherence to their walking program. In turn, it reduces cancer treatment symptoms that ultimately improve the patient's quality of life and overall health."

Limitations of the study include a small sample size, and a heterogeneous population related to gender, ethnicity, and cancer type.