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Newly Developed Reference Chart Helps Monitor Cancer-Related Fatigue Improvements Through Exercise Program

Using survey data from BfitBwell participants, Ryan Marker, PhD, PT, is working to personalize exercise prescriptions for people during and soon after cancer treatment.

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Written by Rachel Sauer on July 29, 2022

For people living with and beyond cancer, one of the most common and limiting side effects is cancer-related fatigue (CRF).

This broad category of symptoms can include physical, cognitive, or emotional side effects that may range from persistent exhaustion to insomnia, irritability, lack of energy, or inability to concentrate. Its effects can be especially obvious during exercise for people currently undergoing or who recently completed cancer treatment.

For trainers who personalize exercise prescriptions for people during and after cancer treatment, adapting each workout to an individual’s CRF that day often relies on the trainer’s experience and expertise. However, Ryan Marker, PhD, PT, a University of Colorado Cancer Center member and assistant professor of physical medicine and rehabilitation, noticed there was limited data to help monitor CRF improvement through exercise.

In recently published research, Marker and his co-researchers outline the process of addressing this resource gap by creating a reference chart to monitor CRF improvement through a cancer-specific exercise program.

“From the literature we know that exercise is effective at reducing cancer-related fatigue, and we also know from the literature that there’s not one correct exercise prescription that’s going to work for every patient,” Marker explains. “We saw a need for data to help us establish a baseline for cancer-related fatigue specific to each person, and a reference chart to monitor improvement through their exercise program. Monitoring during the program allows us to adjust the exercise prescription to increase benefits for each individual.”

Personalizing exercise prescriptions

Marker first noticed the need for a data-based tool to monitor CRF improvement working with cancer exercise specialists in the CU Cancer Center’s BfitBwell program, a three-month individualized exercise program for people currently undergoing or less than six months after cancer treatment.

“Something BfitBwell does really well is personalize the exercise prescriptions for individual patients,” Marker says. “We work with people who are in the midst of treatment or just a few months past it, and work with them wherever they’re at that day. If someone comes in and they’re really slammed by a recent chemo treatment, instead of us telling them to go home, we say, ‘Let’s adapt your exercise intensity down today.’ And so often this results in improved symptoms and they leave feeling better than when they came in.”

Because CRF is such a common symptom across all types of cancer, Marker and his colleagues began tracking it more than two years ago by asking BfitBwell participants to complete a 13-item questionnaire every two weeks. The questionnaire, using the FACIT-Fatigue scale, asked people to rank themselves using a 0 to 4 scale on statements such as “I feel fatigued,” “I am able to do my usual activities,” and “I need to sleep during the day.”

Marker and his co-researchers analyzed data from 741 observations submitted by 173 individuals as they began developing a reference chart to monitor CRF improvement through the three-month BfitBwell program. A goal is to predict the magnitude and time course of improvement for an individual participating in a cancer-related exercise program.

Directing resources to patients

Developing a data-based reference chart is important for cancer-specific exercise programs because it helps trainers and participants establish a CRF baseline at the beginning of a program and monitor it through the program. Participants complete the 13-item questionnaire every two weeks and the data are plotted on the reference chart.

“Now we have an evidence-based tool to complement the art of personal training with data,” Marker says. “We’re able to measure this individual through the program, and we can see whether or not they’re progressing as we’d expect. That data is really valuable in helping us personalize each person’s program to see improvement in cancer-related fatigue.”

By continuing to gather data, Marker and his colleagues hope to make reference charts for specific types of cancer, age groups, and other factors that further allow trainers to personalize exercise prescriptions.

The reference chart also is a useful tool for trainers working virtually with people in rural areas. Using the chart ensures that trainers get the information they need to personalize the exercise prescription. “We're also using the reference chart to replicate the effects of BfitBwell virtually,” Marker says, adding that the unsupervised exercise programs currently available to rural survivors have reduced effects compared to supervised programs.

“One of our most important goals is using the reference chart as one tool to make the BfitBwell program more accessible and scalable,” Marker says. “The rural program is a really good example of that in terms of accessibility, because you can do it anywhere you have internet, you don’t have to come in to an exercise facility. We want to use the reference chart to direct resources to patients who need them and in a way that works for them.”

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Ryan Marker, PhD, PT