Feasibility of a physical exercise intervention for patients on a palliative care unit: a critical analysis

BMC Palliative Care, vol. 23, pp. 58

Abstract

BACKGROUND: Recent exercise intervention studies have shown promising results in improving quality of life (QoL) and physical function (PF) in diverse chronic disease and advanced cancer patients. However, the effects of structured exercise in palliative care patients, having different therapeutic needs, lower life expectancies and PFs remain unknown. This study primarily aimed to assess the feasibility of an exercise intervention with follow-up by analysing recruitment numbers, screening procedures, acceptability, preferences, and safety of the exercise intervention as well as retention in follow-up. Our secondary aims related to changes in QoL and PF. METHODS: This study comprised of a one-arm design without a control group. Over 6 months, every in-hospital palliative care unit (PCU) patient was screened for eligibility. Eligible patients were asked to participate in a 2-week exercise intervention consisting of resistance training and/or endurance training with moderate or high intensity based on personal preferences and a 4-week follow-up. Before and after the exercise intervention, QoL and PF were assessed and a qualitative interview after the intervention addressed expectations and experiences of the exercise intervention. For follow-up, patients were provided with information on independent training and after 1 and 4 weeks a QoL assessment and qualitative interview were conducted. RESULTS: Of 124 patients screened, 10 completed the intervention with an adherence rate of (80 ± 25%), of which 6 patients completed follow-up. Endurance training was the most performed training type and only a few minor adverse events occurred in certain or likely connection to the exercise intervention. While physical QoL and PF measured by arm curl strength and time up and go performance improved, mental QoL and the other PF tests remained unchanged. CONCLUSION: Despite the challenges that were faced in our screening and testing process, that are specific to the palliative patient population with their unique therapeutic requirements and varying mental-/ physical capabilities, we discovered the 2-week exercise intervention to be feasible, safe, and well tolerated by palliative care patients. Moreover, it seems that short-term improvements in QoL and PF are possible. Further full scale studies are required to confirm our findings. TRIAL REGISTRATION: The study was retrospectively registered on 25.01.2022 in the German Clinical Trials Register (DRKS00027861).

Authors 8

1. Inken Schwonke corresponding Aachen Medical Faculty Department of Palliative Medicine

   RWTH Aachen University

   Affiliation as printed

   Department of Palliative Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany. inken.schwonke@rwth-aachen.de

   Department of Palliative Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany

2. Nils Freitag

   German Sport University Cologne

   Affiliation as printed

   Department of Molecular and Cellular Sports Medicine, Institute of Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany

   Olympic Training Centre Berlin, Berlin, Germany

3. Paula Aschendorf

   German Sport University Cologne

   Affiliation as printed

   Department of Molecular and Cellular Sports Medicine, Institute of Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany

4. Kerstin Wucharz Aachen Department of Physiotherapy

   RWTH Aachen University · Universitätsklinikum Aachen · Bethlehem Gesundheitszentrum Stolberg

   Affiliation as printed

   Department of Physiotherapy, Franziska-Schervier Educational Center, Bethlehem Hospital, Stolberg, Germany

   Department of Physiotherapy, RWTH Aachen University Hospital, Aachen, Germany

5. Johanna Thieme Aachen Department of Physiotherapy

   RWTH Aachen University · Universitätsklinikum Aachen

   Affiliation as printed

   Department of Physiotherapy, RWTH Aachen University Hospital, Aachen, Germany

   Pro Sanum Health and Therapy Center Eifel, Nettersheim, Germany

6. Iris Appelmann Aachen Medical Faculty Department of Palliative Medicine

   RWTH Aachen University

   Affiliation as printed

   Department of Palliative Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany

7. Moritz Schumann

   Chemnitz University of Technology

   Affiliation as printed

   Department of Sports Medicine and Exercise Therapy, Chemnitz University of Technology, Chemnitz, Germany

8. Frank Elsner Aachen Medical Faculty Department of Palliative Medicine

   RWTH Aachen University

   Affiliation as printed

   Department of Palliative Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany