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A Behavioral Physical Activity Intervention to Manage Moderate and Severe Fatigue Among Head and Neck Cancer Patients—Pre-efficacy Study in the National Institutes of Health ORBIT Model

Wang, Hsiao-Lan PhD, RN, CMSRN, ACSM EP-C; McMillan, Susan C. PhD, ARNP, FAAN; Vijayakumar, Nisha MS; McDonald, Sally MS, RN; Huang, Li-Ting PhD, RN; Gwede, Clement PhD, MPH, RN, FAAN; Padhya, Tapan MD; Russell, Jeffery MD, PhD; Vondruska, Karen RN; Buck, Harleah G. PhD, RN, FPCN, FAAN; Huang, Yangxin PhD; Visovsky, Connie PhD, RN, ACNP-BC, FAAN

doi: 10.1097/NCC.0000000000000568

Background Cancer-related fatigue (CRF) reduces head and neck cancer (HNC) survival rates and is the most common, severe, and distressing symptom negatively impacting activities of daily living (ADLs) dependence among HNC patients. These patients remain physically inactive after their cancer treatment, although there is consensus that physical activity mitigates CRF in cancer patients.

Objective A home-based personalized behavioral physical activity intervention with fitness graded motion exergames (PAfitME) was evaluated for its intervention components, intervention delivery mode, and intervention contact time/duration with initial assessment of the feasibility, acceptability, safety, and outcomes.

Methods This study (N = 8) was a single-group, pre-post design to evaluate a 6-week PAfitME at the end of HNC treatment. Health outcomes were CRF, ADL dependence, and fitness performance. Behavioral outcomes were exergame adherence.

Results Positive health and behavioral outcomes support the PAfitME protocol including intervention components, intervention delivery mode, and intervention contact times/duration. The PAfitME intervention is feasible and acceptable with promising adherence rates. No adverse events were reported. There was marked improvement in CRF, ADL dependence, cardiorespiratory fitness, balance, muscle strength, and shoulder forward flexion, with large to moderate effect sizes as a result of the PAfitME intervention.

Conclusion The PAfitME protocol is ready for additional testing in a randomized clinical trial.

Implications for Practice The PAfitME intervention is a nurse-led nonpharmacological intervention. It can be integrated into home care or telehealth care for HNC patients at the end of their cancer treatment once effectiveness is established.

Author Affiliations: College of Nursing (Drs Wang, McMillan, L.-T. Huang, Buck, and Visovsky and Ms McDonald), College of Public Health (Dr Y. Huang and Ms Vijayakumar), and College of Medicine (Dr Padhya), University of South Florida; and Moffitt Cancer Center (Drs Gwede, Padhya, and Russell and Ms Vondruska), Tampa, Florida.

This project has been funded by the Oncology Nursing Society Foundation (RE01); the Sigma Theta Tau International Honor Society Beta Chapter-At-Large; and the Center for Hospice, Palliative Care, and End of Life Studies at University of South Florida.

The authors have no conflicts of interest to disclose.

Correspondence: Hsiao-Lan Wang, PhD, RN, CMSRN, ACSM EP-C, University of South Florida College of Nursing, 12901 Bruce B. Downs Blvd, MDC22, Tampa, FL 33612 (

Accepted for publication September 18, 2017.

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