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Effect of a multimodal high intensity exercise intervention in cancer patients undergoing chemotherapy: randomised controlled trial

BMJ 2009; 339 doi: (Published 14 October 2009) Cite this as: BMJ 2009;339:b3410
  1. Lis Adamsen, professor clinical nursing12,
  2. Morten Quist, research physiotherapist 2,
  3. Christina Andersen, research nurse 2,
  4. Tom Møller, research nurse 2,
  5. Jørn Herrstedt, professor clinical oncology 3,
  6. Dorte Kronborg, associate professor4,
  7. Marie T Baadsgaard, research assistant2,
  8. Kirsten Vistisen, MD 5,
  9. Julie Midtgaard, research psychologist 2,
  10. Birgitte Christiansen, staff study nurse 5,
  11. Maria Stage, student assistant2,
  12. Morten T Kronborg, BSc Stud Act6,
  13. Mikael Rørth, professor 7
  1. 1Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
  2. 2University Hospitals Centre for Nursing and Care Research, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark
  3. 3Department of Oncology, Odense University Hospital, Odense, Denmark
  4. 4Centre for Statistics, Copenhagen Business School, Frederiksberg, Denmark
  5. 5Department of Oncology, Herlev University Hospital, Herlev, Denmark
  6. 6Department of Mathematical Sciences, University of Copenhagen, Copenhagen, Denmark
  7. 7Department of Oncology, Copenhagen University Hospital
  1. Correspondence to: L Adamsen, University Hospitals Centre for Nursing and Care Research, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark la{at}
  • Accepted 8 May 2009


Objective To assess the effect of a multimodal group exercise intervention, as an adjunct to conventional care, on fatigue, physical capacity, general wellbeing, physical activity, and quality of life in patients with cancer who were undergoing adjuvant chemotherapy or treatment for advanced disease.

Design Randomised controlled trial.

Setting Two university hospitals in Copenhagen, Denmark.

Participants 269 patients with cancer; 73 men, 196 women, mean age 47 years (range 20-65) representing 21 diagnoses. Main exclusion criteria were brain or bone metastases. 235 patients completed follow-up.

Intervention Supervised exercise comprising high intensity cardiovascular and resistance training, relaxation and body awareness training, massage, nine hours weekly for six weeks in addition to conventional care, compared with conventional care.

Main outcome measures European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), Medical Outcomes Study Short Form (MOS SF-36), Leisure Time Physical Activity Questionnaire, muscular strength (one repetition maximum), maximum oxygen consumption (Vo2max).

Statistical methods The general linear model was used for continuous outcome while analysis of associates between categorical outcomes was performed as analysis of marginal homogeneity in contingency tables.

Results Adjusted for baseline score, disease, and demographic covariates, the intervention group showed an estimated improvement at six weeks for the primary outcome, fatigue, of −6.6 points (95% confidence interval −12.3 to −0.9, P=0.02; effect size=0.33, 0.04 to 0.61). Significant effects were seen on vitality (effect size 0.55, 95% CI 0.27 to 0.82), physical functioning (0.37, 0.09 to 0.65), role physical (0.37, 0.10 to 0.64), role emotional (0.32, 0.05 to 0.59), and mental health (0.28, 0.02 to 0.56) scores. Improvement was noted in physical capacity: estimated mean difference between groups for maximum oxygen consumption was 0.16 l/min (95% CI 0.1 to 0.2, P<0.0001) and for muscular strength (leg press) was 29.7 kg (23.4 to 34.9, P<0.0001). No significant effect was seen on global health status/quality of life.

Conclusion A supervised multimodal exercise intervention including high and low intensity components was feasible and could safely be used in patients with various cancers who were receiving adjuvant chemotherapy or treatment for advanced disease. The intervention reduced fatigue and improved vitality, aerobic capacity, muscular strength, and physical and functional activity, and emotional wellbeing, but not quality of life.

Trial registration Current Controlled trials ISRCTN05322922.


  • Contributors: LA, CA, MQ, TM, JM, and MR contributed to conception and trial design. LA, JM, MR, and JH wrote the protocol. JH, KV, BC, CA, and TM were responsible for recruitment of patients to the trial. MQ, CA, and TM conducted the daily training sessions. CA, MQ, TM, and BC collected the data. JH, MR, and KV provided clinical expertise. DK was study statistician. MTB, MS and MK contributed to the statistical analysis and interpretation of data. LA and MR drafted the first version of the manuscript. LA obtained the funding. JH, DK, KV, MQ, TM, CA, BC, and JM critically reviewed, revised, and supplemented the manuscript. All authors approved the final version. LA is the guarantor.

  • Funding: This research was supported by grants from The Lundbeck Foundation, The Novo Nordic Foundation, The Egmont Foundation, The Danish Cancer Society, The Svend Andersen Foundation, The Aase and Ejnar Danielsen Foundation, The Beckett Foundation, The Wedell-Wedellsborg Foundation, The Hede Nielsen Family Foundation, The Gangsted Foundation, Copenhagen University Hospital. The authors’ work was independent from the funders.

  • Competing interests: None declared.

  • Ethical approval: Ethical approval was obtained from the Scientific Committees of the Copenhagen and Frederiksberg Municipalities ( 01273/00) and the Danish Data Protection Agency ( 2000-41-0-149).

  • Accepted 8 May 2009

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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