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Improving Sleep Quality for Cancer Patients: Benefits of a Home-Based Exercise Intervention. Mei-Fang Tang, RN, MS, Wan-Fang Hospital, Taipei, Taiwan. Journal : Supportive Care In Cancer(2009.9) Authors : 1.Mei-Fang Tang , RN, MS, Wan-Fang Hospital, - PowerPoint PPT Presentation
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Improving Sleep Quality for Cancer Patients: Benefits of a Home-
Based Exercise Intervention
Mei-Fang Tang, RN, MS,
Wan-Fang Hospital, Taipei, Taiwan
Journal : Supportive Care In Cancer(2009.9)
Authors : 1.Mei-Fang Tang, RN, MS, Wan-Fang Hospital, Taipei, Taiwan 2.Tsan-Hon Liou, MD, PhD, Shuang-Ho Hosptial, Taipei, Taiwan 3.Chia-Chin Lin, RN, PhD, Professor, School of Nursing, Taipei Medical University; Taipei Medical University Hospital, Taipei, Taiwan
Introduction Exercise as an intervention has been
suggested as having the potential to improve sleep quality (Sherrill DL, et al;1998).
In large surveys, up to 80% of people spontaneously report exercise as a factor that promotes sleep quality (Shapiro CM, et al ;1988)
Introduction
Poor sleep quality is a common and distressing problem for cancer patients.
Patients with cancer often report that their sleep is disturbed during the stressful periods associated with diagnosis, treatment side effects, and physical discomfort (Espie CA, et al ;2008).
Introduction
Payne et al.(2008) allocated 20 women with breast cancer who were receiving hormonal treatment to usual care or a home-based walking exercise Intervention.
Self-reported sleep quality improved in the exercise group.
Purpose
1) To determine the effect of a home-based walking exercise program on the sleep quality and quality of life of cancer patients.
2)To determine if enhanced sleep quality was associated with improvement in quality of life over time.
Hypothesized
A home-based walking exercise would have beneficial effects on sleep quality and quality of life.
Methods-- Study Design
A prospective, longitudinal, two-arm, randomized clinical trial designed
A home-based walking exercise for cancer patients on sleep quality and quality of life.
Participants were allocated either to usual care (n = 35) or the walking exercise intervention group (n = 36).
Methods--Setting and Participants - Participants were recruited from the
oncology outpatient clinics of two teaching hospitals in Taipei, Taiwan.
Participants -- criteria(1) Have been diagnosed with cancer
(2) Over the age of 18 years
(3) Have complained of sleep disturbance
with a PSQI score > 5
(4) No neuromuscular deficits that would
contraindicate a walking exercise
intervention
Participants -- criteria(5) No uncontrolled hypertension, cardiac
or psychiatric illness.
(6) Blood pressure less than 140/90 mmHg
(7) Have not regularly undertaken more
than one session of moderate intensity
exercise each week over the past six
months.
Participants -- criteria
(8) Were approved for participation by
their oncologists.
(9) Are able to communicate in Mandarin
or Taiwanese.
Methods -- Exercise training booklet
The 8-week time period was based on previous exercise research among cancer patients.
Patients were instructed to walk at a pace that was faster than normal and based on ratings of perceived exertion (RPE; 11–13).
Methods -- Exercise training booklet
Three days a week, for 30 minutes a day in the evening before supper(4:00 p.m. to 6:00 p.m.).
A five-minute warm up and finish with a five-minute cool down, after completing the 30-minute walking program.
Procedure Patients were informed consent a baseline
assessment . Randomly assigned to either the
experimental or control group . Data collect from each patient during the
initial visit (baseline) and two follow-up visits(1 and 2 months).
Randomly Assigned(N=72)
Exercise Groupn=37
Control Groupn=35
n=36Not interested (n=1)
n=35Discontinued (n=0)
n=24Lack of motivation (n=5)
Discomfort (n=4)Insufficient time (n=3)
n=35Lost to follow-up (n=0)
n=35Lost to follow-up (n=0)
n=36Lost to follow-up (n=0)
Allocation
BaselineAssessment
FirstFollow-up
SecondFollow-up
Figure 1 Flow diagram of participants’ progress through the study phases.
Methods -- Measures The Taiwanese version of the Pittsburgh
Sleep Quality Index The Medical Outcomes Study Short
Form-36 The Taiwanese Version Ratings of the
Perceived Exertion Scale, (RPE) A walking exercise log
The Taiwanese version of the Pittsburgh Sleep Quality Index
Global PSQI score ranging from of 0 21∼ Including 19 items, each weighted equally
on a 0 3∼ scale. Higher scores indicate poorer sleep quality.
The Taiwanese version of the Pittsburgh Sleep Quality Indexseven component scores: subjective sleep Quality sleep latency sleep duration habitual sleep efficiency sleep disturbances sleeping medication use daytime dysfunction.
The Medical Outcomes Study Short Form-36
Lower scores indicate poorer life quality.
Physical Component Summary (PCS)
Mental Component Summary (MCS)
The Medical Outcomes Study Short Form-36
Physical Component Summary (PCS) Physical Functioning (PF) Role-Physical (RP) Bodily Pain (BP) General Health (GH)
The Medical Outcomes Study Short Form-36
Mental Component Summary (MCS) Vitality (VT) Social Functioning (SF) Role-Emotional (RE) Mental Health (MH)
The Taiwanese Version Ratings of the Perceived Exertion Scale, (RPE)
Exertion ratings range from 6 (resting) to 20 (very, very hard).
walking exercise log
Patients were asked to complete walking exercise logs daily.
Rentering ratings of : perceived exertion exercise performed duration of exercise any symptoms experienced
Analysis
Generalized Estimating Equation (GEE) method was used to analyze whether the exercise program effectively improved patients' sleep quality and quality of life 4 and 8 weeks following afterward.
Results
Patients in the exercise group reported significant improvements in sleep quality (β=−3.54, p<0.01)
Among patients who exercised, enhanced sleep quality also corresponded with reduced bodily pain (β=0.98,p=0.04)
Improvements over time in the mental health
dimension of quality of life (β=−3.87, p<0.01).
Results Demographic and Disease-related
Information (Table 1)
GEE Model of Quality of Sleep, the PCS Score, and the MCS Score (Table 2 )
Univariate Analysis of Changes in Sleep Quality in Relation to Quality of Life in the Exercise Group by GEE Method (Table 3)
Results Changes in Sleep Quality (PSQI Score) in
the Exercise and Control Groups (Figure 2 )
Changes of Physical Component Summary (PCS) Scores of Quality of Life in the Exercise and Control Groups (Figure 3 )
Changes in Mental Component Summary (MCS) Scores of Quality of Life in the Exercise and Control Groups (Figure 4 )
Conclusions
A home-based walking exercise program can be easily incorporated into care for cancer patients who are suffering from sleep disturbances.
Home-based walking exercise program improves sleep quality and quality of life.
Conclusions
Improvements in quality of life may in part be mediated by sleep.
Enhanced sleep quality also contributed to reduce bodily pain and improvements in the mental health dimension of quality of life.