Effects of Pilates exercise on functional capacity, cancer-related fatigue, depression, salivary cortisol and quality of life among colorectal cancer survivors in Klang Valley, Malaysia.

Recruitment All colorectal cancer survivors who were treated and completed treatment at both study sites that met the eligibility criteria are recruited using convenience sampling. The comparability of the variables s is carried out to determine whether the study populations in both groups are similar. Next, the participants from Hospital Canselor Tuanku Muhriz will be allocated to the intervention group and participants from Hospital University Technology MARA will become the control group. Intervention The intervention group will perform Pilates exercises with a certified Pilates instructor for 60 minutes 3 sessions per week for eight weeks. The Pilates exercise programme is a moderate-intensity exercise with a heart rate maximum is 50-60% (Algayer et al. 2008) and corresponding to a rating of perceived exertion between 12 and 13 (ACSM, 2014) adapted from the study by Cantarero-Villanueva et al. (2016). Our expert panels consisting of sports medicine specialists, Pilates instructors, colorectal surgeons and physiotherapists already verified the exercise prescription is safe as an intervention among colorectal cancer survivors by The Pilates exercise will start with a warm-up session then followed by the Pilates exercise. The Pilates exercise steps will be carried out in this study as follows; 1. One-leg stretch i. Participants are lying down in a supine position and stretch one leg. 2. One-leg circle i. Participants are lying down supine, stretching one leg and making circular movements using the stretched leg. 3. Bridging i. Participants will lie on their back with hands at sides, knees bent and feet flat on the floor under the knees. ii. Then tighten the abdominal and buttock muscles by pushing their low back into the ground before pushing up. iii. Next, they will raise their hips to create a straight line between knees and shoulders. Then, squeeze their core and pull the belly button back toward their spine. Hold for 20 to 30 seconds and then return to starting position. 4. Dead bug resting i. Participants are lying flat on their backs. ii. Extend the arms and raise their feet, knees and hips. iii. Then lower their opposite arms and legs simultaneously. iv. Repeat with the other arm and leg. 5. Saw i. Participants sit down on the exercise mat with both legs straight and arms flexed at 90 degrees. ii. Then, participants will turn their body to the left and stretch the right hand to get as close as possible to the toes. iii. This step is then repeated with the left hand. The exercise is adapted to each participant's ability and tolerance. The participants will do the exercise via online streaming at the participants' homes in a group of sixteen (16) per session. The participants will be given a booklet that consists of exercise techniques and safety measures to be followed during the exercise. (This booklet is newly designed to act as a study manual specifically for this research). Besides that, we will give a video recording showing the demonstration of the exercise to the participants to ease them in following the activity. They are also provided with a polar heart rate sensor during the exercise to monitor their heart rate. The exercise is adapted to each participant's ability and tolerance. Therefore, each participant will perform the exercise according to their capacity (i.e., stop and rest in between the steps or repetitions, drinking water). The instructor and facilitators will monitor the participants closely. The exercise is adapted to each participant's ability and tolerance. Adherence will be considered if they meet 75% of the session during the intervention period (Cantarero-Villanueva et al., 2016; Eyigor et al., 2010). The attendance for every session will be recorded in the attendance sheet by our researcher.