Effect of Exercise Intervention on Cancer-Related Fatigue Among Cervical Cancer Patients

Intervention: Six-week exercise training, alternating between supervised session at hospital and home-based session. Supervised exercise session will be conducted once a week in the first, third, and fifth week, in a group consisting of three to five participants supervised by one researcher (physiotherapist). Each exercise session will be conducted approximately 20 to 30 minutes, starting with a warm-up session, followed by aerobic and resistance exercises, ending with a cool-down session. Participants are advised to do exercise activities according to their own pace and allowed to take short rest periods at any time before resuming exercise activities during the exercise session. The exercise intervention aimed to reach the intensity of low to moderate which is 55 to 75 percent of maximum heart rate or rate of perceived exertion (RPE) between 11 to 14. The number of sets and intensity will be gradually increased throughout the intervention weeks following participants’ capability. Blood pressure and heart rate will be recorded at the beginning and end of each session, while during the exercise, RPE value will be monitored using Borg scale to maintain low- to moderate-exercise intensity. Home-based exercise session will be performed in the second, fourth, and sixth week with online supervision (if needed) through participants’ preferred method (such as 'WhatsApp', 'Telegram', or phone calls). Exercise components will consist of the same exercise from the supervised exercise session of the preceding week to enhance adherence and sustainability to the exercise routine. Through this method, participants may feel more confident in exercising as they will be taught proper exercise techniques during the supervised exercise session and just continuing what have been taught at home during home-based exercise session. Exercise handout will be given as a guide while exercising at home. (This exercise handout is specifically designed for this research which consist of exercise techniques and also as an exercise diary for participants to record their exercise session.) Participants are advised to exercise at home for at least three times a week for 30 minutes each session, or at least engage in exercise for 150 minutes per week. They are free to exercise at any time throughout the home-based exercise week or whenever they feel their fatigue level at the lowest. The exercise intensity of low to moderate will be self-monitored by the participants through RPE value using Borg scale between 11 to 14 and through the talk test, where they can still talk but cannot sing while exercising. Below are exercise component of every week for six weeks: Week 1 (Supervised exercise) & Week 2 (Home-based exercise) Warming-up session: - Breathing control exercise; 5x, 1 set - Shoulder roll; 5x, 1 set - Seated leg lift; 5x, 1 set - Seated leg tap-out reach; 5x, 1 set Strengthening exercise: - Seated heel raise; 5x, 2 sets - Seated leg extension; 5x, 2 sets - Sit-to-Stand/Squatting; 5x, 2 sets Aerobic exercise: - Seated jack; 30 secs, 1 set - Seated marching; 30 secs, 1 set - Step-ups; 30 secs, 1 set Cool down session: - Deep breathing exercise; 3x, 1 set - Shoulder stretch; 15 sec holds, 3x, 1 set - Chest stretch; 15 sec holds, 3x, 1 set - Calf stretch; 15 sec holds, 3x, 1 set - Quads stretch; 15 sec holds, 3x, 1 set - Hamstring stretch; 15 sec holds, 3x, 1 set Week 3 (Supervised exercise) & Week 4 (Home-based exercise) Warming up session: - Breathing control exercise; 5x, 1 set - Shoulder roll (progress with hands on shoulder and circle the elbows); 5x, 1 set - Standing leg lift; 5x, 1 set - Standing leg tap-out reach; 5x, 1 set Strengthening exercise: - Arm supported heel raise; 10x, 2 sets - Seated leg extension (both); 5x, hold 3-5 sec, 2 sets - Sit-to-Stand/Squatting; 10x, 2 sets Aerobic exercise: - Star jacks; 30 secs, 2 set - Marching; 30 secs, 2 set - Step-ups; 30 secs, 2 set Cool down session: - Deep breathing exercise; 3x, 1 set - Shoulder stretch; 15 sec holds, 3x, 1 set - Chest stretch; 15 sec holds, 3x, 1 set - Calf stretch; 15 sec holds, 3x, 1 set - Quads stretch; 15 sec holds, 3x, 1 set - Hamstring stretch; 15 sec holds, 3x, 1 set Week 5 (Supervised exercise) & Week 6 (Home-based exercise) Warming up session: - Breathing control exercise; 5x, 1 set - Shoulder roll (progress with arms extended and circle the arm); 5x, 1 set - Standing leg lift; 5x, 2 sets - Standing leg tap-out reach; 5x, 2 sets Strengthening exercise: - Heel raise; 10x, 3 sets - One-leg standing; 5x, hold 3-5 sec, 2 sets - Sit-to-Stand/Squatting; 10x, 3 sets Aerobic exercise: - Side walking; 1 min, 2 sets - Standing knee lift; 1 min, 2 sets - Step-ups; 1 min, 2 sets - Walking back and forth; 1 min, 2 sets Cool down session: - Deep breathing exercise; 3x, 1 set - Shoulder stretch; 15 sec holds, 3x, 1 set - Chest stretch; 15 sec holds, 3x, 1 set - Calf stretch; 15 sec holds, 3x, 1 set - Quads stretch; 15 sec holds, 3x, 1 set - Hamstring stretch; 15 sec holds, 3x, 1 set