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The effectiveness of a deep water aquatic exercise program in cancer-related fatigue in breast cancer survivors: a randomized clinical trial deep water aquatic exercise in cancer survivors
Cantarero-Villanueva I, Fernandez-Lao C, Cuesta-Vargas AI, del Moral-Avila R, Fernandez-de-las-Penas CC, Arroyo-Morales M
Archives of Physical Medicine and Rehabilitation 2013 Feb;94(2):221-230
clinical trial
7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVE: The aim of the current randomized clinical trial was to investigate the effectiveness of an 8-week aquatic program on cancer-related fatigue, as well as, physical and psychological outcomes in breast cancer survivors. DESIGN: A randomized clinical trial. SETTING: Outpatient clinic, urban, academic medical center and a sport university swimming pool. PARTICIPANTS: Sixty-eight breast cancer survivors were randomly assigned to either an experimental (aquatic exercise group in deep water pool) or control (usual care) group. INTERVENTIONS: The intervention group attended aquatic exercise sessions 3 times per week for 8 weeks in a heated deep swimming pool. Sessions lasted 60 minutes in duration: 10 min of warm-up, 40 min of aerobic and endurance exercises and 10 min cool-down. Patients allocated to the usual care group followed the oncologist recommendations in relation to a healthy lifestyle. OUTCOME MEASURES: Fatigue (Piper Fatigue Scale), mood state (Profile of Mood States), and abdominal (trunk curl static endurance test) and leg (multiple sit-to-stand test) strength were collected at baseline, after the last treatment session, and at a 6-month follow-up. RESULTS: Immediately after discharge, the aquatic exercise group showed a large effect size in total fatigue score (d 0.87, 95%CI 0.48 to 1.26), trunk curl endurance (d 0.92, 95%CI 1.97 to 3.83), leg strength (d 1.10, 0.55 to 2.76), but negligible effects in vigor, confusion and disturbance of mood (d < 0.25). At the 6-month follow-up period, the aquatic exercise group maintained large to small effect sizes in fatigue scores, multiple sit-to-stand test and trunk curl static endurance (0.25 > d > 0.90) and negligible effects for fatigue-severity dimension and different scales of the profile of mood state (d < 0.25). CONCLUSION: An aquatic exercise program conducted in deep water was effective for improving cancer-related fatigue and strength in breast cancer survivors.

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