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Virtual Reality Bringing a New Reality to Postthoracotomy Lung Cancer Patients Via a Home-Based Exercise Intervention Targeting Fatigue While Undergoing Adjuvant Treatment

Hoffman, Amy J. PhD, RN; Brintnall, Ruth Ann PhD, AOCN, APRN-BC; Brown, Jean K. PhD, RN, FAAN; von Eye, Alexander PhD; Jones, Lee W. PhD; Alderink, Gordon PhD, PT; Ritz-Holland, Deborah BSN, RN, OCN; Enter, Mark BSN, RN, OCN; Patzelt, Lawrence H. MD; VanOtteren, Glenn M. MD

doi: 10.1097/NCC.0b013e318278d52f

Background: Little is known about rehabilitation for postthoracotomy non–small cell lung cancer (NSCLC) patients. This research uses a perceived self-efficacy-enhancing light-intensity exercise intervention targeting a priority symptom, cancer-related fatigue (CRF), for postthoracotomy NSCLC patients. This article reports on phase II of a 2-phase study. Phase I focused on initiation and tolerance of exercise during the 6 weeks immediately after thoracotomy, whereas phase II addressed maintenance of exercise for an additional 10 weeks including participants initiating and completing chemotherapy and/or radiation therapy.

Objective: The objective of this study was to investigate the feasibility, acceptability, and preliminary efficacy of an exercise intervention for postthoracotomy NSCLC patients to include those initiating and completing adjuvant therapy.

Interventions/Methods: A single-arm design composed of 7 participants postthoracotomy for NSCLC performed light-intensity exercises using an efficacy-enhancing virtual-reality approach using the Nintendo Wii Fit Plus.

Results: Despite most participants undergoing chemotherapy and/or radiation therapy, participants adhered to the intervention at a rate of 88% with no adverse events while giving the intervention high acceptability scores on conclusion. Likewise, participants’ CRF scores improved from initiation through the conclusion of the intervention with perceived self-efficacy for walking at a light intensity continuously for 60 minutes, improving significantly upon conclusion over presurgery values.

Conclusions: Postthoracotomy NSCLC patients maintained exercise for an additional 10 weeks while undergoing adjuvant therapy showing rehabilitation potential because the exercise intervention was feasible, safe, well tolerated, and highly acceptable showing positive changes in CRF self-management.

Implications for Practice: A randomized controlled trial is needed to further investigate these relationships.

Author Affiliations: College of Nursing, Michigan State University, East Lansing (Dr Hoffman); Kirkhof College of Nursing, Grand Valley State University, Grand Rapids, Michigan (Dr Brintnall); School of Nursing, University at Buffalo, State University of New York (Dr Brown); Psychology Department, Michigan State University, East Lansing (Dr von Eye); Duke Center for Cancer Survivorship, Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (Dr Jones); Frederik Meijer Honors College, Grand Valley State University, Grand Rapids, Michigan (Dr Alderink); Lemmen-Holton Cancer Pavilion, Spectrum Health, Grand Rapids (Ms Ritz-Holland and Mr Enter), Michigan; and Spectrum Health, Grand Rapids, Michigan, and College of Human Medicine, Michigan State University, East Lansing (Drs Patzelt and VanOtteren).

Funding for this research was received from Michigan State University, College of Nursing, East Lansing.

The authors have no conflicts of interest to disclose.

Correspondence: Amy J. Hoffman, PhD, RN, College of Nursing, Michigan State University, Office C246, Bott Building for Nursing Education and Research, 1355 Bogue St, East Lansing, MI 48824 (

Accepted for publication October 10, 2012.

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins