UNIVERSITY OF CALGARY

UNIVERSITY OF CALGARY
Objective Causes of Cancer-Related Fatigue: Roles of Neuromuscular Dysfunction and Sleep
Disorders
by
Mary Elizabeth Medysky
A THESIS
SUBMITTED TO THE FACULTY OF GRADUATE STUDIES
IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE
DEGREE OF MASTER OF SCIENCE
GRADUATE PROGRAM IN KINESIOLOGY
CALGARY, ALBERTA
JUNE, 2016
© Mary Elizabeth Medysky 2016

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Abstract
Cancer-related fatigue (CRF) is a common and debilitating symptom of cancer-treatment,
described as a severe, feeling of fatigue, not improved by rest. A number of factors contribute to
the occurrence of CRF. It has been observed using a variety of subjective scales, focusing on the
psychological aspect. Few studies have assessed if neuromuscular function is related to CRF. It
is unclear if sleep disorders, are associated with CRF. The purposes of this thesis were to 1)
examine if neuromuscular variables are related to subjective feelings of fatigue and 2) determine
if sleep disturbances are associated with CRF in cancer patients and survivors. Independent t-
tests found no significant differences between subjective fatigued and non-fatigued groups in
both neuromuscular and sleep parameters. However, sleep efficiency had a medium significant
correlation with FACT-F scores (r= 0.31, p<0.05). While the results should be considered
preliminary, it is suggested that sleep but not resistance to acute muscle fatigue due to exercise
plays a role in CRF.

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Acknowledgements
To Dr. Guillaume Millet, thank you for giving me the opportunity to conduct this research and
your guidance throughout. Thank you for taking a chance on me!
Thank you to Dr. Nicole Culos-Reed for your contributions to this project and your direction
over the past two years.
To my committee members and examiners, Dr. Lianne Tomfohr, Dr. Chester Ho, and Dr.
Michael Speca, thank you for your constructive input to this thesis.
Dr. John Temesi, thank you for your endless support, kindness and laughs over the past two
years. I hope we will meet up on the other side of the world someday!
To my family, thank you for showing me that I can be both a beach girl and a career woman.
Eddie, thank you for always being my rock.
Thank you Doug, Renata, Felipe and the CEPs for your assistance in collecting some of the
included data. Thibault, thank you for analyzing the neuromuscular data.
To many of my office-mates, thank you for your support, laughs and putting up with my office
chatter.

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Dedication
To the cancer patients and survivors who participated in this study, you are my reminder to
always be brave.

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Table of Contents
Abstract ................................................................................................................................ ii!
Acknowledgements ............................................................................................................ iii!
Dedication ........................................................................................................................... iv!
Table of Contents ................................................................................................................ v!
List of Tables .................................................................................................................... viii!
List of Figures and Illustrations .......................................................................................... ix!
List of Symbols, Abbreviations and Nomenclature ............................................................ x!
Epigraph ............................................................................................................................ xii!
CHAPTER ONE: INTRODUCTION ................................................................................ 1!
1.1 Cancer-Related Fatigue ............................................................................................. 1!
1.2 Neuromuscular Fatigue due to Physical Activity ...................................................... 7!
1.2.1 Central Fatigue ................................................................................................ 10!
1.2.2 Peripheral Fatigue ........................................................................................... 12!
1.2.3 Muscle Function Recovery ............................................................................. 12!
1.2.4 Neuromuscular Fatigue Research in Cancer Patients and Survivors .............. 13!
1.3 Sleep Disorders and Cancer-Related Fatigue .......................................................... 15!
1.3.1 Insomnia in Cancer Patients and Survivors .................................................... 17!
1.3.2 Sleep Quantification ........................................................................................ 19!
1.3.2.1 Polysomnography .................................................................................. 19!
1.3.2.2 Actigraphy ............................................................................................. 21!
1.3.2.3 Subjective Assessment Scales ............................................................... 22!
1.3.3 Exercise and Sleep Improvements in the General Population ........................ 23!
1.3.4 Exercise and Sleep in the Cancer Population .................................................. 24!
1.3.5 Factors Related to Sleep Disorders ................................................................. 35!
1.3.5.1 Treatment Type and Status .................................................................... 35!
1.3.5.2 Medications ........................................................................................... 36!
1.3.5.3 Psycho-Social Factors ........................................................................... 37!
1.3.5.4 Demographics and Lifestyle Factors ..................................................... 37!
1.4 Objectives ................................................................................................................ 37!
1.4.1 Specific Objectives .......................................................................................... 38!
1.5 Significance and clinical relevance ......................................................................... 39!
CHAPTER TWO: METHODS ........................................................................................ 40!
2.1 Participants and Recruitment ................................................................................... 40!
2.1.1 Sample Size ..................................................................................................... 43!
2.1.2 Experimental Design ....................................................................................... 45!
2.1.3 Appointment #1 ............................................................................................... 47!
2.1.3.1 Subjective Questionnaires ..................................................................... 47!
2.1.3.2 Dual-X-Ray Absorptiometry ................................................................. 47!
2.1.3.3 Neuromuscular Experimental Set-Up and Familiarization Protocol ..... 47!
2.1.3.4 Daily Subjective Fatigue ....................................................................... 48!
2.1.3.5 Sleep Assessment .................................................................................. 48!
2.1.4 Appointment #2 ............................................................................................... 49!
2.1.4.2 Neuromuscular function at rest ............................................................. 49!