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Which exercise prescriptions improve quality of life and physical function in patients with cancer during and following treatment? A systematic review and meta-analysis of randomised controlled trials
  1. Maike G Sweegers1,2,
  2. Teatske M Altenburg3,
  3. Mai J Chinapaw3,
  4. Joeri Kalter1,2,
  5. Irma M Verdonck-de Leeuw2,4,5,
  6. Kerry S Courneya6,
  7. Robert U Newton7,
  8. Neil K Aaronson8,
  9. Paul B Jacobsen9,
  10. Johannes Brug1,10,
  11. Laurien M Buffart1,2,7,11
  1. 1Department of Epidemiology and Biostatistics, Amsterdam Public Health Institute, VU University Medical Center, Amsterdam, The Netherlands
  2. 2Cancer Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
  3. 3Department of Public and Occupational Health, Amsterdam Public Health Institute, VU University Medical Center, Amsterdam, The Netherlands
  4. 4Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands
  5. 5Department of Clinical Psychology, Vrije Universiteit, Amsterdam, The Netherlands
  6. 6Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada
  7. 7Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
  8. 8Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
  9. 9Division of Population Science, Moffitt Cancer Center and Research Institute, Amsterdam, The Netherlands
  10. 10Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Amsterdam, The Netherlands
  11. 11Department of Medical Oncology, VU University Medical Center, Amsterdam, The Netherlands
  1. Correspondence to Laurien M Buffart, Department of Epidemiology and Biostatistics and Medical Oncology, VU University Medical Center, De Boelelaan 1089a, 1081 HV Amsterdam, The Netherlands; l.buffart{at}vumc.nl

Abstract

Objective Certain exercise prescriptions for patients with cancer may improve self-reported quality of life (QoL) and self-reported physical function (PF). We investigated the effects of exercise on QoL and PF in patients with cancer and studied differences in effects between different intervention-related and exercise-related characteristics.

Design We searched four electronic databases to identify randomised controlled trials investigating exercise effects on QoL and PF in patients with cancer. Pooled effects (Hedges’ g) were calculated using Comprehensive Meta-Analysis software. Subgroup analyses were conducted based on intervention dimensions, including timing, duration and delivery mode, and exercise dimensions, including frequency, intensity, type and time (FITT factors).

Results We included 74 exercise arms. Patients who were randomised to exercise interventions had significantly improved QoL (g=0.15, 95% CI (0.10 to 0.20), n=67 exercise arms) and PF (g=0.21, 95% CI (0.15 to 0.27), n=59 exercise arms) compared with patients in control groups. We found a significant between-group difference for exercise delivery mode, with significant beneficial effects for supervised exercise interventions (g=0.20, 95% CI (0.14 to 0.26) for QoL and g=0.27, 95% CI (0.20 to 0.33) for PF), but not for unsupervised interventions (g=0.04, 95% CI (−0.06 to 0.13) for QoL and g=0.09, 95% CI (−0.01 to 0.19) for PF). No statistically significant differences in intervention effects were found for variations in intervention timing, duration or exercise FITT factors. Unsupervised exercise with higher weekly energy expenditure was more effective than unsupervised exercise with lower energy expenditure (z=2.34, p=0.02).

Conclusions Exercise interventions, especially when supervised, have statistically significant and small clinical benefit on self-reported QoL and PF in patients with cancer. Unsupervised exercise intervention effects on PF were larger when prescribed at a higher weekly energy expenditure.

  • neoplasm
  • quality of life
  • physical activity
  • exercise
  • meta-analysis

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Footnotes

  • Contributors MGS, TMA, MJC, LMB and JB contributed to the concept and design of the study. MGS, TMA, LMB and JK gathered and analysed the data. This study was performed alongside the POLARIS study. LMB, JB and IMVdL are members of the steering committee of POLARIS. KSC, RUN, PBJ and NKA are members of the international advisory board of POLARIS. All authors have revised the manuscript and approved the final version.

  • Funding Via ‘Bas Mulder Award’ granted to LMB by the Alpe d’HuZes Foundation/Dutch Cancer Society (VU 2011-5045).

  • Competing interests None declared.

  • Ethics approval Ethics committee from local institutes where randomised controlled trials were conducted, which are included in this review/meta-analysis.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Correction notice This article has been corrected since it was published Online First. Figure 2B has been corrected.

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