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Are Exercise Programs Effective for Improving Health-Related Quality of Life Among Cancer Survivors? A Systematic Review and Meta-Analysis

Shiraz I. Mishra

Roberta W. Scherer

Claire Snyder

Paula Geigle

Carolyn Gotay

quality of life, health status, anxiety, depression, fatigue, neoplasm, neoplasm therapy, exercise, survivors, walking, yoga, resistance training, breathing exercises, bicycling, physical activity
ONF 2014, 41(6), E326-E342. DOI: 10.1188/14.ONF.E326-E342

Purpose/Objectives: To evaluate the effectiveness of exercise interventions on overall health-related quality of life (HRQOL) and its domains among cancer survivors who have completed primary treatment.

Data Sources: 11 electronic databases were searched from inception (dates varied) to October 2011. The authors also identified eligible trials through a search of additional sources.

Data Synthesis: 40 trials with 3,694 participants met the inclusion criteria. At 12 weeks, cancer survivors exposed to exercise interventions had greater positive improvement in overall HRQOL (standardized mean difference [SMD] 0.48; 95% confidence interval [CI] [0.16, 0.81]), emotional well-being (SMD 0.33; 95% CI [0.05, 0.61]), and social functioning (SMD 0.45; 95% CI [0.02, 0.87]); and had a significant reduction in anxiety (SMD -0.26; 95% CI [-0.44, -0.07]) and fatigue (SMD -0.82; 95% CI [-1.5, -0.14]).

Conclusions: Exercise programs have a beneficial effect on HRQOL and most of its domains and can be integrated into the management plans for cancer survivors who have completed treatment. Future research is needed to help understand specific attributes of exercise programs that are beneficial for improving HRQOL within and across cancer types.

Implications for Nursing: Evidence presented in this review supports the inclusion of exercise programs in clinical guidelines for the management of cancer survivors who have completed treatment, such as the Oncology Nursing Society's Putting Evidence Into Practice resource.

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    References

    American College of Sports Medicine. (1998). Position stand: The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness, and flexibility in healthy adults. Medicine and Science in Sports and Medicine, 30, 975-991.
    American College of Sports Medicine. (2005). ACSM's guidelines for exercise testing and prescription (7th ed.). Philadelphia, PA: Lippincott Williams and Wilkins.
    Bai, S. M., Ma, C., Liu, Y. M., Xue, W. P., Luo, M., & Ou, Z. H. (2004). Effects of cognitive behavior intervention and cinesiateics on the quality of life of patients with nsaopharyngeal carcinoma after radiotherapy. Chinese Journal of Clinical Rehabilitation, 8, 6312-6313.
    Banasik, J., Williams, H., Haberman, M., Blank, S. E., & Bendel, R. (2011). Effect of Iyengar yoga practice on fatigue and diurnal salivary cortisol concentration in breast cancer survivors. Journal of the American Academy of Nurse Practitioners, 23(3), 135-142. doi:10.1111/j.1745-7599.2010.00573.x
    Berglund, G., Bolund, C., Gustafsson, U. L., & Sjoden, P. O. (1994). One-year follow-up of the ‘Starting Again’ group rehabilitation programme for cancer patients. European Journal of Cancer, 30A(12), 1744-1751.
    Bourke, L., Thompson, G., Gibson, D. J., Daley, A., Crank, H., Adam, I., … Saxton, J. (2011). Pragmatic lifestyle intervention in patients recovering from colon cancer: A randomized controlled pilot study. Archives of Physical Medicine and Rehabilitation, 92, 749-755. doi: 10.1016/j.apmr.2010.12.020
    Brownson, R. C., Colditz, G. A., & Proctor, E. K. (Eds.). (2012). Dissemination and implementation research in health: Translating science to practice. New York, NY: Oxford University Press.
    Brundage, M., Blazeby, J., Revicki, D., Bass, B., de Vet, H., Duffy, H., … Calvert, M. (2013). Patient-reported outcomes in randomized clinical trials: Development of ISOQOL reporting standards. Quality of Life Research, 22, 1161-1175. doi:10.1007/s11136-012-0252-1
    Burnham, T. R., & Wilcox, A. (2002). Effects of exercise on physiological and psychological variables in cancer survivors. Medicine and Science in Sports and Exercise, 34, 1863-1867. doi:10.1249/01.MSS.0000040995.26076.CC
    Cadmus, L. A., Salovey, P., Yu, H., Chung, G., Kasl, S., & Irwin, M. L. (2009). Exercise and quality of life during and after treatment for breast cancer: Results of two randomized controlled trials. Psycho-Oncology, 18, 343-352. doi:10.1002/pon.1525
    Calvert, M., Blazeby, J., Altman, D. G., Revicki, D. A., Moher, D., & Brundage, M. D. (2013). Reporting of patient-reported outcomes in randomized trials: The CONSORT PRO extension. JAMA, 309, 814-822. doi:10.1001/jama.2013.879
    Cella, D., Riley, W., Stone, A., Rothrock, N., Reeve, B., Yount, S., … Hays, R. (2010). The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005-2008. Journal of Clinical Epidemiology, 63, 1179-1194. doi:10.1016/j.jclinepi.2010.04.011
    Cho, O. H., Yoo, Y. S., & Kim, N. C. (2006). Efficacy of comprehensive group rehabilitation for women with early breast cancer in South Korea. Nursing and Health Sciences, 8, 140-146. doi:10.1111/j.1442-2018.2006.00271.x
    Cohen, L., Warneke, C., Fouladi, R. T., Rodriguez, M. A., & Chaoul-Reich, A. (2004). Psychological adjustment and sleep quality in a randomized trial of the effects of a Tibetan yoga intervention in patients with lymphoma. Cancer, 100, 2253-2260. doi:10.1002/cncr.20236
    Courneya, K. S., Friedenreich, C. M., Quinney, H. A., Fields, A. L., Jones, L. W., & Fairey, A. S. (2003). A randomized trial of exercise and quality of life in colorectal cancer survivors. European Journal of Cancer Care, 12, 347-357.
    Courneya, K. S., Friedenreich, C. M., Sela, R. A., Quinney, H. A., Rhodes, R. E., & Handman, M. (2003). The group psychotherapy and home-based physical exercise (group-hope) trial in cancer survivors: Physical fitness and quality of life outcomes. Psycho-Oncology, 12, 357-374. doi:10.1002/pon.658
    Courneya, K. S., Mackey, J. R., Bell, G. J., Jones, L. W., Field, C. J., & Fairey, A. S. (2003). Randomized controlled trial of exercise training in postmenopausal breast cancer survivors: Cardiopulmonary and quality of life outcomes. Journal of Clinical Oncology, 21, 1660-1668. doi:10.1200/JCO.2003.04.093
    Courneya, K. S., Sellar, C. M., Stevinson, C., McNeely, M. L., Peddle, C. J., Friedenreich, C. M., … Reiman, T. (2009). Randomized controlled trial of the effects of aerobic exercise on physical functioning and quality of life in lymphoma patients. Journal of Clinical Oncology, 27, 4605-4612. doi:10.1200/JCO.2008.20.0634
    Cramp, F., & Byron-Daniel, J. (2012). Exercise for the management of cancer-related fatigue in adults. Cochrane Database of Systematic Reviews, 11, CD006145. doi:10.1002/14651858.CD006145.pub3
    Cramp, F., James, A., & Lambert, J. (2010). The effects of resistance training on quality of life in cancer: A systematic literature review and meta-analysis. Supportive Care in Cancer, 18, 1367-1376. doi:10.1007/s00520-010-0904-z
    Creswell, J. W. (2014). Research design: Qualitative, quantitative, and mixed method approaches (4th ed.). Thousand Oaks, CA: Sage.
    Culos-Reed, S. N., Carlson, L. E., Daroux, L. M., & Hately-Aldous, S. (2006). A pilot study of yoga for breast cancer survivors: Physical and psychological benefits. Psycho-Oncology, 15, 891-897. doi:10.1002/pon.1021
    Daley, A. J., Crank, H., Saxton, J. M., Mutrie, N., Coleman, R., & Roalfe, A. (2007). Randomized trial of exercise therapy in women treated for breast cancer. Journal of Clinical Oncology, 25, 1713-1721. doi:10.1200/JCO.2006.09.5083
    Danhauer, S. C., Mihalko, S. L., Russell, G. B., Campbell, C. R., Felder, L., Daley, K., & Levine, E. A. (2009). Restorative yoga for women with breast cancer: Findings from a randomized pilot study. Psycho-Oncology, 18, 360-368. doi:10.1002/pon.1503
    Dimeo, F. C., Thomas, F., Raabe-Menssen, C., Propper, F., & Mathias, M. (2004). Effect of aerobic exercise and relaxation training on fatigue and physical performance of cancer patients after surgery. A randomised controlled trial. Supportive Care in Cancer, 12, 774-779. doi:10.1007/s00520-004-0676-4
    Dodd, M. J., Cho, M. H., Miaskowski, C., Painter, P. L., Paul, S. M., Cooper, B. A., … Bank, K. A. (2010). A randomized controlled trial of home-based exercise for cancer-related fatigue in women during and after chemotherapy with or without radiation therapy. Cancer Nursing, 33, 245-257. doi:10.1097/NCC.0b013e3181ddc58c
    Donnelly, C. M., Blaney, J. M., Lowe-Strong, A., Rankin, J. P., Campbell, A., McCrum-Gardner, E., & Gracey, J. H. (2011). A randomised controlled trial testing the feasibility and efficacy of a physical activity behavioural change intervention in managing fatigue with gynaecological cancer survivors. Gynecologic Oncology, 122, 618-624. doi:10.1016/j.ygyno.2011.05.029
    Duijts, S. F., Faber, M. M., Oldenburg, H. S., van Beurden, M., & Aaronson, N. K. (2011). Effectiveness of behavioral techniques and physical exercise on psychosocial functioning and health-related quality of life in breast cancer patients and survivors—A meta-analysis. Psycho-Oncology, 20, 115-126. doi:10.1002/pon.1728
    Ferrer, R. A., Huedo-Medina, T. B., Johnson, B. T., Ryan, S., & Pescatello, L. S. (2011). Exercise interventions for cancer survivors: A meta-analysis of quality of life outcomes. Annals of Behavioral Medicine, 41, 32-47. doi:10.1007/s12160-010-9225-1
    Fillion, L., Gagnon, P., Leblond, F., Gelinas, C., Savard, J., Dupuis, R., … Larochelle, M. (2008). A brief intervention for fatigue management in breast cancer survivors. Cancer Nursing, 31, 145-159. doi:10.1097/01.NCC.0000305698.97625.95
    Galvao, D. A., & Newton, R. U. (2005). Review of exercise intervention studies in cancer patients. Journal of Clinical Oncology, 23, 899-909.
    Glanz, K., Rimer, B. K., & Viswanath, K. (2008). Health behavior and health education: Theory, research, and practice (4th ed.). New York, NY: John Wiley and Sons.
    Heim, M. E., Malsburg, M. L., & Niklas, A. (2007). Randomized controlled trial of a structured training program in breast cancer patients with tumor-related chronic fatigue. Onkologie, 30(8-9), 429-434. doi:10.1159/0000104097
    Herrero, F., San Juan, A. F., Fleck, S. J., Balmer, J., Perez, M., Canete, S., … Lucia, A. (2006). Combined aerobic and resistance training in breast cancer survivors: A randomized, controlled pilot trial. International Journal of Sports Medicine, 27, 573-580. doi:10.1055/s-2005-865848
    Higgins, J. P. T., Altman, D. G., & Sterne, J. A. C. (2011). Chapter 8: Assessing risk of bias in included studies. In J. P. T. Higgins & S. Green (Eds.), Cochrane handbook for systematic reviews of interventions (version 5.1.0, updated March 2011). Retrieved from http://www.cochrane.org/handbook
    Knols, R., Aaronson, N. K., Uebelhart, D., Fransen, J., & Aufdemkampe, G. (2005). Physical exercise in cancer patients during and after medical treatment: A systematic review of randomized and controlled clinical trials. Journal of Clinical Oncology, 23, 3830-3842.
    Knols, R. H., de Bruin, E. D., Uebelhart, D., Aufdemkampe, G., Schanz, U., Stenner-Liewen, F., … Aaronson, N. K. (2011). Effects of an outpatient physical exercise program on hematopoietic stem-cell transplantation recipients: A randomized clinical trial. Bone Marrow Transplantation, 46, 1245-1255. doi:10.1038/bmt.2010.288
    McNeely, M. L., Campbell, K. L., Rowe, B. H., Klassen, T. P., Mackey, J. R., & Courneya, K. S. (2006). Effects of exercise on breast cancer patients and survivors: A systematic review and meta-analysis. Canadian Medical Association Journal, 175, 34-41.
    McNeely, M. L., Parliament, M. B., Seikaly, H., Jha, N., Magee, D. J., Haykowsky, M. J., & Courneya, K. S. (2008). Effect of exercise on upper extremity pain and dysfunction in head and neck cancer survivors: A randomized controlled trial. Cancer, 113, 214-222. doi:10.1002/cncr.23536
    Mehnert, A., Veers, S., Howaldt, D., Braumann, K. M., Koch, U., & Schulz, K. H. (2011). Effects of a physical exercise rehabilitation group program on anxiety, depression, body image, and health-related quality of life among breast cancer patients. Onkologie, 34, 248-253. doi:10.1159/000327813
    Milne, H. M., Wallman, K. E., Gordon, S., & Courneya, K. S. (2008). Effects of a combined aerobic and resistance exercise program in breast cancer survivors: A randomized controlled trial. Breast Cancer Research and Treatment, 108, 279-288. doi:10.1007/s10549-007-9602-z
    Mishra, S. I., Scherer, R. W., Geigle, P. M., Berlanstein, D. R., Topaloglu, O., Gotay, C. C., & Snyder, C. (2012). Exercise interventions on health-related quality of life for cancer survivors. Cochrane Database of Systematic Reviews, 8, CD007566. doi:10.1002/14651858.CD007566.pub2
    Moadel, A. B., Shah, C., Wylie-Rosett, J., Harris, M. S., Patel, S. R., Hall, C. B., & Sparano, J. A. (2007). Randomized controlled trial of yoga among a multiethnic sample of breast cancer patients: Effects on quality of life. Journal of Clinical Oncology, 25, 4387-4395. doi:10.1200/JCO.2006.06.6027
    Mustian, K. M., Katula, J. A., Gill, D. L., Roscoe, J. A., Lang, D., & Murphy, K. (2004). Tai Chi Chuan, health-related quality of life and self-esteem: A randomized trial with breast cancer survivors. Supportive Care in Cancer, 12, 871-876. doi:10.1007/s00520-004-0682-6
    Mustian, K. M., Morrow, G. R., Carroll, J. K., Figueroa-Moseley, C. D., Jean-Pierre, P., & Williams, G. C. (2007). Integrative non-pharmacologic behavioral interventions for the management of cancer-related fatigue. Oncologist, 12(Suppl. 1), 52-67. doi:10.1634/theoncologist.12-S1-52
    National Cancer Institute. (2014). Patient-Reported Outcomes Measurement Information System (PROMIS). Retrieved from http://www.nihpromis.org
    Oh, B., Butow, P., Mullan, B., & Clarke, S. (2008). Medical Qigong for cancer patients: Pilot study of impact on quality of life, side effects of treatment and inflammation. American Journal of Chinese Medicine, 36, 459-472.
    Oh, B., Butow, P., Mullan, B., Clarke, S., Beale, P., Pavlakis, N., … Rosenthal, D. (2010). Impact of medical Qigong on quality of life, fatigue, mood and inflammation in cancer patients: A randomized controlled trial. Annals of Oncology, 21, 608-614. doi:10.1093/annonc/mdp479
    Ohira, T., Schmitz, K. H., Ahmed, R. L., & Yee, D. (2006). Effects of weight training on quality of life in recent breast cancer survivors: The Weight Training for Breast Cancer Survivors (WTBS) study. Cancer, 106, 2076-2083. doi:10.1002/cncr.21829
    Payne, J. K., Held, J., Thorpe, J., & Shaw, H. (2008). Effect of exercise on biomarkers, fatigue, sleep disturbances, and depressive symptoms in older women with breast cancer receiving hormonal therapy. Oncology Nursing Forum, 35, 635-642. doi:10.1188/08.ONF.635-642
    Penttinen, H. M., Saarto, T., Kellokumpu-Lehtinen, P., Blomqvist, C., Huovinen, R., Kautiainen, H., … Hakamies-Blomqvist, L. (2011). Quality of life and physical performance and activity of breast cancer patients after adjuvant treatments. Psycho-Oncology, 20, 1211-1220. doi:10.1002/pon.1837
    Pinto, B. M., Clark, M. M., Maruyama, N. C., & Feder, S. I. (2003). Psychological and fitness changes associated with exercise participation among women with breast cancer. Psycho-Oncology, 12, 118-126. doi:10.1002/pon.618
    Pinto, B. M., Frierson, G. M., Rabin, C., Trunzo, J. J., & Marcus, B. H. (2005). Home-based physical activity intervention for breast cancer patients. Journal of Clinical Oncology, 23, 3577-3587. doi:10.1200/JCO.2005.03.080
    Rogers, L. Q., Hopkins-Price, P., Vicari, S., Pamenter, R., Courneya, K. S., Markwell, S., … Lowy, M. (2009). A randomized trial to increase physical activity in breast cancer survivors. Medicine and Science in Sports and Exercise, 41, 935-946. doi:10.1249/MSS.0b013e31818e0e1b
    Schmitz, K. H., Holtzman, J., Courneya, K. S., Masse, L. C., Duval, S., & Kane, R. (2005). Controlled physical activity trials in cancer survivors: A systematic review and meta-analysis. Cancer Epidemiology, Biomarkers, and Prevention, 14, 1588-1595.
    Schulz, K. F., Altman, D. G., & Moher, D. (2010). CONSORT 2010 statement: Updated guidelines for reporting parallel group randomised trials. BMJ, 340, c332. doi:10.1136/bmj.c332
    Segar, M. L., Katch, V. L., Roth, R. S., Garcia, A. W., Portner, T. I., Glickman, S. G., … Wilkins, E. G. (1998). The effect of aerobic exercise on self-esteem and depressive and anxiety symptoms among breast cancer survivors. Oncology Nursing Forum, 25, 107-113.
    Speck, R. M., Courneya, K. S., Masse, L. C., Duval, S., & Schmitz, K. H. (2010). An update of controlled physical activity trials in cancer survivors: A systematic review and meta-analysis. Journal of Cancer Survivorship, 4, 87-100. doi:10.1007/s11764-009-0110-5
    Speck, R. M., Gross, C. R., Hormes, J. M., Ahmed, R. L., Lytle, L. A., Hwang, W. T., & Schmitz, K. H. (2010). Changes in the Body Image and Relationship Scale following a one-year strength training trial for breast cancer survivors with or at risk for lymphedema. Breast Cancer Research and Treatment, 121, 421-430. doi:10.1007/s10549-009-0550-7
    Stevinson, C., Lawlor, D. A., & Fox, K. R. (2004). Exercise interventions for cancer patients: Systematic review of controlled trials. Cancer Causes Control, 15, 1035-1056.
    Tang, M. F., Liou, T. H., & Lin, C. C. (2010). Improving sleep quality for cancer patients: Benefits of a home-based exercise intervention. Supportive Care in Cancer, 18, 1329-1339. doi:10.1007/s00520-009-0757-5
    Targ, E. F., & Levine, E. G. (2002). The efficacy of a mind-body-spirit group for women with breast cancer: A randomized controlled trial. General Hospital Psychiatry, 24, 238-248.
    Thorsen, L., Courneya, K. S., Stevinson, C., & Fossa, S. D. (2008). A systematic review of physical activity in prostate cancer survivors: Outcomes, prevalence, and determinants. Supportive Care in Cancer, 16, 987-997.
    Thorsen, L., Skovlund, E., Stromme, S. B., Hornslien, K., Dahl, A. A., & Fossa, S. D. (2005). Effectiveness of physical activity on cardiorespiratory fitness and health-related quality of life in young and middle-aged cancer patients shortly after chemotherapy. Journal of Clinical Oncology, 23, 2378-2388. doi:10.1200/JCO.2005.04.106
    U. S. Food and Drug Administration. (2009). Guidance for industry. Patient reported outcome measures: Use in medical product development to support labeling claims. Federal Register, 74, 65132-65133.