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Effects and moderators of exercise on muscle strength, muscle function and aerobic fitness in patients with cancer: a meta-analysis of individual patient data
  1. Maike G Sweegers1,2,
  2. Teatske M Altenburg3,
  3. Johannes Brug4,
  4. Anne M May5,
  5. Jonna K van Vulpen5,
  6. Neil K Aaronson6,
  7. Gill Arbane7,
  8. Martin Bohus8,9,
  9. Kerry S Courneya10,
  10. Amanda J Daley11,
  11. Daniel A Galvao12,
  12. Rachel Garrod13,
  13. Kathleen A Griffith14,
  14. Wim H Van Harten6,15,
  15. Sandra C Hayes16,
  16. Fernando Herrero-Román17,
  17. Marie J Kersten18,
  18. Alejandro Lucia19,
  19. Alex McConnachie20,
  20. Willem van Mechelen3,
  21. Nanette Mutrie21,
  22. Robert U Newton12,
  23. Frans Nollet22,
  24. Karin Potthoff23,24,
  25. Martina E Schmidt25,
  26. Kathryn H Schmitz26,
  27. Karl Heinz Schulz27,
  28. Gabe Sonke28,
  29. Karen Steindorf25,
  30. Martijn M Stuiver29,
  31. Dennis R Taaffe12,
  32. Lene Thorsen30,
  33. Jos W Twisk1,
  34. Miranda J Velthuis31,
  35. Jennifer Wenzel32,
  36. Kerri M Winters-Stone33,
  37. Joachim Wiskemann23,34,
  38. Mai J Chin A Paw3,
  39. Laurien M Buffart1,2,12,35
  1. 1 Department of Epidemiology & Biostatistics, Amsterdam University Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
  2. 2 Cancer Center Amsterdam, Amsterdam, The Netherlands
  3. 3 Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Amsterdam, The Netherlands
  4. 4 Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Amsterdam, The Netherlands
  5. 5 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
  6. 6 Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, Noord-Holland, The Netherlands
  7. 7 Lane Fox Respiratory Research Unit, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
  8. 8 Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Mannheim, Germany
  9. 9 Faculty of Health, University of Antwerp, Antwerp, Belgium
  10. 10 Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, Alberta, Canada
  11. 11 School of Sport, Exercise and Health Sciences, University of Loughborough, Loughborough, UK
  12. 12 Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
  13. 13 Department of Respiratory Medicine, Kings College London, London, UK
  14. 14 The George Washington University School of Nursing, Washington, DC, USA
  15. 15 University of Twente, Enschede, The Netherlands
  16. 16 School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
  17. 17 Fundación GIAFyS Cancer, Miranda de Ebro, Spain
  18. 18 Department of Hematology, Amsterdam University Medical Center, Amsterdam, The Netherlands
  19. 19 European University, Madrid, Spain
  20. 20 Robertson Centre for biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
  21. 21 Physical Activity for Health Research Center, University of Edinburgh, Edinburgh, UK
  22. 22 Department of Rehabilitation, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
  23. 23 Department of Medical Oncology, National Center for Tumor Diseases (NCT) and Heidelberg University Hospital, Heidelberg, Germany
  24. 24 Department of Radiation Oncology, National Center for Tumor Diseases (NCT) and Heidelberg University Hospital, Heidelberg, Germany
  25. 25 Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
  26. 26 Penn State Health, College of Medicine and Cancer Institute, Hershey, Pennsylvania, USA
  27. 27 Athleticum – Competence Center for Sports- and Exercise Medicine and Institute for Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
  28. 28 Netherlands Cancer Institute, Amsterdam, The Netherlands
  29. 29 Center for Quality of Life, Netherlands Cancer Institute, Amsterdam, The Netherlands
  30. 30 National Advisory Unit on Late Effects after Cancer Treatment, Department of Oncology and Department of Clinical Service, Oslo University Hospital, Oslo, Norway
  31. 31 Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
  32. 32 Johns Hopkins School of Nursing, Johns Hopkins School of Medicine, Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland, USA
  33. 33 Knight Cancer Institute, School of Nursing, Oregon Health & Science University, Portland, OR, USA
  34. 34 College of Medicine and Cancer Institute, Penn State University, Hershey, Pennsylvania, USA
  35. 35 Department of Medical Oncology, Amsterdam University Medical Center, Amsterdam, The Netherlands
  1. Correspondence to Laurien M Buffart, Department of Epidemiology and Biostatistics and Medical Oncology, VU University Medical Center, Amsterdam 1081 HV, The Netherlands; l.buffart{at}


Objective To optimally target exercise interventions for patients with cancer, it is important to identify which patients benefit from which interventions.

Design We conducted an individual patient data meta-analysis to investigate demographic, clinical, intervention-related and exercise-related moderators of exercise intervention effects on physical fitness in patients with cancer.

Data sources We identified relevant studies via systematic searches in electronic databases (PubMed, Embase, PsycINFO and CINAHL).

Eligibility criteria We analysed data from 28 randomised controlled trials investigating the effects of exercise on upper body muscle strength (UBMS) and lower body muscle strength (LBMS), lower body muscle function (LBMF) and aerobic fitness in adult patients with cancer.

Results Exercise significantly improved UBMS (β=0.20, 95% Confidence Interval (CI) 0.14 to 0.26), LBMS (β=0.29, 95% CI 0.23 to 0.35), LBMF (β=0.16, 95% CI 0.08 to 0.24) and aerobic fitness (β=0.28, 95% CI 0.23 to 0.34), with larger effects for supervised interventions. Exercise effects on UBMS were larger during treatment, when supervised interventions included ≥3 sessions per week, when resistance exercises were included and when session duration was >60 min. Exercise effects on LBMS were larger for patients who were living alone, for supervised interventions including resistance exercise and when session duration was >60 min. Exercise effects on aerobic fitness were larger for younger patients and when supervised interventions included aerobic exercise.

Conclusion Exercise interventions during and following cancer treatment had small effects on UBMS, LBMS, LBMF and aerobic fitness. Demographic, intervention-related and exercise-related characteristics including age, marital status, intervention timing, delivery mode and frequency and type and time of exercise sessions moderated the exercise effect on UBMS, LBMS and aerobic fitness.

  • exercise
  • physical activity
  • physical fitness
  • oncology
  • meta-analysis

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  • Contributors MGS, TMA, LMB, JB, MJCAP and AMM contributed to the concept and design of the study. LMB and JB are members of the steering committee of POLARIS. KSC, RUN, AMM and NKA are members of the (inter)national advisory board of POLARIS. MGS and LMB, gathered, pooled and analszed the data. JKvV was involved in analysing the data. MGS, TMA and LMB drafted the manuscript. LMB, KSC, RUN, NKA, AMM, DAG, MJCAP, KS, MMS, KAG, AL, NM, AJD, AM, MB, LT, FH-R, KatHS, GA, MES, KP, GS, WHVH, RG, KarHS, KMW-S, MJV, WvM, MJK, FN, JeW, JoW and JB are principal investigators of the randomised controlled trials of which the data are pooled for the current study and have consequently contributed to the study concept, design and conduct of the trial that they were responsible for. All authors have critically 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.

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