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Meta-Analysis
. 2018 Dec 11;12(12):CD012280.
doi: 10.1002/14651858.CD012280.pub2.

Exercise interventions for people undergoing multimodal cancer treatment that includes surgery

Lisa A Loughney  1 , Malcolm A West, Graham J Kemp, Michael Pw Grocott, Sandy Jack
Affiliations
Meta-Analysis

Exercise interventions for people undergoing multimodal cancer treatment that includes surgery

Lisa A Loughney et al. Cochrane Database Syst Rev. .

Abstract

Background: People undergoing multimodal cancer treatment are at an increased risk of adverse events. Physical fitness significantly reduces following cancer treatment, which is related to poor postoperative outcome. Exercise training can stimulate skeletal muscle adaptations, such as increased mitochondrial content and improved oxygen uptake capacity may contribute to improved physical fitness.

Objectives: To determine the effects of exercise interventions for people undergoing multimodal treatment for cancer, including surgery, on physical fitness, safety, health-related quality of life (HRQoL), fatigue, and postoperative outcomes.

Search methods: We searched electronic databases of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, SPORTDiscus, and trial registries up to October 2018.

Selection criteria: We included randomised controlled trials (RCTs) that compared the effects of exercise training with usual care, on physical fitness, safety, HRQoL, fatigue, and postoperative outcomes in people undergoing multimodal cancer treatment, including surgery.

Data collection and analysis: Two review authors independently selected studies, performed the data extraction, assessed the risk of bias, and rated the quality of the studies using Grading of Recommendation Assessment, Development, and Evaluation (GRADE) criteria. We pooled data for meta-analyses, where possible, and reported these as mean differences using the random-effects model.

Main results: Eleven RCTs were identified involving 1067 participants; 568 were randomly allocated to an exercise intervention and 499 to a usual care control group. The majority of participants received treatment for breast cancer (73%). Due to the nature of the intervention, it was not possible to blind the participants or personnel delivering the intervention. The risk of detection bias was either high or unclear in some cases, whilst most other domains were rated as low risk. The included studies were of moderate to very low-certainty evidence. Pooled data demonstrated that exercise training may have little or no difference on physical fitness (VO2 max) compared to usual care (mean difference (MD) 0.05 L/min-1, 95% confidence interval (CI) -0.03 to 0.13; I2 = 0%; 2 studies, 381 participants; low-certainty evidence). Included studies also showed in terms of adverse effects (safety), that it may be of benefit to exercise (8 studies, 507 participants; low-certainty evidence). Furthermore, exercise training probably made little or no difference on HRQoL (EORTC global health status subscale) compared to usual care (MD 2.29, 95% CI -1.06 to 5.65; I2 = 0%; 3 studies, 472 participants; moderate-certainty evidence). However, exercise training probably reduces fatigue (multidimensional fatigue inventory) compared to usual care (MD -1.05, 95% CI -1.83 to -0.28; I2 = 0%; 3 studies, 449 participants moderate-certainty evidence). No studies reported postoperative outcomes.

Authors' conclusions: The findings should be interpreted with caution in view of the low number of studies, the overall low-certainty of the combined evidence, and the variation in included cancer types (mainly people with breast cancer), treatments, exercise interventions, and outcomes. Exercise training may, or may not, confer modest benefit on physical fitness and HRQoL. Limited evidence suggests that exercise training is probably not harmful and probably reduces fatigue. These findings highlight the need for more RCTs, particularly in the neoadjuvant setting.

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Conflict of interest statement

Lisa Loughney: None known Malcolm West: None known Graham Kemp: None known Michael Grocott: None known Sandy Jack: None known Michael Grocott: received honoraria for speaking, for travel expenses, or both from Edwards Lifescience, Fresenius‐Kabi, BOC Medical (Linde Group), Ely‐Lilly Critical Care, and Cortex GmBH. He has also received research grants from the National Institute of Health Research, Association of Anaesthetists of Great Britain and Ireland, Sir Halley Stuart Trust, and Francis and Augustus Newman Foundation. He leads the Xtreme‐Everest hypoxia research consortium, which has received unrestricted research grant funding from BOC Medical (Alinde Group), Ely‐Lilly Critical Care, Smiths Medical, Deltex Medical, London Clinic, and Rolex. None of these activities are related to the work under consideration in this review.

Figures

1
1
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
3
3
Study flow diagram.
1.1
1.1. Analysis
Comparison 1 Intervention versus control, Outcome 1 Aerobic fitness (VO2 max on cycle ergometer).
1.2
1.2. Analysis
Comparison 1 Intervention versus control, Outcome 2 Aerobic fitness (6‐minute walk test).
1.3
1.3. Analysis
Comparison 1 Intervention versus control, Outcome 3 Muscle strength (upper body: grip strength).
1.4
1.4. Analysis
Comparison 1 Intervention versus control, Outcome 4 HRQoL (EORTC QLQ‐C30 global health status).
1.5
1.5. Analysis
Comparison 1 Intervention versus control, Outcome 5 HRQoL (EORTC QLQ‐C30 cognitive functioning).
1.6
1.6. Analysis
Comparison 1 Intervention versus control, Outcome 6 HRQoL (EORTC QLQ‐C30 social functioning).
1.7
1.7. Analysis
Comparison 1 Intervention versus control, Outcome 7 HRQoL (EQ‐5D utility).
1.8
1.8. Analysis
Comparison 1 Intervention versus control, Outcome 8 HRQoL (SF‐36 general health perceptions).
1.9
1.9. Analysis
Comparison 1 Intervention versus control, Outcome 9 HRQoL (SF‐36 mental component scale).
1.10
1.10. Analysis
Comparison 1 Intervention versus control, Outcome 10 HRQoL (SF‐36 bodily pain).
1.11
1.11. Analysis
Comparison 1 Intervention versus control, Outcome 11 Fatigue (multidimensional fatigue inventory).
1.12
1.12. Analysis
Comparison 1 Intervention versus control, Outcome 12 Fatigue (EORTC QLQ‐C30).
See this image and copyright information in PMC

Update of

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References to ongoing studies

Loughney 2016 {unpublished data only}
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NCT02159157 {unpublished data only}
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NCT02454777 {unpublished data only}
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NCT02802826 {unpublished data only}
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NCT02999074 {unpublished data only}
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NCT03102866 {unpublished data only}
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NCT03280836 {unpublished data only}
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NCT03509428 {unpublished data only}
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