Optimal exercise dose-response improves health-related quality of life in cancer survivors: a systematic review and Bayesian network meta-analysis of RCTs

Abstract

Objective: Cancer survivors often face significant health-related quality of life (HRQoL) challenges. Although exercise has been proven to improve HRQoL in cancer survivors, the optimal dose and intensity of exercise for this population has not been fully determined. Adherence to exercise may vary based on exercise intensity, affecting results. This study explored the dose-response relationship of different exercise types and intensities to better understand their impact on HRQoL in cancer survivors.

Methods: We searched five databases-PubMed, Embase, the Cochrane Library, Web of Science, and Scopus-from their inception until 1 December 2023. Data analysis was performed using R software with the MBNMA and RJAGS packages. Due to combining data from different scales, effect sizes were reported as standardized mean differences (SMD) with 95% credible intervals (95% CrI). The risk of bias was assessed independently by three reviewers using the RoB2 tool.

Results: A total of 48 studies involving 3050 cancer survivors. Across all exercise types, the most beneficial exercise dose was identified to be 850 metabolic equivalents of task (METs)-min/week (SMD: 0.753, 95%Crl: 0.463 to 1.096), with diminishing returns observed beyond 1,100 METs-min/week. Among the various types of exercises, mixed training (MT) emerged as the optimal choice, demonstrating its efficacy at 970 METs-min/week (SMD: 0.883, 95% Crl: 0.455 to 1.345). Aerobic exercise (AE) at a dose of 430 METs-min/week (SMD: 0.681, 95% Crl: 0.206 to 1.099) and resistance training (RT) at 450 METs-min/week (SMD: 0.695, 95% Crl: 0.227 to 1.203) also showed significant benefits. Additionally, mind-body exercises, such as tai chi, qigong, or yoga, exhibited optimal effects at a dose of 390 METs-min/week (SMD: 0.672, 95% Crl: 0.259 to 1.087).

Conclusion: Our study sheds light on the intricate relationship between exercise interventions and health-related quality of life in cancer survivors, as elucidated through a systematic review and Bayesian network meta-analysis. The identified optimal exercise dose of 850 METs-min/week resulted in a significant improvement in health-related quality of life, underscoring the importance of regular exercise in cancer survivorship. MT emerged as the most effective modality, closely followed by RT, AE, and MBE.

Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=493328, identifier CRD42024493328.

Keywords: Bayesian network meta-analysis; cancer survivor; dose-response; exercise; health-related quality of life.

Figure 1

PRISMA flow diagram of the search process for studies. RCT, randomized controlled trials.

Figure 2

Treatment-level (A) and agent-level network plots (B) for specific interventions. AE, aerobic exercise; RT, resistance training; MBE, mind-body exercise; MT, mixed training (aerobic + resistance training); CON, control group. Exercise dose corresponds to different exercise types (METs-min/week).

Figure 3

Dose-response relationship between overall exercise dose and change in the HRQoL of cancer survivors.

Figure 4

Dose-response relationship between different exercise doses and change in the HRQoL of cancer survivors. AE, aerobic exercise; RT, resistance training; MBE, mind-body exercise; MT, mixed training (aerobic + resistance Training).

Figure 5

Cochrane risk of bias tool.

Figure 6

Funnel plot of the publication bias among the comparison groups. The funnel plot shows the relationship between the effect size and standard error of different exercise methods (AE, MBE, CON, RT, MT). The Egger’s test result was 0.485, indicating that the possibility of publication bias was small. AE, aerobic exercise; RT, resistance training; MBE, mind-body exercise; MT, mixed training (aerobic + resistance Training); CON, control.