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Clinician Article

Efficacy of Exercise Therapy on Cardiorespiratory Fitness in Patients With Cancer: A Systematic Review and Meta-Analysis.



  • Scott JM
  • Zabor EC
  • Schwitzer E
  • Koelwyn GJ
  • Adams SC
  • Nilsen TS, et al.
J Clin Oncol. 2018 Aug 1;36(22):2297-2305. doi: 10.1200/JCO.2017.77.5809. Epub 2018 Jun 12. (Review)
PMID: 29894274
Read abstract Read evidence summary
Disciplines
  • Oncology - Breast
    Relevance - 6/7
    Newsworthiness - 5/7
  • Oncology - Gastrointestinal
    Relevance - 6/7
    Newsworthiness - 5/7
  • Internal Medicine
    Relevance - 5/7
    Newsworthiness - 5/7
  • Oncology - General
    Relevance - 5/7
    Newsworthiness - 5/7
  • Oncology - Palliative and Supportive Care
    Relevance - 5/7
    Newsworthiness - 5/7
  • Oncology - Lung
    Relevance - 5/7
    Newsworthiness - 4/7
  • Family Medicine (FM)/General Practice (GP)
    Relevance - 5/7
    Newsworthiness - 3/7
  • General Internal Medicine-Primary Care(US)
    Relevance - 5/7
    Newsworthiness - 3/7
  • Oncology - Hematology
    Relevance - 5/7
    Newsworthiness - 3/7
  • Oncology - Genitourinary
    Relevance - 4/7
    Newsworthiness - 3/7

Abstract

Purpose To evaluate the effects of exercise therapy on cardiorespiratory fitness (CRF) in randomized controlled trials (RCTs) among patients with adult-onset cancer. Secondary objectives were to evaluate treatment effect modifiers, safety, and fidelity. Methods A systematic search of PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Library was conducted to identify RCTs that compared exercise therapy to a nonexercise control group. The primary end point was change in CRF as evaluated by peak oxygen consumption (VO2peak; in mL O2 × kg-1 × min-1) from baseline to postintervention. Subgroup analyses evaluated whether treatment effects differed as a function of exercise prescription (ie, modality, schedule, length, supervision), study characteristics (ie, intervention timing, primary cancer site), and publication year. Safety was defined as report of any adverse event (AE); fidelity was evaluated by rates of attendance, adherence, and loss to follow-up. Results Forty-eight unique RCTs that represented 3,632 patients (mean standard deviation age, 55 ± 7.5 years; 68% women); 1,990 (55%) and 1,642 (45%) allocated to exercise therapy and control/usual care groups, respectively, were evaluated. Exercise therapy was associated with a significant increase in CRF (+2.80 mL O2 × kg-1 × min-1) compared with no change (+0.02 mL O2 × kg-1 × min-1) in the control group (weighted mean differences, +2.13 mL O2 × kg-1 × min-1; 95% CI, 1.58 to 2.67; I2, 20.6; P < .001). No statistical significant differences were observed on the basis of any treatment effect modifiers. Thirty trials (63%) monitored AEs; a total of 44 AEs were reported. The mean standard deviation loss to follow-up, attendance, and adherence rates were 11% ± 13%, 84% ± 12%, and 88% ± 32%, respectively. Conclusion Exercise therapy is an effective adjunctive therapy to improve CRF in patients with cancer. Our findings support the recommendation of exercise therapy for patients with adult-onset cancer.


Clinical Comments

General Internal Medicine-Primary Care(US)

It's not surprising that exercise improves cardiopulmonary fitness.

Oncology - Breast

The article has given insight into advising exercise to patients being treated with systemic therapy so as to maintain cardiovascular health.

Oncology - General

Weighted mean difference in VO2peak is only 2.13 mL O2 x Kg-1 x min -1, that is -more or less- a 5% of an average VO2peak.

Oncology - Genitourinary

The main finding of this meta-analysis is that exercise improves VO2peak in cancer patients, which is not surprising. This is only a surrogate marker; what I would be interested in is whether exercise improved QOL, or more importantly, overall survival. Unfortunately, this is information is not available.

Oncology - Hematology

There are cancers and there are cancers; there is staging and grading!

Oncology - Hematology

This is a meta-analysis that demonstrates the somewhat obvious point that exercise improves cardiorespiratory fitness, specifically in cancer patients.

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