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Exercise interventions for people undergoing multimodal cancer treatment that includes surgery

Exercise interventions for people undergoing multimodal cancer treatment that includes surgery
Exercise interventions for people undergoing multimodal cancer treatment that includes surgery
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.
1469-493X
Loughney, Lisa A.
9c3e7db1-468b-405c-b32f-cedd9cc251fe
West, Malcolm A.
98b67e58-9875-4133-b236-8a10a0a12c04
Kemp, Graham J.
e655122f-ff43-49ae-92d3-b569d4cb7707
Grocott, Michael P.W.
1e87b741-513e-4a22-be13-0f7bb344e8c2
Jack, Sandy
a175e649-83e1-4a76-8f11-ab37ffd954ea
Loughney, Lisa A.
9c3e7db1-468b-405c-b32f-cedd9cc251fe
West, Malcolm A.
98b67e58-9875-4133-b236-8a10a0a12c04
Kemp, Graham J.
e655122f-ff43-49ae-92d3-b569d4cb7707
Grocott, Michael P.W.
1e87b741-513e-4a22-be13-0f7bb344e8c2
Jack, Sandy
a175e649-83e1-4a76-8f11-ab37ffd954ea

Loughney, Lisa A., West, Malcolm A., Kemp, Graham J., Grocott, Michael P.W. and Jack, Sandy (2018) Exercise interventions for people undergoing multimodal cancer treatment that includes surgery. Cochrane Database of Systematic Reviews, 2018 (12), [CD012280]. (doi:10.1002/14651858.CD012280.pub2).

Record type: Review

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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Loughney et al 2018 Cochrane Database of Systematic Reviews - Version of Record
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More information

Accepted/In Press date: 11 December 2018
e-pub ahead of print date: 11 December 2018
Published date: 11 December 2018

Identifiers

Local EPrints ID: 427244
URI: http://eprints.soton.ac.uk/id/eprint/427244
ISSN: 1469-493X
PURE UUID: 39734f3d-893d-414e-a0ef-bbfe1ad2a0e7
ORCID for Malcolm A. West: ORCID iD orcid.org/0000-0002-0345-5356
ORCID for Michael P.W. Grocott: ORCID iD orcid.org/0000-0002-9484-7581

Catalogue record

Date deposited: 09 Jan 2019 17:30
Last modified: 16 Mar 2024 07:27

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Contributors

Author: Lisa A. Loughney
Author: Malcolm A. West ORCID iD
Author: Graham J. Kemp
Author: Sandy Jack

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