Effects and moderators of exercise on muscle strength, muscle function and aerobic fitness in patients with cancer: a meta-analysis of individual patient data

Maike G Sweegers; Teatske M Altenburg; Johannes Brug; Anne M May; Jonna K van Vulpen; Neil K Aaronson; Gill Arbane; Martin Bohus; Kerry S Courneya; Amanda J Daley; Daniel A Galvao; Rachel Garrod; Kathleen A Griffith; Wim H Van Harten; Sandra C Hayes; Fernando Herrero-Román; Marie J Kersten; Alejandro Lucia; Alex McConnachie; Willem van Mechelen; Nanette Mutrie; Robert U Newton; Frans Nollet; Karin Potthoff; Martina E Schmidt; Kathryn H Schmitz; Karl Heinz Schulz; Gabe Sonke; Karen Steindorf; Martijn M Stuiver; Dennis R Taaffe; Lene Thorsen; Jos W Twisk; Miranda J Velthuis; Jennifer Wenzel; Kerri M Winters-Stone; Joachim Wiskemann; Mai J Chin A Paw; Laurien M Buffart

doi:10.1136/bjsports-2018-099191

Effects and moderators of exercise on muscle strength, muscle function and aerobic fitness in patients with cancer: a meta-analysis of individual patient data

Br J Sports Med. 2019 Jul;53(13):812. doi: 10.1136/bjsports-2018-099191. Epub 2018 Sep 4.

Authors

Maike G Sweegers^{1

2}, Teatske M Altenburg³, Johannes Brug⁴, Anne M May⁵, Jonna K van Vulpen⁵, Neil K Aaronson⁶, Gill Arbane⁷, Martin Bohus^{8

9}, Kerry S Courneya¹⁰, Amanda J Daley¹¹, Daniel A Galvao¹², Rachel Garrod¹³, Kathleen A Griffith¹⁴, Wim H Van Harten^{6

15}, Sandra C Hayes¹⁶, Fernando Herrero-Román¹⁷, Marie J Kersten¹⁸, Alejandro Lucia¹⁹, Alex McConnachie²⁰, Willem van Mechelen³, Nanette Mutrie²¹, Robert U Newton¹², Frans Nollet²², Karin Potthoff^{23

24}, Martina E Schmidt²⁵, Kathryn H Schmitz²⁶, Karl Heinz Schulz²⁷, Gabe Sonke²⁸, Karen Steindorf²⁵, Martijn M Stuiver²⁹, Dennis R Taaffe¹², Lene Thorsen³⁰, Jos W Twisk¹, Miranda J Velthuis³¹, Jennifer Wenzel³², Kerri M Winters-Stone³³, Joachim Wiskemann^{23

34}, Mai J Chin A Paw³, Laurien M Buffart^{1

2

12

35}

Affiliations

¹ Department of Epidemiology & Biostatistics, Amsterdam University Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
² Cancer Center Amsterdam, Amsterdam, The Netherlands.
³ Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Amsterdam, The Netherlands.
⁴ Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Amsterdam, The Netherlands.
⁵ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands.
⁶ Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, Noord-Holland, The Netherlands.
⁷ Lane Fox Respiratory Research Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK.
⁸ Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Mannheim, Germany.
⁹ Faculty of Health, University of Antwerp, Antwerp, Belgium.
¹⁰ Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, Alberta, Canada.
¹¹ School of Sport, Exercise and Health Sciences, University of Loughborough, Loughborough, UK.
¹² Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia.
¹³ Department of Respiratory Medicine, Kings College London, London, UK.
¹⁴ The George Washington University School of Nursing, Washington, DC, USA.
¹⁵ University of Twente, Enschede, The Netherlands.
¹⁶ School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.
¹⁷ Fundación GIAFyS Cancer, Miranda de Ebro, Spain.
¹⁸ Department of Hematology, Amsterdam University Medical Center, Amsterdam, The Netherlands.
¹⁹ European University, Madrid, Spain.
²⁰ Robertson Centre for biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
²¹ Physical Activity for Health Research Center, University of Edinburgh, Edinburgh, UK.
²² Department of Rehabilitation, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.
²³ Department of Medical Oncology, National Center for Tumor Diseases (NCT) and Heidelberg University Hospital, Heidelberg, Germany.
²⁴ Department of Radiation Oncology, National Center for Tumor Diseases (NCT) and Heidelberg University Hospital, Heidelberg, Germany.
²⁵ Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany.
²⁶ Penn State Health, College of Medicine and Cancer Institute, Hershey, Pennsylvania, USA.
²⁷ Athleticum - Competence Center for Sports- and Exercise Medicine and Institute for Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
²⁸ Netherlands Cancer Institute, Amsterdam, The Netherlands.
²⁹ Center for Quality of Life, Netherlands Cancer Institute, Amsterdam, The Netherlands.
³⁰ National Advisory Unit on Late Effects after Cancer Treatment, Department of Oncology and Department of Clinical Service, Oslo University Hospital, Oslo, Norway.
³¹ Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.
³² Johns Hopkins School of Nursing, Johns Hopkins School of Medicine, Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland, USA.
³³ Knight Cancer Institute, School of Nursing, Oregon Health & Science University, Portland, OR, USA.
³⁴ College of Medicine and Cancer Institute, Penn State University, Hershey, Pennsylvania, USA.
³⁵ Department of Medical Oncology, Amsterdam University Medical Center, Amsterdam, The Netherlands.

PMID: 30181323
DOI: 10.1136/bjsports-2018-099191

Abstract

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.

Keywords: exercise; meta-analysis; oncology; physical activity; physical fitness.

Publication types

Meta-Analysis

MeSH terms

Exercise Therapy / methods*
Humans
Muscle Strength / physiology*
Muscular Diseases / physiopathology*
Muscular Diseases / therapy*
Neoplasms / physiopathology*
Physical Fitness / physiology*
Quality of Life