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Thomsen SN, Lahart IM, Thomsen LM, Fridh MK, Larsen A, Mau-Sørensen M, Bolam KA, Fairman CM, Christensen JF, Simonsen C. Harms of exercise training in patients with cancer undergoing systemic treatment: a systematic review and meta-analysis of published and unpublished controlled trials. EClinicalMedicine 2023; 59:101937. [PMID: 37096190 PMCID: PMC10121410 DOI: 10.1016/j.eclinm.2023.101937] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 04/26/2023] Open
Abstract
Background Exercise is recommended for people with cancer. The aim of this study was to evaluate the harms of exercise in patients with cancer undergoing systemic treatment. Methods This systematic review and meta-analysis included published and unpublished controlled trials comparing exercise interventions versus controls in adults with cancer scheduled to undergo systemic treatment. The primary outcomes were adverse events, health-care utilization, and treatment tolerability and response. Eleven electronic databases and trial registries were systematically searched with no date or language restrictions. The latest searches were performed on April 26, 2022. The risk of bias was judged using RoB2 and ROBINS-I, and the certainty of evidence for primary outcomes was assessed using GRADE. Data were statistically synthesised using pre-specified random-effect meta-analyses. The protocol for this study was registered in the PROESPERO database (ID: CRD42021266882). Findings 129 controlled trials including 12,044 participants were eligible. Primary meta-analyses revealed evidence of a higher risk of some harms, including serious adverse events (risk ratio [95% CI]: 1.87 [1.47-2.39], I2 = 0%, n = 1722, k = 10), thromboses (risk ratio [95% CI]: 1.67 [1.11-2.51], I2 = 0%, n = 934, k = 6), and fractures (risk ratio [95% CI]: 3.07 [3.03-3.11], I2 = 0%, n = 203, k = 2) in intervention versus control. In contrast, we found evidence of a lower risk of fever (risk ratio [95% CI]: 0.69 [0.55-0.87], I2 = 0% n = 1109, k = 7) and a higher relative dose intensity of systemic treatment (difference in means [95% CI]: 1.50% [0.14-2.85], I2 = 0% n = 1110, k = 13) in intervention versus control. For all outcomes, we downgraded the certainty of evidence due to imprecision, risk of bias, and indirectness, resulting in very low certainty of evidence. Interpretation The harms of exercise in patients with cancer undergoing systemic treatment are uncertain, and there is currently insufficient data on harms to make evidence-based risk-benefits assessments of the application of structured exercise in this population. Funding There was no funding for this study.
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Affiliation(s)
- Simon N. Thomsen
- Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen OE, Denmark
| | - Ian M. Lahart
- Faculty of Health, Education, and Wellbeing, School of Sport, University of Wolverhampton, Walsall Campus, Walsall, WS1 3BD, UK
| | - Laura M. Thomsen
- Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen OE, Denmark
| | - Martin K. Fridh
- Department of Pediatrics and Adolescent Medicine, The Juliane Marie Center, University Hospital of Copenhagen – Rigshospitalet, Juliane Maries Vej 9, 2100, Copenhagen OE, Denmark
| | - Anders Larsen
- University Hospitals Centre for Health Research, Copenhagen University Hospital - Rigshospitalet, Ryesgade 27, 2200, Copenhagen N, Denmark
| | - Morten Mau-Sørensen
- Department of Oncology, Centre for Cancer and Organ Diseases, University Hospital of Copenhagen - Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen OE, Denmark
| | - Kate A. Bolam
- Department of Physical Activity and Health, The Swedish School of Sport and Health Sciences, Lidingovagen, 5626, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Alle 23, 141 35, Stockholm, Sweden
| | - Ciaran M. Fairman
- Department of Exercise Science, University of South Carolina, Columbia, SC, USA
| | - Jesper F. Christensen
- Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen OE, Denmark
- Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
- Digestive Disease Center, Bispebjerg Hospital, Nielsine Nielsens Vej 11, 2400, Copenhagen, Denmark
| | - Casper Simonsen
- Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen OE, Denmark
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Exercise Intervention for Bone Metastasis: Safety, Efficacy and Method of Delivery. Cancers (Basel) 2023; 15:cancers15061786. [PMID: 36980672 PMCID: PMC10046160 DOI: 10.3390/cancers15061786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/28/2023] [Accepted: 03/10/2023] [Indexed: 03/18/2023] Open
Abstract
Background: The benefits of exercise for patients with cancer are well-established, however, for patients with bone metastases, exercise as adjuvant therapy is underutilised due to concerns for safety, efficacy and other barriers such as the method of delivery. This scoping review explores these barriers by reviewing the results of clinical trials conducted on participants with bone metastases. Methods: A thorough literature search was undertaken using PubMed, Scopus, NIH Clinical Trials and Google Scholar databases. Articles that involved an exercise intervention and patients with bone metastases were included. Data were pooled, charted, analysed and reported according to PRISMA-ScR standards. Results: A total of 26 trials were reviewed with interventions that included aerobic and resistance training. Only three serious adverse events occurred, not likely related to bone metastases. Nine trials (34.6%) involved unsupervised exercise sessions. Remote exercise delivery had an average of 80.3% compliance, rivalling in-person and mixed supervision. The results of this review reaffirm that exercise helps improve functional capacity, muscle strength, lean mass and cardiovascular function, and is safe in patients with bone metastases irrespective of in-person or remote delivery. Conclusions: Exercise therapy, whether delivered in person or remotely, is safe and efficacious for patients with bone metastases.
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Zhai H, Wei H, Xia J, Wang W. Dose-response relationship of resistance training for muscle morphology and strength in elderly cancer patients: A meta-analysis. Front Med (Lausanne) 2023; 10:1049248. [PMID: 37089606 PMCID: PMC10115997 DOI: 10.3389/fmed.2023.1049248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 01/17/2023] [Indexed: 04/25/2023] Open
Abstract
Objective To systematically evaluate the effects of resistance training (RT) on muscle strength and muscle hypertrophy in elderly cancer patients, and to provide dose-response relationships of RT variables that could improve muscle strength and morphology in elderly cancer patients. Method The Review Manager 5.3 was applied to analyze the 12 literatures (616 participants) through random or fixed effects model and global effect size to examine upper limb strength, lower extremity strength, and muscle hypertrophy. Sub-group analysis was made on five variables: the total number of repeated training times/week, load intensity, exercise frequency/week, exercise duration and gender. This study also examines the heterogeneity and publication bias. Results Twelve literatures (616 participants, 60-80 years) were included in meta-analysis. RT significantly increased the upper limb muscular strength (SMD = 0.51, 95% CI: 0.10-0.93; Z = 2.41; p = 0.02) and lower extremity strength (SMD = 0.48, 95% CI: 0.28-0.67; Z = 4.82; p < 0.00001), but had no significant effect on muscle morphology(SMD = 0.21, 95% CI: 0.01-0.42; Z = 1.88; p = 0.06). In subgroup analysis for lower extremity muscle strength in elderly male cancer patients, it was found that male intensity of 70-90%1RM, volume of 400-500 times per week, frequencies of 3 times per week, and session of 12-24 weeks, revealed the greatest effect. Funnel plot of the three studies shows that the results were reliable, and no publication bias was found. Conclusion RT had medium effects on improving muscle strength in elderly cancer patients, but it is not effective in improving muscle hypertrophy. In addition, when RT is performed, different training protocols can have an effect on the growth of muscle strength. Therefore, a lower extremity training protocol with a training intensity of 70-90% 1RM, a total of 400-500 repetitions per week, 3 times per week, and an exercise session of 12-24 weeks is most effective in improving lower extremity strength in elderly male cancer patients.
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Affiliation(s)
- Haiting Zhai
- School of Basic Sciences for Aviation, Naval Aviation University, Yantai, China
- School of Strength and Conditioning Training, Beijing Sport University, Beijing, China
| | - Hongwen Wei
- School of Strength and Conditioning Training, Beijing Sport University, Beijing, China
- *Correspondence: Hongwen Wei,
| | - Jixiang Xia
- School of Basic Sciences for Aviation, Naval Aviation University, Yantai, China
- Jixiang Xia,
| | - Wei Wang
- School of Basic Sciences for Aviation, Naval Aviation University, Yantai, China
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Exercise and Bone Health in Cancer: Enemy or Ally? Cancers (Basel) 2022; 14:cancers14246078. [PMID: 36551564 PMCID: PMC9776461 DOI: 10.3390/cancers14246078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/05/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
Bone health is often threatened in cancer patients. Bone metastasis and osteoporosis frequently occur in patients with cancer and may lead to different skeletal-related events, which may negatively affect patients' quality of life and are associated with high mortality risk. Physical exercise has been recognized as a potential adjunctive strategy in the cancer setting to improve physical function as well as treatment-related side effects. Nevertheless, exercise is often not recommended to patients with bone health impairments due to safety concerns. In the current review, we aimed, through a comprehensive review of the evidence, to explore the impact of exercise in terms of safety profile, bone outcomes, and the effects on other outcomes in patients with cancer affected by bone metastasis or at high risk of losing bone. Additionally, we explored the potential mechanisms by which exercise may act on bone, particularly the impact of mechanical load on bone remodeling. Finally, considerations about exercise prescription and programming in these populations are also discussed.
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Lee J. The effects of resistance training on muscular strength and hypertrophy in elderly cancer patients: A systematic review and meta-analysis. JOURNAL OF SPORT AND HEALTH SCIENCE 2022; 11:194-201. [PMID: 33592324 PMCID: PMC9068528 DOI: 10.1016/j.jshs.2021.02.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 11/30/2020] [Accepted: 12/17/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND One of the most life-threatening comorbidities in elderly cancer patients is cancer cachexia, which is characterized by the ongoing loss of skeletal muscular strength and mass and is also associated with aging. There is a lack of recommendations for optimal resistance training (RT) for those patients. The purpose of this study was to systematically review and quantify the effects of RT on muscular strength and hypertrophy in elderly cancer patients. METHODS Five electronic databases were searched (until January 2020) for studies that met the following criteria: (i) cancer patients aged ≥60 years; (ii) structured and supervised RT intervention for ≥6 weeks; and (iii) measured muscular strength and/or hypertrophy. RESULTS Thirteen studies (717 participants, average age = 66 years) met the inclusion criteria. RT significantly increased muscular strength (mean effect size = 0.87, 95% confidence interval (95%CI): 0.43-1.32, p < 0.001) and did not significantly induce muscle hypertrophy (mean effect size = 0.09, 95%CI: -0.14 to 0.31, p = 0.45). In subgroup analyses for muscle strength, higher weekly frequency was significantly associated with larger effect size. Egger's test showed no significant publication bias for the 2 outcomes. CONCLUSION The results suggest that RT improves muscular strength but does not significantly induce muscle hypertrophy in elderly cancer patients.
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Affiliation(s)
- Junghoon Lee
- Department of Kinesiology and Health Education, College of Education, University of Texas at Austin, Austin, TX 78712, USA.
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Weller S, Hart NH, Bolam KA, Mansfield S, Santa Mina D, Winters-Stone KM, Campbell A, Rosenberger F, Wiskemann J, Quist M, Cormie P, Goulart J, Campbell KL. Exercise for individuals with bone metastases: A systematic review. Crit Rev Oncol Hematol 2021; 166:103433. [PMID: 34358650 DOI: 10.1016/j.critrevonc.2021.103433] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 03/26/2021] [Accepted: 07/28/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Exercise has the potential to improve physical function and quality of life in individuals with bone metastases but is often avoided due to safety concerns. This systematic review summarizes the safety, feasibility and efficacy of exercise in controlled trials that include individuals with bone metastases. METHODS MEDLINE, Embase, Pubmed, CINAHL, PEDro and CENTRAL databases were searched up to July 16, 2020. RESULTS A total of 17 trials were included incorporating aerobic exercise, resistance exercise or soccer interventions. Few (n = 4, 0.5%) serious adverse events were attributed to exercise participation, with none related to bone metastases. Mixed efficacy results were found, with exercise eliciting positive changes or no change. The majority of trials included an element of supervised exercise instruction (n = 16, 94%) and were delivered by qualified exercise professionals (n = 13, 76%). CONCLUSIONS Exercise appears safe and feasible for individuals with bone metastases when it includes an element of supervised exercise instruction.
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Affiliation(s)
- Sarah Weller
- Provincial Programs, BC Cancer, 750 West Broadway, Vancouver, BC, V5Z 1H5, Canada. https://twitter.com/_sarahweller
| | - Nicolas H Hart
- Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, 191 Ipswich Rd, Woolloongabba, QLD, 4102, Australia; Exercise Medicine Research Institute, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia; Institute for Health Research, University of Notre Dame Australia, 23 High Street, Freemantle, WA, 6160, Australia. https://twitter.com/DrNicolasHart
| | - Kate A Bolam
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Fack 23400, SE-141 83 Huddinge, Stockholm, Sweden. https://twitter.com/katebolam
| | - Sami Mansfield
- Cancer Wellness for Life, 8022 Reeder Street, Lenexa, KS, 66214, USA. https://twitter.com/bewellwithsami
| | - Daniel Santa Mina
- Faculty of Kinesiology and Physical Education, University of Toronto, 27 King's College Cir, Toronto, Ontario, ON M5S, Canada. https://twitter.com/DR_SantaMina
| | - Kerri M Winters-Stone
- Knight Cancer Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA. https://twitter.com/winters_stone
| | - Anna Campbell
- Department of Sport, Exercise and Health & Science, School of Applied Sciences, Edinburgh Napier University, Sighthill Court, Edinburgh, EH11 4BN, UK. https://twitter.com/CanRehab
| | - Friederike Rosenberger
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Im Neuenheimer Feld 460, Heidelberg, 69120, Germany
| | - Joachim Wiskemann
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Im Neuenheimer Feld 460, Heidelberg, 69120, Germany. https://twitter.com/exoncolgermany
| | - Morten Quist
- The University Hospitals Centre for Health Research, Rigshospitalet, Blegdamsvej 9, 2100, København, Denmark. https://twitter.com/QuistMorten
| | - Prue Cormie
- Mary MacKillop Institute for Health Research, Australian Catholic University, 5/215 Spring Street, Melbourne, VIC, 3000, Australia. https://twitter.com/PrueCormie
| | - Jennifer Goulart
- Department of Radiation Oncology, BC Cancer, 2410 Lee Avenue, Victoria, BC, V8R 6V5, Canada
| | - Kristin L Campbell
- Department of Physical Therapy, 212-2177 Wesbrook Mall, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada.
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Spinal Stabilization Exercises for Cancer Patients with Spinal Metastases of High Fracture Risk: Feasibility of the DISPO-II Training Program. Cancers (Basel) 2021; 13:cancers13020201. [PMID: 33429892 PMCID: PMC7827062 DOI: 10.3390/cancers13020201] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/27/2020] [Accepted: 01/04/2021] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Previous research indicates that the outcomes of irradiation of spinal metastases can be improved through exercise. After this was demonstrated for metastases of low fracture risk, we conducted the first study in patients with spinal metastases of high fracture risk to investigate exercise feasibility. An exercise group performed four spinal stabilization exercises daily over two weeks of radiotherapy, while a control group received relaxation. Patients in the exercise group attended 90% of training sessions, compared to 80% in the control group. No injuries occurred. However, about half of the patients could not perform two out of the four exercises due to pain, weakness or immobility. Nevertheless, they increased exercise time and training-specific strength. Altogether, exercise is well accepted and enhances muscle strength in these patients, but frequent individual adaptations of the training program are needed. This knowledge is a prerequisite for larger studies addressing exercise effects on health. Abstract Exercise concomitant to radiotherapy for stable spinal metastases was demonstrated to increase bone density and reduce pain. In the DISPO-II study, the feasibility of exercise concomitant to radiotherapy for unstable spinal metastases was investigated. Here, a detailed analysis of the training program is presented. Cancer patients with spinal metastases (Taneichi score ≥ D) were randomly assigned to an intervention group (INT, n = 27, 62 ± 9 years) or control group (CON, n = 29, 61 ± 9 years). INT performed spinal stabilization exercises (“all fours”/“plank”/“swimmer”/“band exercise”), and CON received relaxation, daily concomitant to radiotherapy. Exercise attendance rate was 90% in INT and 80% in CON (p = 0.126). Within INT, exercise dose increased significantly (p < 0.001). 54% of patients could not perform “swimmer” in some or all sessions. 42% could not perform “plank” in some or all sessions. 13 and 25% could not perform “all fours” and “band exercise” in some sessions. “Plank” holding time increased in INT and remained unchanged in CON with different development between groups (p = 0.022). Handgrip strength did not develop differently between groups (p = 0.397). The exercise intervention demonstrated high acceptability but required frequent modifications due to pain, weakness and immobility to be feasible for the majority of participants. It enhanced specific muscle strength. Larger trials should now investigate exercise effects on health.
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