Effect of progressive resistance training on health-related quality of life in the first year after breast cancer surgery - results from a randomized controlled trial

Resistance training for fatigue in people with cancer

BACKGROUND

Cancer-related fatigue (CRF) is one of the most common symptoms associated with cancer and its treatment. Different types of exercise have demonstrated beneficial effects on CRF. Previous evidence syntheses provided promising but inconclusive results when focusing on the effects of resistance training.

OBJECTIVES

To evaluate the effects of resistance training on CRF in people with cancer and, specifically, to compare the effects of resistance training with no training on CRF at: different periods of treatment in relation to anticancer therapy (before, during, or after anticancer therapy); different periods of assessment (up to 12 weeks after the intervention, between more than 12 weeks and less than six months after the intervention, or six months or longer after the intervention). Moreover, we wanted to compare the effects of resistance training with no training on quality of life (QoL), adverse events, depression, and anxiety.

SEARCH METHODS

We performed an extensive literature search in eight databases including CENTRAL, Medline, and Embase in October 2023. We searched trial registries for ongoing studies, and we integrated results from update searches of previously published Cochrane reviews.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) that compared resistance training with no training in adults with any type of cancer who received resistance training initiated before, during, or after anticancer therapy. Eligible RCTs needed to evaluate CRF or QoL. Resistance training had to be structured, last for at least five sessions, and include face-to-face instruction. We excluded studies that randomised fewer than 20 participants per group.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methodology. For analyses, we pooled short-term, medium-term, and long-term effects (i.e. up to 12 weeks, between more than 12 weeks and less than six months, and six months or longer, after the intervention). We assessed risk of bias and certainty of the evidence using Cochrane's risk of bias tool (RoB 1), and the GRADE approach, respectively.

MAIN RESULTS

We included 21 RCTs with a total of 2221 participants, with diverse types of cancer, who received resistance training initiated during (14 studies), or after (7 studies) anticancer therapy. None of the studies investigated the effects of resistance training initiated before anticancer therapy. Here, we present the results on CRF, QoL, and adverse events. Results on depression and anxiety are reported in the full review. Resistance training during anticancer therapy Resistance training probably has a beneficial effect compared with no training on short-term CRF (mean difference (MD) on Functional Assessment of Chronic Illness Therapy - Fatigue scale (FACIT-Fatigue) 3.90, 95% confidence interval (CI) 1.30 to 6.51; scale from 0 to 52, higher values mean better outcome, minimal important difference (MID) 3; 12 RCTs, 1120 participants; moderate-certainty evidence). The evidence is very uncertain about the effect of resistance training compared with no training on medium-term CRF (MD on Multidimensional Fatigue Inventory -8.33, 95% CI -18.34 to 1.68; scale from 20 to 100, higher values mean worse outcome, MID 11.5; 1 RCT, 47 participants; very low-certainty evidence). The evidence is very uncertain about the effect of resistance training compared with no training on long-term CRF (MD on FACIT-Fatigue -0.70, 95% CI -4.16 to 2.76; 1 RCT, 133 participants; very low-certainty evidence). Resistance training may have a small beneficial effect compared with no training on short-term QoL (MD on EORTC QoL Questionnaire C30 - global health (QLQ-C30) 4.93, 95% CI 2.01 to 7.85; scale from 0 to 100, higher values mean better outcome, MID 10; 12 RCTs, 1117 participants; low-certainty evidence). The evidence is very uncertain about the effect of resistance training compared with no training on medium-term QoL (MD on QLQ-C30 6.48, 95% CI -4.64 to 17.60; 1 RCT, 42 participants; very low-certainty evidence). The evidence is very uncertain about the effect of resistance training compared with no training on long-term QoL (MD on Functional Assessment of Cancer Therapy - Anemia (FACT-An) 0.50, 95% CI -8.46 to 9.46; scale from 0 to 188; higher values mean better outcome, MID 7; 1 RCT, 133 participants; very low-certainty evidence). Only two RCTs (116 participants) reported data on adverse events for both the resistance training and the control arm. The evidence is very uncertain about the effect of resistance training compared with no training on the occurrence of adverse events (very low-certainty evidence). Resistance training after anticancer therapy The evidence is very uncertain about the effect of resistance training compared with no training on short-term CRF (MD on Chalder Fatigue Scale -0.27, 95% CI -2.11 to 1.57; scale from 0 to 33, higher values mean worse outcome, MID 2.3; 3 RCTs, 174 participants; very low-certainty evidence). Resistance training may have a small beneficial effect or no effect compared with no training on short-term QoL (MD on QLQ-C30 3.87, 95% CI -1.22 to 8.97; 4 RCTs, 243 participants; low-certainty evidence). None of the studies reported data on medium-, or long-term effects on CRF or QoL. Only three RCTs (238 participants) reported data on adverse events for both the resistance training and the control arm. The evidence is very uncertain about the effect of resistance training compared with no training on the occurrence of adverse events (very low-certainty evidence).

AUTHORS' CONCLUSIONS

Our review demonstrates beneficial effects of resistance training during anticancer therapy compared with no training on short-term CRF and QoL for people with cancer. Resistance training after anticancer therapy may also have a small beneficial effect on short-term QoL. Data on medium-, and long-term effects are sparse. In order to facilitate evidence syntheses beyond a narrative report of the data, investigators of resistance training programmes should report adverse events more consistently and completely for all study arms, including control groups.

Can resistance exercise prevent breast cancer-related lymphoedema? A systematic review and metanalysis protocol

INTRODUCTION

Evidence shows that resistance training (RT) reduces lymphoedema in patients with breast cancer-related lymphoedema (BRCL), making it a safe and efficient intervention. However, it is uncertain if RT is safe and effective in patients at risk of developing BRCL. This systematic review (SR) protocol aims to describe all methodological aspects in order to evaluate the short-, medium- and long-term effects of RT on the prevention of BCRL.

MATERIALS AND METHODS

Throughout 2024, randomised clinical trials (RCTs) will be identified in electronic databases MEDLINE/PubMed, Embase, Cochrane Central Register of Controlled Trials, PEDro and LILACS. Only studies in English, Spanish and Portuguese will be included. Grey literature and clinical trial registration will also be reviewed. The primary outcome will be the occurrence of lymphoedema and quality of life. Second, pain intensity, upper limb function, range of movement, grip strength and adverse events will be considered. The individual studies' risk of bias will be evaluated using the Cochrane Risk of Bias 2.0 tool. Pairwise meta-analyses using a frequentist approach and random effects model will be conducted. The Grading of Recommendations Assessment, Development and Evaluation system will be used to evaluate the certainty of the evidence.

ETHICS AND DISSEMINATION

This protocol does not require the approval of an ethics committee, as it is a secondary study. The results will be disseminated through peer-reviewed publications.

PROSPERO REGISTRATION NUMBER

CRD42023455720.

Nonpharmacological Interventions for Managing Symptom Clusters in Adults: A Systematic Review

Objectives: The complex effects of multiple co-occurring symptoms are a major cause of reduced quality of life; thus, it is necessary to identify symptom clusters experienced by patients and explore interventions. This study aimed to provide an overview of non-pharmacological interventions based on symptom clusters in adults to identify effective intervention strategies and methods. Methods. This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. For the search databases, PubMed, Embase, Cochrane Library, CINAHL, RISS, KISS, and KISTI were used. It includes English and Korean experimental studies published up to May 2023. The literature quality was evaluated using the Joanna Briggs Institute Quality Assessment Tool. Results. Of the 18 studies selected, 15 were randomized controlled trials and three were quasi-experimental studies, all of which were conducted on patients with cancer. The symptom clusters-based interventions in the literature are classified as movement-based, relaxation-based, integrated, and miscellaneous interventions. Integrated interventions, which were effective in all studies, might prove to be very effective for managing symptom clusters. Movement-based intervention studies, which include dance, Qigong, and Tai Chi, might be very effective in improving health-related quality of life (HRQoL). Conclusions. This review demonstrates that non-pharmacological interventions reduce the occurrence and severity of symptom clusters, thereby improving HRQoL. Further studies are required to evaluate the effects of these interventions in patients with various chronic conditions other than cancer.

The efficacy of exercise training for improving body composition in patients with breast cancer: A systematic review and meta-analysis of randomized controlled trials

OBJECTIVES

To evaluate the efficacy of exercise in improving body composition in patients with breast cancer; the effects of exercise on weight and BMI were evaluated as secondary outcomes.

DATA SOURCES

Cochrane Library, EMBASE, PubMed and Web of Science were searched for randomized controlled trials published in English from database inception to 29 November 2023.

METHODS

The effects of exercise on body composition in patients with breast cancer were explored. After separately extracting the data, two reviewers assessed the overall quality of the evidence as well as the methodological quality of the included studies.

RESULTS

Fourteen studies with 1241 participants were included, of which 12 studies were eligible for meta-analysis. Exercise significantly reduced body fat (mean difference [MD], -0.33; 95% CI, -0.37 to -0.29; P < 0.00001) and increased lean mass (MD, 0.42; 95% CI, 0.34 to 0.49; P < 0.00001) in patients with breast cancer. Further, exercise intervention was associated with increased BMI of patients with breast cancer (MD, 0.03; 95% CI, 0.01 to 0.06; P = 0.01), while no significant difference in weight was detected between the exercise and the non-exercise groups. Subgroup analysis results showed that only resistance exercise reduced fat mass (MD, -0.22; 95% CI, -0.27 to -0.16; P < 0.00001).

CONCLUSIONS

Exercise effectively improves body composition in patients with breast cancer. Clinicians should encourage patients to engage in exercise and develop optimized exercise prescriptions.

Early Implementation of Exercise to Facilitate Recovery After Breast Cancer Surgery: A Randomized Clinical Trial

Importance

Recovery of shoulder function following breast cancer surgery is crucial for physical functioning and quality of life. While early implementation of shoulder rehabilitation exercises may enhance recovery, the optimal timing and exercise program remain unclear.

Objective

To investigate whether an early exercise intervention, initiated 1 day postsurgery and continued for 1 month through subsequent visits, could improve shoulder range of motion (ROM) and strength in patients with breast cancer.

Design, Setting, and Participants

A parallel-group, 2-arm randomized clinical trial was conducted between June 2020 and October 2021 at the Breast Cancer Center in Seoul, South Korea. Fifty-six patients (of 119 screened) with early-stage breast cancer who were scheduled for partial or total mastectomy were randomized into a tailored resistance exercise group (n = 28) or a usual care group (n = 28). Data were analyzed from November 2021 to June 2022.

Interventions

The exercise intervention commenced 1 day postsurgery and consisted of 4 supervised exercise education sessions corresponding with surgeon visits and daily home-based exercises for the first postoperative month. Tailored programs, including stretching and strength exercises, were adjusted based on individual shoulder function recovery status.

Main Outcomes and Measures

Primary end points were shoulder ROM and strength at 1 and 6 months postsurgery. Physical activity, body composition, and quality of life were assessed at 6 months.

Results

Of 56 patients randomized (mean [SD] age, 50.3 [6.6] years), 54 completed the trial (96%), with 100% and 97% compliance to supervised and home-based exercise sessions, respectively. At 1 month postsurgery, 19 (67.9%) in the exercise group had fully recovered shoulder strength compared to 1 (3.6%) in the usual care group (P < .001). At 6 months, 22 (78.6%) in the exercise group had fully recovered shoulder ROM and 24 (85.7%) had fully recovered strength compared to 6 (21.4%) and 5 (17.9%), respectively, in the usual care group (P < .001). The exercise group exhibited less loss in muscle mass and improved physical activity and quality of life compared to the usual care group.

Conclusion and Relevance

In this trial, 1-month tailored exercise program, initiated immediately after breast cancer surgery and supplemented with supervised sessions coinciding with surgeon visits, significantly improved shoulder function in patients with breast cancer.

Trial Registration

WHO International Clinical Trials Registry identifier: KCT0006997.

Effect of resistance exercise on physical fitness, quality of life, and fatigue in patients with cancer: a systematic review

Objective

The purpose of this study is to conduct a systematic review to assess the effects of different forms of resistance exercises (resistance exercise, resistance exercise combined with aerobic exercise, and resistance exercise combined with other exercises) on physical fitness, quality of life (QOL), and fatigue of patients with cancer.

Methods

We conducted a systematic review using the Cochrane Handbook for Systematic Reviews of Interventions guidelines. We searched PubMed, Web of Science, and Scopus databases for the studies from the establishment of the database to September 2023, including randomized controlled trials and clinical trials that evaluated the effects of different resistance exercise on physical fitness, QOL, and fatigue in all patients with cancer. Two reviewers independently assessed the quality of all the included studies using the Cochrane Handbook for Systematic Reviews of Interventions and MINORS scale. We divided the intervention into three types: resistance exercise, resistance exercise combined with aerobic exercise, and resistance exercise combined with other exercises.

Results

In total, 48 studies (3,843 participants) met the inclusion criteria. The three exercise intervention forms have significant effects on physical fitness and QOL, but the improvement effect on fatigue is not clear. A total of 34 studies reported significant and beneficial effects of resistance exercise on physical fitness across all types of cancer. There were 28 studies that reported significant or borderline improvement effects of resistance on QOL, and only 10 studies reported significant effects of resistance exercise interventions on fatigue improvement in patients with cancer.

Conclusions

Resistance exercise, resistance exercise combined with aerobic exercise, and resistance exercise combined with other exercises all have a positive effect on improving fitness and QOL in patients with cancer. Resistance exercise has an advantage in improving muscle strength, while combined resistance exercise has an advantage in improving QOL; however, there are no consistent findings in improving fatigue, although low-intensity resistance exercise is effective.

Systematic review registration

www.inplasy.com, identifier INPLASY2023110034.

Preventing lower limb lymphedema after pelvic lymphadenectomy with progressive resistance exercise training: A randomized controlled trial

Objective

This study aimed to assess the efficacy of a self-designed progressive resistance exercise training program for preventing the development of lower limb lymphedema.

Methods

An open-label randomized controlled trial was conducted in patients who underwent radical surgery for cervical cancer treatment in our department between October 7, 2019, and October 7, 2021. The participants were randomly assigned to one of three groups: progressive resistance exercise training, graduated compression stocking, and control group.

Results

A total of 267 patients were enrolled (89 in each group). The incidence of lower limb lymphedema was 9.0% (n = 8) in the progressive resistance exercise training group, 28.1% (n = 25) in the graduated compression stocking group, and 42.7% (n = 38) in the control group. Over the 2-year follow-up period, the risk of lower limb lymphedema was significantly lower in the progressive resistance exercise training group than in the control group, with a hazard ratio (HR) (95% confidence interval [CI]) of 0.156 (0.073-0.335). The study was underpowered to demonstrate a statistically significant reduction in risk in the graduated compression stocking group, with an HR (95% CI) of 0.624 (0.376-1.033).

Conclusions

Progressive resistance exercise training is an effective strategy for preventing lower limb lymphedema after pelvic lymphadenectomy for cervical cancer. It imposes no additional economic burden and can be performed conveniently without the need for dedicated exercise facilities. This makes it particularly accessible to patients in developing countries, allowing them to exercise at their convenience.

Trial registration

ChiCTR1800014905.

Moderate Intensity Exercise Reduces Side Effects of Cancer Therapy and Maintains Cardiorespiratory Fitness in Male Breast Cancer Patients: Findings from the BRECA Male Crossover Study

Introduction

There is growing evidence that aerobic exercise mitigates cancer therapy-related side effects and improves cardiorespiratory fitness (CRF). However, to the best of our knowledge, no exercise study has been conducted in male breast cancer (MBC) patients. The aim of this study was to investigate the feasibility and efficacy of different exercise intensities on CRF and self-reported questionnaire items in MBC patients.

Methods

Twenty-two MBC patients (60 ± 9 years) participated in this randomized crossover study. After completion of medical treatment, MBC patients were randomly assigned to either moderate (40-50% of heart rate [HR] max. and self-perceived exertion: 11) or vigorous (70-80% of HR max. and self-perceived exertion: 15) exercise intensity during the first 3 months of the study. After a 1-month washout period, participants switched group assignments. Primary endpoints were CRF and questionnaire items.

Results

We observed a dropout rate of 36% over 7 months, with the number of participants decreasing from 22 to 14. The results showed significant improvements in "Physical Function" (p = 0.037) and "Social Function" (p = 0.016) after moderate training. A non-significant improvement was also observed in "Breast Symptoms" (p = 0.095), but there was no change in "Fatigue" (p = 0.306). There were no differences observed in cardiovascular fitness (V̇O2 peak) between the treatment groups.

Conclusion

This study emphasizes the effectiveness of exercise intervention for an exceedingly rare cancer, highlighting the vital role of moderate intensity aerobic exercise in mitigating treatment side effects. Despite minimal peak V̇O2 differences, both exercise protocols adequately sustain CRF. Future studies are imperative to design optimized, sex-specific rehabilitation strategies tailored to the unique requirements of MBC patients, advancing our understanding of this under explored realm.

Differential Impact of Exercises on Quality-of-Life Improvement in Breast Cancer Survivors: A Network Meta-Analysis of Randomized Controlled Trials

This study aimed to assess the effectiveness of various exercise interventions in enhancing the quality of life for breast cancer survivors. To achieve this, randomized controlled trials were identified from major electronic databases, focusing on the relationship between exercise and quality of life in breast cancer survivors. The primary outcome was the impact of exercise on quality of life 12 weeks after the intervention, with a secondary outcome comparing dropout rates between intervention groups and a regular care control group. The study protocol was registered with INPLASY (INPLASY202340007). A network meta-analysis of nine randomized controlled trials involving 725 participants was conducted, examining aerobic and strength training, aerobic activity, yoga, and strength exercise. Results showed that aerobic and strength training was the most effective intervention, significantly improving the quality of life of breast cancer survivors (1.31; 95% confidence interval: 0.49 to 2.12). Aerobic activity had a borderline effect (0.83; 0.03 to 1.63), while no exercise interventions were associated with an increased dropout risk compared to the control group (regular care). The study concluded that concurrent aerobic and strength training can improve breast cancer survivors' quality of life after 12 weeks of intervention without increasing dropout risk compared to regular care.

Self-managed physical activity in breast cancer survivors: A scoping review

OBJECTIVE

Breast cancer survivors (BCS) experience many issues of rehabilitative concern due to the treatments they have undergone. Given the chronicity of these outcomes, the increasing number of survivors, and the positive results obtained by supervised exercise, professionals should consider offering self-managed physical activity (PA) programs to this population. Our aim was to map the currently available evidence about self-care rehabilitation for BCS.

METHODS

Medline, CINAHL, and Cochrane databases were searched for primary literature. Scoping review methodological frameworks were used to tackle the heterogeneity of the topic. Studies investigating self-managed PA interventions prescribed to adult BCS were included.

RESULTS

One hundred-eight studies were included, with sample sizes ranging from 6 to 692 patients. Information was systematically collected in tables displaying study design, type of PA, duration and recommended frequency, professional leading the study, type of supervision, initial training, strategies used to help patients integrate self-care into their daily lives, and self-managed PA efficacy. Tables were produced for every oncological side effect that BCS might experience: lymphedema, arthralgia, cancer-related fatigue, a decline in physical parameters, treatment-related cardiotoxicity, peripheral neurotoxicity, and a possible decline in the quality of life.

CONCLUSIONS

Self-managed PA has the potential to improve BCS oncological issues. Professionals can adopt many strategies to support patients and empower them with long-lasting self-care competencies. This scoping review provided a comprehensive and easy-to-consult overview of self-managed PA interventions for BCS. We also provided recommendations for future primary studies and secondary synthesis.

Physical Activity and Health-Related Quality of Life in Women With Breast Cancer: A Meta-Analysis

BACKGROUND

Physical activity (PA) is associated with improved health-related quality of life (HRQoL) among women with breast cancer; however, uncertainty remains regarding PA types and dose (frequency, duration, intensity) and various HRQoL measures. A systematic review and meta-analysis of randomized controlled trials was conducted to clarify whether specific types and doses of physical activity was related to global and specific domains of HRQoL, as part of the Global Cancer Update Programme, formerly known as the World Cancer Research Fund-American Institute for Cancer Research Continuous Update Project.

METHODS

PubMed and CENTRAL databases were searched up to August 31, 2019. Weighted mean differences (WMDs) in HRQoL scores were estimated using random effects models. An independent expert panel graded the evidence.

RESULTS

A total of 79 randomized controlled trials (14 554 breast cancer patients) were included. PA interventions resulted in higher global HRQoL as measured by the Functional Assessment of Cancer Therapy-Breast (WMD = 5.94, 95% confidence intervals [CI] = 2.64 to 9.24; I2 = 59%, n = 12), Functional Assessment of Cancer Therapy-General (WMD = 4.53, 95% CI = 1.94 to 7.13; I2 = 72%, n = 18), and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (WMD = 6.78, 95% CI = 2.61 to 10.95; I2 = 76.3%, n = 17). The likelihood of causality was considered probable that PA improves HRQoL in breast cancer survivors. Effects were weaker for physical function and mental and emotional health. Evidence regarding dose and type of PA remains insufficient for firm conclusions.

CONCLUSION

PA results in improved global HRQoL in breast cancer survivors with weaker effects observed for physical function and mental and emotional health. Additional research is needed to define the impact of types and doses of activity on various domains of HRQoL.

Conservative interventions and clinical outcome measures used in the perioperative rehabilitation of breast cancer patients undergoing mastectomy: a scoping review

BACKGROUND

Mastectomy is the first-line treatment approach for more than 90% of breast cancer patients. The numerous physical impairments associated with this surgical procedure negatively impact the patient's quality of life. To date, rehabilitation resources available for breast cancer patients undergoing mastectomy within the institutions affiliated to the Centre intégré universitaire de soins de santé et de services sociaux de la Mauricie-et-du-Centre-du-Québec (CIUSSS-MCQ) are lacking and do not always seem to reflect the particularities of breast cancer care pathways. The purpose of this review was to identify and describe the conservative interventions and the clinical outcome measures used in the perioperative physical rehabilitation of women with breast cancer who are awaiting or have undergone mastectomy. We also aimed to report on the barriers and facilitators to study participation and completion.

METHODS

MEDLINE, CINAHL, and the Cochrane Library were searched from inception to January 2021, and we updated the search on July 11, 2022. We included peer-reviewed English and French literature with quantitative designs, describing conservative interventions and clinical outcome measures used within rehabilitation programs designed for women who were awaiting or had undergone mastectomy. Paired reviewers independently reviewed all citations and articles using a two-phase screening process and independently extracted the data.

RESULTS

Of the 6080 articles identified, 57 met the inclusion criteria. Most interventions were multimodal, which combined exercise with patient education, manual therapy, and/or lymphatic drainage. The most frequently used objective measures of physical function were shoulder range of motion, muscle strength, and signs of lymphedema. In contrast, the primary patient-reported outcome measures were quality of life, shoulder function, and pain. Undergoing another breast surgery, death, and cancer recurrence were the most reported barriers to study completion.

CONCLUSION

This scoping review reports on the heterogeneity and wide range of conservative interventions and clinical outcome measures used in the physical rehabilitation of breast cancer patients who had undergone or were scheduled to undergo mastectomy. Tailoring interventions to breast cancer patients' needs and promoting outpatient rehabilitation interventions appear to be better suited to the particularities of breast cancer care pathways. Further research is needed to better identify barriers and facilitators to study participation and completion.

Breast cancer-related lymphoedema and resistance exercise: An evidence-based review of guidelines, consensus statements and systematic reviews

AIMS AND OBJECTIVES

Breast cancer-related lymphoedema (BCRL) is a side effect of cancer treatment and can be alleviated by resistance exercise. This systematic, evidence-based review examined the existing best evidence on resistance exercise for BCRL to accurately describe the current status of the field and offer recommendations for clinicians.

METHODS

This review adheres to the PRISMA guidelines. Clinical practice guidelines, consensus documents, systematic reviews and other related evidence-based resources about resistance exercise for BCRL were retrieved through the English databases and guideline websites. The publication data limit was set to December 2020. The following search terms were used: 'breast cancer/breast neoplasm/breast carcinoma/breast tumor/breast malignancy, lymphedema/swelling/edema/lymphoedema, resistance/weight/strength training, best practice/clinical practice/guideline/consensus documents'. The quality of the included studies was evaluated by two authors independently using AGREE II and AMSTAR II tools. Evidence-based recommendations on resistance exercise relevant for BCRL were synthesised and categorised.

RESULTS

Twenty two articles (seven guidelines, four consensus documents and eleven systematic reviews) were included. The overall quality of the eleven eligible guidelines and consensus documents was moderate to high according to the AGREE II criteria. The quality of the eleven systematic reviews was critically low to high according to the AMSTAR criteria. Six clinical topics involving 43 recommendations were identified. Recommendations were categorised by safety of resistance training, effectiveness of resistance training, evaluation prior to resistance exercise, resistance exercise prescription, resistance training outcome index and points for attention.

CONCLUSIONS

This study summarises 43 recommendations for resistance training for BCRL and provides guidance for clinicians. Based on randomised trials and systematic reviews published in recent years, there is an urgent need to update the guidelines and consensus documents in terms of topics, for example effectiveness of resistance training and resistance training outcome index.

ONS Guidelines™ for Cancer Treatment-Related Lymphedema

PURPOSE

Lymphedema is a chronic condition that may result from cancer-related surgery. The incidence of lymphedema varies greatly; however, patients remain at risk for life and may experience decreased quality of life and functional capacity. Providing recommendations for an evidence-based guideline for care of cancer treatment-related lymphedema will help to improve outcomes for patients with this chronic condition.

METHODOLOGIC APPROACH

A panel of healthcare professionals with patient representation convened to develop a national clinical practice guideline on prospective surveillance, risk reduction, and conservative treatment of lymphedema. Systematic reviews of the literature were conducted and the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology approach was used to assess the evidence.

FINDINGS

The panel made multiple recommendations for patients who are at risk for or experiencing lymphedema.

IMPLICATIONS FOR NURSING

Early diagnosis and treatment of lymphedema may mitigate symptoms. This evidence-based guideline supports patients, clinicians, and other healthcare professionals in clinical decision making.

SUPPLEMENTARY MATERIAL CAN BE FOUND AT&NBSP;HTTPS

//onf.ons.org/supplementary-material-ons-guidelines-cancer-treatment-related-lymphedema.

Evaluation of a Post-Operative Rehabilitation Program in Patients Undergoing Laparoscopic Colorectal Cancer Surgery: A Pilot Study

This pilot study explores the effects of a post-operative physical exercise program on the quality of life (QoL) and functional and nutritional parameters of patients that underwent laparoscopic colorectal cancer surgery, compared to usual care alone. The intervention group (IG) attended a 2-month-long supervised and combined exercise–training program during the post-operative period. Both IG and control group (CG) participated in the QoL, functional, and nutritional assessments before exercise training (T0), 2 months after the beginning of the exercise (end of treatment) (T1), and 2 (T2) and 4 (T3) months from the end of treatment. Eleven patients with colorectal cancer that underwent laparoscopic surgery were enrolled (six intervention; five control). The IG showed significant improvements compared to the CG in “Physical functioning” (PF2) (p = 0.030), “Cognitive functioning” (CF) (p = 0.018), and “Fatigue” (FA) (p = 0.017) of the European Organization for Research and Treatment of Cancer Quality of Life-C30 Questionnaire (EORTC QLQ-C30) at T1; in SMWT (p = 0.022) at T1; in PF2 (p = 0.018) and FA (p = 0.045) of EORTC QLQ-C30 at T2, in phase angle (PhA) of bioelectrical impedance analysis (p = 0.022) at T3. This pilot study shows that a post-operative, combined, and supervised physical exercise program may have positive effects in improving the QoL, functional capacity, and nutritional status in patients that undergo laparoscopic colorectal cancer surgery.

Sports Medicine-Related Breast and Chest Conditions-Update of Current Literature

ABSTRACT

This article reviews the most up-to-date evidence-based recommendations pertaining to breast and upper chest conditions, specifically for the sports medicine physician. Because of the unique circumstances of the team physician, they can see a wide breadth of pathology. Athletes may not have a primary care physician and may prefer to present to their team physician for breast and upper chest conditions. It is often more comfortable and convenient for athletes to seek treatment in the team setting. Therefore, it is important that the medical professional be aware of not only common pathology but also of that which is rarer. Any delay in evaluation can result in unnecessary morbidity and lead to complications or extended time lost from sport. Consequently, it also is important to facilitate an atmosphere encouraging early presentation and workup.

Evidence-Based Exercise Recommendations to Improve Mental Wellbeing in Women with Breast Cancer During Active Treatment: A Systematic Review and Meta-Analysis

Breast cancer was the most common cancer in women worldwide. The aims of the current systematic review and meta-analysis are: (i) to systematically examine the effects of exercise interventions on mental wellbeing; (ii) to examine the specific effect of the type of supervised exercise and its intensity, volume and frequency on mental wellbeing; and (iii) to explore which interventions are most effective in mental wellbeing among women with breast cancer during active treatment. An electronic literature search was performed using MEDLINE (via PubMed), Embase (Ovid), and Web of Science, we identified 175 full-text articles. The 57 publications included data from 6988 participants, age ranging from 18 to 78 years (weighted mean: 50.85 years). Compared with the control conditions, exercise training programs were associated with significant reductions in anxiety (d = -0.22, I² = 53.0%), depression (d = -0.24, I² = 66.6%), and fatigue (d = -0.47, I² = 69.8%), as well as increases in body image (d = 0.27, I² = 69.2%) and quality of life (overall, d = 0.46, I² = 71.6%; emotional function, d = 0.33, I² = 65.7%; and FACT-B, d = 0.60, I² = 76.2%). There were a variety of frequencies, intensities, and durations of supervised exercise programs reported in the included meta-analytic approach. In addition, we found that concomitant concurrent training, at moderate-to-vigorous intensity, and with a volume ≥50 min/week had benefits on a number of health outcomes, such as fatigue, depression, and quality of life measure by the FACT-B instrument. These findings have important implications for healthcare providers and multidisciplinary teams involved in mental health management in cancer patients during active treatment.

Resistance Training in Breast Cancer Survivors: A Systematic Review of Exercise Programs

The aim of this study was to identify the characteristics of resistance training (RT) programs for breast cancer survivors (BCS). A systematic review of the literature was performed using PubMed, Medline, Science Direct, the Cochrane Breast Cancer Specialised Register of the Cochrane Library, the Physiotherapy Evidence Database (PEDro), and Scopus, with the aim of identifying all published studies on RT and BCS from 1 January 1990 to 6 December 2019, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The risk of bias in the studies was assessed using the revised Cochrane Risk of Bias tool (RoB 2.0). Sixteen trials were included for qualitative analysis. More than half of the trials do not adequately report the characteristics that make up the exercise program. The maximal strength was the most frequently monitored manifestation of strength, evaluated mainly as one-repetition maximum (1RM). Resistance training was performed on strength-training machines, twice a week, using a load between 50% and 80% of 1RM. The trials reported significant improvement in muscle strength, fatigue, pain, quality of life, and minor changes in aerobic capacity.

Prospective Surveillance and Risk Reduction of Cancer Treatment-Related Lymphedema: Systematic Review and Meta-Analysis

PROBLEM IDENTIFICATION

Secondary lymphedema is a chronic condition that may result from cancer-related treatments. Evidence is emerging on prospective surveillance and risk reduction.

LITERATURE SEARCH

Databases were systematically searched through April 1, 2019, for comparative studies evaluating interventions aiming to prevent lymphedema in patients with cancer.

DATA EVALUATION

A random-effects model was used to perform meta-analysis, when appropriate.

SYNTHESIS

A total of 26 studies (4,095 patients) were included, with 23 providing data sufficient for meta-analysis. Surveillance programs increased the likelihood of detecting lymphedema. Physiotherapy, exercise programs, and delayed exercise reduced the incidence of lymphedema.

IMPLICATIONS FOR RESEARCH

Future research should standardize (a) evidence-based interventions to reduce the development of lymphedema and increase the likelihood of early detection and (b) outcome measures to build a body of evidence that leads to practice change.

SUPPLEMENTAL MATERIAL CAN BE FOUND AT&NBSP;HTTPS

//onf.ons.org/supplementary-material-systematic-review-cancer-treatment-related-lymphedema.