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Paul M, Smart TF, Doleman B, Toft S, Williams JP, Lund JN, Phillips BE. A systematic review of the impact of postoperative aerobic exercise training in patients undergoing surgery for intra-abdominal cancers. Tech Coloproctol 2023; 27:1169-1181. [PMID: 37548782 PMCID: PMC10638144 DOI: 10.1007/s10151-023-02844-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/01/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION Enhanced recovery after surgery (ERAS) programmes which advocate early mobility after surgery have improved immediate clinical outcomes for patients undergoing abdominal cancer resections with curative intent. However, the impact of continued physical activity on patient-related outcomes and functional recovery is not well defined. The aim of this review was to assess the impact of postoperative aerobic exercise training, either alone or in conjunction with another exercise modality, on patients who have had surgery for intra-abdominal cancer. METHODS A literature search was performed of electronic journal databases. Eligible papers needed to report an outcome of aerobic capacity in patients older than 18 years of age, who underwent cancer surgery with curative intent and participated in an exercise programme (not solely ERAS) that included an aerobic exercise component starting at any point in the postoperative pathway up to 12 weeks. RESULTS Eleven studies were deemed eligible for inclusion consisting of two inpatient, one mixed inpatient/outpatient and eight outpatient studies. Meta-analysis of four outpatient studies, each reporting change in 6-min walk test (6MWT), showed a significant improvement in 6MWT with exercise (MD 74.92 m, 95% CI 48.52-101.31 m). The impact on health-related quality of life was variable across studies. CONCLUSION Postoperative exercise confers benefits in improving aerobic function post surgery and can be safely delivered in various formats (home-based or group/supervised).
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Affiliation(s)
- M Paul
- Centre of Metabolism, Ageing and Physiology (COMAP), School of Medicine, MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research and National Institute of Health Research (NIHR) Nottingham Biomedical Research Centre (BRC), Academic Unit of Injury, Rehabilitation, and Inflammation Sciences, University of Nottingham, Royal Derby Hospital Centre, Derby, DE22 3DT, UK
- Department of Surgery and Anaesthetics, Royal Derby Hospital, Derby, UK
| | - T F Smart
- Centre of Metabolism, Ageing and Physiology (COMAP), School of Medicine, MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research and National Institute of Health Research (NIHR) Nottingham Biomedical Research Centre (BRC), Academic Unit of Injury, Rehabilitation, and Inflammation Sciences, University of Nottingham, Royal Derby Hospital Centre, Derby, DE22 3DT, UK
- Department of Surgery and Anaesthetics, Royal Derby Hospital, Derby, UK
| | - B Doleman
- Department of Surgery and Anaesthetics, Royal Derby Hospital, Derby, UK
| | - S Toft
- Library and Knowledge Service, University Hospitals of Derby & Burton NHS Foundation Trust, Derby, UK
| | - J P Williams
- Centre of Metabolism, Ageing and Physiology (COMAP), School of Medicine, MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research and National Institute of Health Research (NIHR) Nottingham Biomedical Research Centre (BRC), Academic Unit of Injury, Rehabilitation, and Inflammation Sciences, University of Nottingham, Royal Derby Hospital Centre, Derby, DE22 3DT, UK
- Department of Surgery and Anaesthetics, Royal Derby Hospital, Derby, UK
| | - J N Lund
- Centre of Metabolism, Ageing and Physiology (COMAP), School of Medicine, MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research and National Institute of Health Research (NIHR) Nottingham Biomedical Research Centre (BRC), Academic Unit of Injury, Rehabilitation, and Inflammation Sciences, University of Nottingham, Royal Derby Hospital Centre, Derby, DE22 3DT, UK
- Department of Surgery and Anaesthetics, Royal Derby Hospital, Derby, UK
| | - B E Phillips
- Centre of Metabolism, Ageing and Physiology (COMAP), School of Medicine, MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research and National Institute of Health Research (NIHR) Nottingham Biomedical Research Centre (BRC), Academic Unit of Injury, Rehabilitation, and Inflammation Sciences, University of Nottingham, Royal Derby Hospital Centre, Derby, DE22 3DT, UK.
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Martins AD, Oliveira R, Brito JP, Costa T, Silva J, Ramalho F, Santos-Rocha R, Pimenta N. Effect of exercise on phase angle in cancer patients: a systematic review. J Sports Med Phys Fitness 2021; 62:1255-1265. [PMID: 34821490 DOI: 10.23736/s0022-4707.21.12727-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Body composition is one of the main variables of interest in clinical practice in cancer patients. Specific markers from bioelectrical impedance analysis, such as phase angle (PhA), have been assuming increasing relevance in this population. The aim of the present systematic review was to study and systematise the effect of exercise on PhA in cancer survivors, as compared to control conditions, namely usual care, with no exercise. The effect of exercise on PhA in the population of cancer survivors is not yet established. EVIDENCE ACQUISITIONː This systematic review was conducted on October 13, 2021, through PubMed, Web of Science, Wiley Online Library, Directory of Open Access Journals, Science Direct and JSTOR, following PRISMA guidelines and PICOS model that include: cancer survivors with ≥18 years; intervention of any exercise program for the target group; comparison between intervention group and control group that followed control conditions, namely usual care, with no exercise; outcome related to PhA; and studies of randomized control trials. EVIDENCE SYNTHESIS We founded a total of 1244 publications, using selected keywords. Eight studies were included in this systematic review, after inclusion/exclusion criteria considered. Compared with the control conditions, exercise training programs seem associated with a positive effect on PhA, both in solid tumours and haematologic cancer types, but only when using resistance exercise alone. According to the best evidence synthesis criteria, we could not conclude the superiority of any exercise program analysed in the value of the PhA. CONCLUSIONS There were several exercise details that may have potential to be beneficial for PhA in cancer patients, including an early start of the exercise intervention (during treatment and immediately after discharge from hospital), the use of resistance exercise or/and aerobic exercise, and mainly a long follow-up period (≥ 4 months) to verify the structural effects of exercise on the PhA. However, there were no effects on the PhA value immediately after the intervention, regardless of the type of protocol and the intervention time.
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Affiliation(s)
- Alexandre D Martins
- Sports Science School of Rio Maior, Polytechnic Institute of Santarém, Rio Maior, Portugal - .,CIEQV, Life Quality Research Centre, Rio Maior, Portugal - .,Comprehensive Health Research Centre (CHRC), Departamento de Desporto e Saúde, Escola de Saúde e Desenvolvimento Humano, Universidade de Évora, Évora, Portugal -
| | - Rafael Oliveira
- Sports Science School of Rio Maior, Polytechnic Institute of Santarém, Rio Maior, Portugal.,CIEQV, Life Quality Research Centre, Rio Maior, Portugal.,CIDESD, Research Center in Sport Sciences, Health Sciences and Human Development, Vila Real, Portugal
| | - João P Brito
- Sports Science School of Rio Maior, Polytechnic Institute of Santarém, Rio Maior, Portugal.,CIEQV, Life Quality Research Centre, Rio Maior, Portugal.,CIDESD, Research Center in Sport Sciences, Health Sciences and Human Development, Vila Real, Portugal
| | - Tiago Costa
- Sports Science School of Rio Maior, Polytechnic Institute of Santarém, Rio Maior, Portugal
| | - Júlia Silva
- Sports Science School of Rio Maior, Polytechnic Institute of Santarém, Rio Maior, Portugal
| | - Fátima Ramalho
- Sports Science School of Rio Maior, Polytechnic Institute of Santarém, Rio Maior, Portugal.,CIPER, Interdisciplinary Centre for the Study of Human Performance, Faculty of Human Kinetics (FMH), University of Lisbon, Cruz Quebrada, Portugal
| | - Rita Santos-Rocha
- Sports Science School of Rio Maior, Polytechnic Institute of Santarém, Rio Maior, Portugal.,CIPER, Interdisciplinary Centre for the Study of Human Performance, Faculty of Human Kinetics (FMH), University of Lisbon, Cruz Quebrada, Portugal
| | - Nuno Pimenta
- Sports Science School of Rio Maior, Polytechnic Institute of Santarém, Rio Maior, Portugal.,CIPER, Interdisciplinary Centre for the Study of Human Performance, Faculty of Human Kinetics (FMH), University of Lisbon, Cruz Quebrada, Portugal
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Attention to principles of exercise training: an updated systematic review of randomized controlled trials in cancers other than breast and prostate. BMC Cancer 2021; 21:1179. [PMID: 34740332 PMCID: PMC8569988 DOI: 10.1186/s12885-021-08701-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/16/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The primary objective of this systematic review was to update our previous review on randomized controlled trials (RCTs) of exercise in cancers other than breast or prostate, evaluating: 1) the application of principles of exercise training within the exercise prescription; 2) reporting of the exercise prescription components (i.e., frequency, intensity, time, and type (FITT)); and 3) reporting of participant adherence to FITT. A secondary objective was to examine whether reporting of these interventions had improved over time. METHODS MEDLINE, EMBASE, CINAHL and SPORTDiscus databases were searched from 2012 to 2020. Eligible studies were RCTs of at least 4 weeks of aerobic and/or resistance exercise that reported on physiological outcomes relating to exercise (e.g., aerobic capacity, muscular strength) in people with cancer other than breast or prostate. RESULTS Eighty-six new studies were identified in the updated search, for a total of 107 studies included in this review. The principle of specificity was applied by 91%, progression by 32%, overload by 46%, initial values by 72%, reversibility by 7% and diminishing returns by 5%. A significant increase in the percentage of studies that appropriately reported initial values (46 to 80%, p < 0.001) and progression (15 to 37%, p = 0.039) was found for studies published after 2011 compared to older studies. All four FITT prescription components were fully reported in the methods in 58% of all studies, which was higher than the proportion that fully reported adherence to the FITT prescription components in the results (7% of studies). Reporting of the FITT exercise prescription components and FITT adherence did not improve in studies published after 2011 compared to older studies. CONCLUSION Full reporting of exercise prescription and adherence still needs improvement within exercise oncology RCTs. Some aspects of exercise intervention reporting have improved since 2011, including the reporting of the principles of progression and initial values. Enhancing the reporting of exercise prescriptions, particularly FITT adherence, may provide better context for interpreting study results and improve research to practice translation.
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Thomsen SN, Mørup ST, Mau-Sørensen M, Sillesen M, Lahart I, Christensen JF. Perioperative exercise training for patients with gastrointestinal cancer undergoing surgery: A systematic review and meta-analysis. Eur J Surg Oncol 2021; 47:3028-3039. [PMID: 34294466 DOI: 10.1016/j.ejso.2021.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/16/2021] [Accepted: 07/10/2021] [Indexed: 10/20/2022] Open
Abstract
Exercise training is emerging as a supportive treatment strategy in surgical oncology, but its effects remain uncertain in patients with gastrointestinal cancer. The primary objective of this systematic review and meta-analysis was to evaluate the effects of perioperative exercise training on gastrointestinal cancer-specific mortality, recurrence, and surgical outcomes (postoperative complications, hospitalization, surgical stress) in patients with gastrointestinal cancer. Randomized or quasi-randomized controlled trials evaluating the effects of perioperative exercise training versus control in patients with GI cancer were eligible. MEDLINE, EMBASE, CENTRAL, CINAHL, PEDro, and SPORTDiscus were systematically searched on June 20, 2020. Data were synthesized using random-effects meta-analyses. Risk of bias was assessed using the Cochrane risk of bias tool 2, and the certainty of evidence was assessed using GRADE. Study selection, data extraction, risk of bias, and GRADE assessments were performed independently by two authors. Ten randomized controlled trials comprising 448 participants with gastrointestinal cancer were eligible. Meta-analyses indicated no statistical effects of exercise on postoperative complications (risk ratio: 1.11, 95% CI: 0.84; 1.47), readmissions (risk ratio: 2.76; 95% CI: 0.00, 9394.76), or postoperative length of stay (difference in means: -0.47, 95% CI: -17.2; 16.2 days). None of the eligible studies assessed gastrointestinal cancer-specific mortality or recurrence. Overall risk of bias was high or of some concerns in all studies, and the certainty of evidence was very low. The effects of perioperative exercise on cancer-specific and surgical outcomes are unknown in patients with gastrointestinal cancer due to lack of studies and very low certainty of evidence.
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Affiliation(s)
- Simon Nørskov Thomsen
- Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
| | - Stine Truel Mørup
- Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Morten Mau-Sørensen
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Martin Sillesen
- Department of Surgical Gastroenterology and Transplantation, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Center for Surgical Translational and Artificial Intelligence Research (CSTAR), Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ian Lahart
- Faculty of Health, Education, and Wellbeing, Institute of Human Sciences, University of Wolverhampton, Walsall Campus, Walsall, WS1 3BD, UK
| | - Jesper Frank Christensen
- Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Denmark
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Nusca SM, Parisi A, Mercantini P, Gasparrini M, Pitasi FA, Lacopo A, Colonna V, Stella G, Cerulli C, Grazioli E, Tranchita E, Santoboni F, Latini E, Trischitta D, Vetrano M, Visco V, Pavan A, Vulpiani MC. Evaluation of a Post-Operative Rehabilitation Program in Patients Undergoing Laparoscopic Colorectal Cancer Surgery: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115632. [PMID: 34070340 PMCID: PMC8197504 DOI: 10.3390/ijerph18115632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/21/2021] [Accepted: 05/21/2021] [Indexed: 01/07/2023]
Abstract
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.
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Affiliation(s)
- Sveva Maria Nusca
- PhD Course in “Translational Medicine and Oncology”, Department of Medical and Surgical Sciences and Translational Medicine, Sant’Andrea University Hospital, “Sapienza” University of Rome, 00189 Rome, Italy
- Correspondence:
| | - Attilio Parisi
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (A.P.); (C.C.); (E.G.); (E.T.)
| | - Paolo Mercantini
- Department of Medical and Surgical Sciences and Translational Medicine, Sant’Andrea University Hospital, “Sapienza” University of Rome, 00189 Rome, Italy;
| | - Marcello Gasparrini
- Department of General Surgery, Sant’Andrea University Hospital, “Sapienza” University of Rome, 00189 Rome, Italy;
| | - Francesco Antonio Pitasi
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences and Translational Medicine, Sant’Andrea University Hospital, “Sapienza” University of Rome, 00189 Rome, Italy; (F.A.P.); (A.L.); (V.C.); (G.S.); (F.S.); (E.L.); (D.T.); (M.V.); (M.C.V.)
| | - Alessandra Lacopo
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences and Translational Medicine, Sant’Andrea University Hospital, “Sapienza” University of Rome, 00189 Rome, Italy; (F.A.P.); (A.L.); (V.C.); (G.S.); (F.S.); (E.L.); (D.T.); (M.V.); (M.C.V.)
| | - Vincenzo Colonna
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences and Translational Medicine, Sant’Andrea University Hospital, “Sapienza” University of Rome, 00189 Rome, Italy; (F.A.P.); (A.L.); (V.C.); (G.S.); (F.S.); (E.L.); (D.T.); (M.V.); (M.C.V.)
| | - Giulia Stella
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences and Translational Medicine, Sant’Andrea University Hospital, “Sapienza” University of Rome, 00189 Rome, Italy; (F.A.P.); (A.L.); (V.C.); (G.S.); (F.S.); (E.L.); (D.T.); (M.V.); (M.C.V.)
| | - Claudia Cerulli
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (A.P.); (C.C.); (E.G.); (E.T.)
| | - Elisa Grazioli
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (A.P.); (C.C.); (E.G.); (E.T.)
| | - Eliana Tranchita
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (A.P.); (C.C.); (E.G.); (E.T.)
| | - Flavia Santoboni
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences and Translational Medicine, Sant’Andrea University Hospital, “Sapienza” University of Rome, 00189 Rome, Italy; (F.A.P.); (A.L.); (V.C.); (G.S.); (F.S.); (E.L.); (D.T.); (M.V.); (M.C.V.)
| | - Eleonora Latini
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences and Translational Medicine, Sant’Andrea University Hospital, “Sapienza” University of Rome, 00189 Rome, Italy; (F.A.P.); (A.L.); (V.C.); (G.S.); (F.S.); (E.L.); (D.T.); (M.V.); (M.C.V.)
| | - Donatella Trischitta
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences and Translational Medicine, Sant’Andrea University Hospital, “Sapienza” University of Rome, 00189 Rome, Italy; (F.A.P.); (A.L.); (V.C.); (G.S.); (F.S.); (E.L.); (D.T.); (M.V.); (M.C.V.)
| | - Mario Vetrano
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences and Translational Medicine, Sant’Andrea University Hospital, “Sapienza” University of Rome, 00189 Rome, Italy; (F.A.P.); (A.L.); (V.C.); (G.S.); (F.S.); (E.L.); (D.T.); (M.V.); (M.C.V.)
| | - Vincenzo Visco
- Department of Clinical and Molecular Medicine, Sant’Andrea University Hospital, “Sapienza” University of Rome, 00189 Rome, Italy; (V.V.); (A.P.)
| | - Antonio Pavan
- Department of Clinical and Molecular Medicine, Sant’Andrea University Hospital, “Sapienza” University of Rome, 00189 Rome, Italy; (V.V.); (A.P.)
| | - Maria Chiara Vulpiani
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences and Translational Medicine, Sant’Andrea University Hospital, “Sapienza” University of Rome, 00189 Rome, Italy; (F.A.P.); (A.L.); (V.C.); (G.S.); (F.S.); (E.L.); (D.T.); (M.V.); (M.C.V.)
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