Physical Function
During Treatment
Systematic review of exercise programmes during chemotherapy helped prevent decline in cardiorespiratory and muscular fitness – with a small improvement.[1] Increase in muscular strength was noted in systematic reviews in patients performing aerobic and/or resistance exercise during chemotherapy or radiotherapy.[2] Significant improvement in physical function in further meta-analysis.[3] In breast cancer a meta-analyses demonstrated moderate improvement in cardiorespiratory fitness and small increase in muscular strength.[4] Systematic reviews of aerobic and resistance exercise therapy for patients receiving androgen deprivation therapy and radiotherapy showed increase in muscular fitness and small improvement in cardiorespiratory fitness.[5, 6]
Quality of evidence
Grade B – Moderate quality. Studies are heterogenous with regards to the design and there is a mixture of studies looking at radiotherapy and chemotherapy.
Strength of recommendation
Grade 2 – Weak recommendation. Overall patients will expect an improvement in their physical function – with more evidence present for improvement in muscular strength. There is a mixture of aerobic and resistance training in studies and it is likely both are of benefit however a dose response has not been indicated.
Conclusion
Further robust RCTs are needed however there is good preliminary evidence, with some promising evidence present for breast cancer to improve physical function with physical activity.
Post treatment
Physical Function
Meta-analyses demonstrates improvement in cardiorespiratory fitness and muscular fitness after aerobic and resistance training.[4] Systematic review demonstrated low to moderate evidence that exercise increased walking endurance.[8] Systematic reviews demonstrated small and moderate sized improvements in cardiorespiratory fitness following aerobic training, for 3 months after lung resection, and for colorectal cancer respectively.[3, 6] Meta-analysis in breast cancer has shown in increase in muscular strength.[4]
Quality of evidence
Grade B – Moderate quality. A number of studies have been done with some looking at aerobic activity and some resistance training. Evidence has primarily shown an improvement in cardiorespiratory fitness. Evidence demonstrates an improvement in muscular fitness.
Strength of recommendation
Grade 2 – Weak evidence. Studies are heterogenous in design. The benefits are likely to outweigh any risks for patients undertaking physical activity.
Conclusion
Patients can expect based on evidence that they will gain an improvement in their physical function – primarily in cardiorespiratory function, but also in muscular fitness.
- Van Moll, C.C., et al., The effect of training during treatment with chemotherapy on muscle strength and endurance capacity: A systematic review. Acta Oncol, 2016. 55(5): p. 539-46.
- Stene, G.B., et al., Effect of physical exercise on muscle mass and strength in cancer patients during treatment–a systematic review. Crit Rev Oncol Hematol, 2013. 88(3): p. 573-93.
- Buffart, L.M., et al., Effects and moderators of exercise on quality of life and physical function in patients with cancer: An individual patient data meta-analysis of 34 RCTs. Cancer Treat Rev, 2017. 52: p. 91-104.
- Furmaniak, A.C., M. Menig, and M.H. Markes, Exercise for women receiving adjuvant therapy for breast cancer. Cochrane Database Syst Rev, 2016. 9: p. CD005001.
- Baumann, F.T., E.M. Zopf, and W. Bloch, Clinical exercise interventions in prostate cancer patients–a systematic review of randomized controlled trials. Support Care Cancer, 2012. 20(2): p. 221-33.
- Gardner, J.R., P.M. Livingston, and S.F. Fraser, Effects of exercise on treatment-related adverse effects for patients with prostate cancer receiving androgen-deprivation therapy: a systematic review. J Clin Oncol, 2014. 32(4): p. 335-46.
- Cramp, F. and J. Byron-Daniel, Exercise for the management of cancer-related fatigue in adults. Cochrane Database Syst Rev, 2012. 11: p. CD006145.
- Capozzi, L.C., et al., The impact of physical activity on health-related fitness and quality of life for patients with head and neck cancer: a systematic review. Br J Sports Med, 2016. 50(6): p. 325-38.
- van Haren, I.E., et al., Physical exercise for patients undergoing hematopoietic stem cell transplantation: systematic review and meta-analyses of randomized controlled trials. Phys Ther, 2013. 93(4): p. 514-28.
- Craft, L.L., et al., Exercise effects on depressive symptoms in cancer survivors: a systematic review and meta-analysis. Cancer Epidemiol Biomarkers Prev, 2012. 21(1): p. 3-19.
- Mishra, S.I., et al., Exercise interventions on health-related quality of life for people with cancer during active treatment. Clin Otolaryngol, 2012. 37(5): p. 390-2.
- Chiu, H.Y., et al., Walking improves sleep in individuals with cancer: a meta-analysis of randomized, controlled trials. Oncol Nurs Forum, 2015. 42(2): p. E54-62.
- Matthews, E., et al., Sleep-Wake Disturbance: A Systematic Review of Evidence-Based Interventions for Management in Patients With Cancer. Clin J Oncol Nurs, 2018. 22(1): p. 37-52.
- Mercier, J., J. Savard, and P. Bernard, Exercise interventions to improve sleep in cancer patients: A systematic review and meta-analysis. Sleep Med Rev, 2017. 36: p. 43-56.