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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].

Body composition, physical fitness, functional performance, quality of life, and fatigue benefits of exercise for prostate cancer patients: a systematic review

JW Keogh and RD MacLeod.

Review published: 2012.

CRD summary

The review found that most prostate cancer patients should be encouraged to exercise regularly and where possible use group-based exercise and resistance training. Limitations in the review, which included insufficient information about the included studies and failure to report comparative data, the authors' conclusions require cautious interpretation.

Authors' objectives

To evaluate the effect of exercise on symptoms and quality of life in individuals with prostate cancer.

Searching

The reviewers searched PubMed (including the related articles option) and CINAHL (including the cited by function) databases and Google Scholar. Search terms were reported. Reference lists of articles retrieved were checked. The search was limited to full-length articles published in peer-reviewed journals. There were no restrictions on language or publication date.

Study selection

Eligible studies reported changes in body composition, physical fitness, functional performance, quality of life or fatigue among people with prostate cancer who underwent an exercise intervention for at least four weeks. Studies that included patients with other cancers were required to report outcomes separately for prostate cancer.

All studies in the review restricted entry to participants who had prostate cancer without co-existing problems that could contra-indicate an exercise programme. Mean participant age ranged from 66 to 72 years. Mean time since diagnosis ranged from two to four years. Most participants had Gleason scores of 6 to 8 out of 10, prostate-specific antigen levels of 3ng/mL to 7ng/mL and at least one other chronic condition. In half of the studies, all participants had regularly used androgen deprivation therapy for one to three years. The intervention was either group-based (in most cases resistance training) or home-based (in most cases aerobic training). In most studies of home-based interventions participants also received group counselling. Studies reported a variety of measures of body composition, physical fitness and functional performance. Various questionnaires were used to measure quality of life and fatigue. Intervention durations ranged from four to 26 weeks and the frequency from twice a week to most days of the week.

The authors did not state how many reviewers performed study selection.

Assessment of study quality

Criteria used to evaluate study quality were: clear description of inclusion criteria and intervention; use of reliable and valid methods to measure the primary outcome; blind assessment of outcomes; and follow-up of all study participants (or explanation of drop-outs). These criteria were based on published methods.

Studies were categorised as Level I (randomised controlled trial (RCT) with over 100 participants), Level II (smaller RCT), and Levels III, IV and V (non RCT).

The authors did not state how many reviewers performed the validity assessment.

Data extraction

Descriptive data were extracted from each study for each outcome and reported in tables as percentage changes from baseline. Statistically significant improvements (p<0.05) were indicated in study tables.

The authors did not state how many reviewers performed the data extraction.

Methods of synthesis

Data were combined in a narrative synthesis grouped by intervention setting and subgrouped by exercise type. A vote-counting approach was used to summarise the review findings.

Results of the review

Twelve studies were included in the review (408 participants in the study tables). Three studies were described as Level I, five as Level II and as four as non-randomised studies. All studies had clear inclusion criteria and used reliable and valid outcomes measures. Ten studies described the intervention clearly enough that it could be replicated. Two studies used blinded outcomes assessment. Five studies accounted adequately for attrition.

Body composition (nine studies): All studies used group-based interventions. Three studies reported that the intervention significantly improved muscle thickness and one reported a significant decrease in body fat.

Physical fitness (11 studies): Exercise significantly improved at least one measure of physical fitness in all seven studies of group-based and two out of four home-based interventions.

Functional outcomes (four studies): All studies were group-based. All studies found that exercise improved at least one measure of functional performance.

Quality of life or fatigue (11 studies): Exercise significantly improved at least one measure of quality of life or fatigue in five out of six studies of group-based and two out of five studies of home-based interventions.

All types of exercise were associated with statistically significant benefits for one or more measures of each outcome. Other findings were non-significant (where statistical significance was reported in the review).

Authors' conclusions

Exercise at least two or three days a week improved physical fitness, functional performance and quality of life and reduced fatigue in prostate cancer patients. Most prostate cancer patients should be encouraged to exercise regularly, if possible using group-based exercise and including resistance training.

CRD commentary

The aims and objectives of the review were clear but (as the authors appeared to acknowledge) body composition and fitness outcomes were of indirect relevance to the review objectives. Only two databases were searched and the search was limited to published full-length articles. Studies may have been missed and the review may have been subject to publication bias. The risk of publication bias was not discussed. Search dates were not reported. It was unclear whether study selection, quality assessment and data extraction were undertaken with sufficient attempts to minimise reviewer error and bias.

There was insufficient information on study methods. There was inconsistency between the sample numbers reported in the text (which referred to three RCTs with over 100 participants) and in the review tables (in which sample sizes ranged from 10 to 82). It appeared that outcome data in the review tables referred only to changes from baseline in the intervention group and that no comparative data were reported. In the absence of data comparing exercise with no exercise, the conclusions of the review were based on observational evidence (before-and-after comparisons) and the effects of randomisation were lost. No measures of variability were reported. Where significant changes from baseline were reported their clinical significance was unclear. The vote-counting approach is difficult to interpret as it does not take account of differences between the studies (such as sample size, variability and quality).

Limitations in the review, which included insufficient information about the included studies and failure to report comparative data, the authors' conclusions require cautious interpretation.

Implications of the review for practice and research

Practice: The authors stated that exercise counselling should be a routine component of care for individuals with prostate cancer. Where possible, exercise should be group-based and include resistance training.

Research: The authors stated that large RCTs should compare group and home-based exercise, assess the effect of home-based exercise on physical fitness and functional performance, investigate different combinations of exercise type and evaluate the effects in different patient groups (such as undergoing different types of treatment or receiving palliative care). Other areas for research should include dose-response effects and ways in which barriers and motivating factors influence participation in exercise programmes.

Funding

Cancer Society of New Zealand; Auckland University of Technology, New Zealand.

Bibliographic details

Keogh JW, MacLeod RD. Body composition, physical fitness, functional performance, quality of life, and fatigue benefits of exercise for prostate cancer patients: a systematic review. Journal of Pain and Symptom Management 2012; 43(1): 96-110. [PubMed: 21640547]

Indexing Status

Subject indexing assigned by NLM

MeSH

Body Composition; Exercise Therapy /statistics & numerical data; Fatigue /epidemiology /rehabilitation; Humans; Male; Motor Activity; Physical Fitness; Prevalence; Prostatic Neoplasms /epidemiology /rehabilitation; Quality of Life; Treatment Outcome

AccessionNumber

12012002102

Database entry date

01/05/2013

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2014 University of York.

PMID: 21640547

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