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Cancer Treat Rev. 2017 Jan;52:91-104. doi: 10.1016/j.ctrv.2016.11.010. Epub 2016 Dec 5.

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.

Author information

1
Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands; Department of Medical Oncology, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: l.buffart@vumc.nl.
2
Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: j.kalter@vumc.nl.
3
Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: m.sweegers@vumc.nl.
4
Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Canada. Electronic address: kerry.courneya@ualberta.ca.
5
Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia. Electronic address: r.newton@ecu.edu.au.
6
Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands. Electronic address: n.aaronson@nki.nl.
7
Division of Population Science, Moffitt Cancer Center and Research Institute, Tampa, FL, USA. Electronic address: Paul.Jacobsen@moffitt.org.
8
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: a.m.may@umcutrecht.nl.
9
Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia. Electronic address: d.galvao@ecu.edu.au.
10
Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: m.chinapaw@vumc.nl.
11
Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany. Electronic address: k.steindorf@dkfz-heidelberg.de.
12
Yale School of Public Health, New Haven, USA. Electronic address: melinda.irwin@yale.edu.
13
Department of Physiotherapy, Netherlands Cancer Institute, Amsterdam, The Netherlands. Electronic address: m.stuiver@nki.nl.
14
School of Public Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD, Australia. Electronic address: sc.hayes@qut.edu.au.
15
School of Nursing, University of Maryland, Baltimore, USA. Electronic address: Griffith@son.umaryland.edu.
16
European University, Madrid, Spain. Electronic address: alejandro.lucia@uem.es.
17
Department of Epidemiology, Maastricht University, The Netherlands. Electronic address: ilse.mesters@maastrichtuniversity.nl.
18
University Medical Centre Groningen, University of Groningen, Center for Rehabilitation, Groningen, The Netherlands. Electronic address: e.van.weert@rev.umcg.nl.
19
Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: hans.knoop@amc.uva.nl.
20
Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. Electronic address: m.m.goedendorp@med.umcg.nl.
21
Physical Activity for Health Research Center, University of Edinburgh, Edinburgh, UK. Electronic address: nanette.mutrie@ed.ac.uk.
22
Primary Care Clinical Sciences, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK. Electronic address: a.daley@bham.ac.uk.
23
Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK. Electronic address: alex.mcconnachie@glasgow.ac.uk.
24
Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Heidelberg University, Mannheim, Germany; Faculty of Health, University of Antwerp, Belgium. Electronic address: martin.bohus@zi-mannheim.de.
25
National Advisory Unit on Late Effects after Cancer, Department of Oncology, Oslo University Hospital, Oslo, Norway. Electronic address: LKA@ous-hf.no.
26
Athleticum - Competence Center for Sports- and Exercise Medicine and Institute for Medical Psychology, University Medical Center Hamburg-Eppendorf, Germany. Electronic address: khschulz@uke.uni-hamburg.de.
27
Freemasons Foundation Centre of Men's Health, School of Medicine, University of Adelaide, SA, Australia. Electronic address: camille.short@adelaide.edu.au.
28
School of Medicine & Public Health, the University of Newcastle, Callaghan, NSW, Australia. Electronic address: erica.james@newcastle.edu.au.
29
Priority Research Centre for Physical Activity and Nutrition, the University of Newcastle, Callaghan, NSW, Australia. Electronic address: ron.plotnikoff@newcastle.edu.au.
30
Lane Fox Respiratory Research Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK. Electronic address: Gill.Arbane@gstt.nhs.uk.
31
Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany. Electronic address: m.schmidt@dkfz.de.
32
Department of Medical Oncology, National Center for Tumor Diseases (NCT) and Heidelberg University Hospital, Heidelberg, Germany; Department of Radiation Oncology, National Center for Tumor Diseases (NCT) and Heidelberg University Hospital, Heidelberg, Germany. Electronic address: karin_potthoff@gmx.de.
33
Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. Electronic address: m.v.beurden@nki.nlm.
34
Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. Electronic address: h.oldenburg@nki.nl.
35
Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. Electronic address: g.sonke@nki.nl.
36
Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands; University of Twente, Enschede, The Netherlands. Electronic address: w.v.harten@nki.nl.
37
Department of Respiratory Medicine, Kings College London, London, UK. Electronic address: rachelgarrod1@gmail.com.
38
Penn State Health, College of Medicine, and Cancer Institute, Hershey, PA, USA. Electronic address: kschmitz@phs.psu.edu.
39
Oregon Health & Science University, Portland, USA. Electronic address: wintersk@ohsu.edu.
40
Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands. Electronic address: M.Velthuis@iknl.nl.
41
Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia. Electronic address: d.taaffe@ecu.edu.au.
42
Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: w.vanmechelen@vumc.nl.
43
Department of Hematology, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: m.j.kersten@amc.uva.nl.
44
Department of Rehabilitation Medicine, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: f.nollet@amc.uva.nl.
45
Johns Hopkins School of Nursing, Johns Hopkins School of Medicine, Sidney Kimmel Comprehensive Cancer Center, Baltimore, USA. Electronic address: jwenzel@jhu.edu.
46
Lane Fox Respiratory Research Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK. Electronic address: joachim.wiskemann@nct-heidelberg.de.
47
Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands; Department of Clinical Psychology, Vrije Universiteit Amsterdam, The Netherlands. Electronic address: im.verdonck@vumc.nl.
48
Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands; Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Amsterdam, The Netherlands. Electronic address: j.brug@uva.nl.

Abstract

This individual patient data meta-analysis aimed to evaluate the effects of exercise on quality of life (QoL) and physical function (PF) in patients with cancer, and to identify moderator effects of demographic (age, sex, marital status, education), clinical (body mass index, cancer type, presence of metastasis), intervention-related (intervention timing, delivery mode and duration, and type of control group), and exercise-related (exercise frequency, intensity, type, time) characteristics. Relevant published and unpublished studies were identified in September 2012 via PubMed, EMBASE, PsycINFO, and CINAHL, reference checking and personal communications. Principle investigators of all 69 eligible trials were requested to share IPD from their study. IPD from 34 randomised controlled trials (n=4519 patients) that evaluated the effects of exercise compared to a usual care, wait-list or attention control group on QoL and PF in adult patients with cancer were retrieved and pooled. Linear mixed-effect models were used to evaluate the effects of the exercise on post-intervention outcome values (z-score) adjusting for baseline values. Moderator effects were studies by testing interactions. Exercise significantly improved QoL (β=0.15, 95%CI=0.10;0.20) and PF (β=0.18, 95%CI=0.13;0.23). The effects were not moderated by demographic, clinical or exercise characteristics. Effects on QoL (βdifference_in_effect=0.13, 95%CI=0.03;0.22) and PF (βdifference_in_effect=0.10, 95%CI=0.01;0.20) were significantly larger for supervised than unsupervised interventions. In conclusion, exercise, and particularly supervised exercise, effectively improves QoL and PF in patients with cancer with different demographic and clinical characteristics during and following treatment. Although effect sizes are small, there is consistent empirical evidence to support implementation of exercise as part of cancer care.

KEYWORDS:

Exercise; Individual patient data meta-analysis; Neoplasm; Physical function; Quality of life

PMID:
28006694
DOI:
10.1016/j.ctrv.2016.11.010
[Indexed for MEDLINE]
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