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J Natl Cancer Inst. 2018 Nov 1;110(11):1190-1200. doi: 10.1093/jnci/djy161.

Targeting Exercise Interventions to Patients With Cancer in Need: An Individual Patient Data Meta-Analysis.

Author information

1
Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.
2
Department of Medical Oncology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands.
3
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands.
4
Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
5
Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia.
6
Division of Psychosocial Research and Epidemiology (NKA) and Center for Quality of life, Netherlands Cancer Institute, Amsterdam, the Netherlands.
7
Division of Cancer Control and Population Science, National Cancer Institute, Bethesda, MD.
8
Department of Clinical Psychology, VU University Amsterdam, Amsterdam, the Netherlands.
9
Department of Otolaryngology-Head and Neck Surgery, Amsterdam Public Health Research Institute and Cancer Center Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands.
10
Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany.
11
Yale School of Public Health, New Haven, CT.
12
School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD, Australia.
13
The George Washington University School of Nursing, Washington, DC.
14
European University and Research Institute, Madrid, Spain.
15
Fundación GIAFyS Cancer, Miranda de Ebro, Spain.
16
Department of Epidemiology, Maastricht University, Maastricht, the Netherlands.
17
University Medical Centre Groningen, University of Groningen, Center for Rehabilitation, Groningen, the Netherlands.
18
Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
19
Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
20
Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.
21
Physical Activity for Health Research Center, University of Edinburgh, Edinburgh, UK.
22
School of Sports, Exercise and Health Sciences, University of Loughborough, Loughborough, UK.
23
Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
24
Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Mannheim, Heidelberg University, Heidelberg, Germany.
25
Faculty of Health, University of Antwerp, Antwerp, Belgium.
26
National Advisory Unit on Late Effects after Cancer Treatment, Department of Oncology (LT) and Department of Clinical Service (LT), Oslo University Hospital, Oslo, Norway.
27
Athleticum - Competence Center for Sports- and Exercise Medicine and Institute for Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
28
Freemasons Foundation Centre of Men's Health, School of Medicine, University of Adelaide, Adelaide, SA, Australia.
29
School of Medicine & Public Health (ELJ) and Priority Research Centre for Physical Activity and Nutrition (RCP), The University of Newcastle, Callaghan, NSW, Australia.
30
Lane Fox Respiratory Research Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK.
31
Department of Medical Oncology (KP, JmW) and Department of Radiation Oncology (KP), National Center for Tumor Diseases (NCT) and Heidelberg University Hospital, Heidelberg, Germany.
32
Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.
33
University of Twente, Enschede, the Netherlands.
34
Department of Respiratory Medicine, Kings College London, London, UK.
35
Department of Public Health Science, College of Medicine and Cancer Institute, Pennsylvania State University, Hershey, PA.
36
Knight Cancer Institute and School of Nursing, Oregon Health & Science University, Portland, OR.
37
Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands.
38
Department of Hematology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
39
Department of Rehabilitation, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences Research Institute, Amsterdam, the Netherlands.
40
Johns Hopkins School of Nursing, Johns Hopkins School of Medicine, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD.
41
Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Amsterdam, the Netherlands.
42
Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada.

Abstract

Background:

Exercise effects in cancer patients often appear modest, possibly because interventions rarely target patients most in need. This study investigated the moderator effects of baseline values on the exercise outcomes of fatigue, aerobic fitness, muscle strength, quality of life (QoL), and self-reported physical function (PF) in cancer patients during and post-treatment.

Methods:

Individual patient data from 34 randomized exercise trials (n = 4519) were pooled. Linear mixed-effect models were used to study moderator effects of baseline values on exercise intervention outcomes and to determine whether these moderator effects differed by intervention timing (during vs post-treatment). All statistical tests were two-sided.

Results:

Moderator effects of baseline fatigue and PF were consistent across intervention timing, with greater effects in patients with worse fatigue (Pinteraction = .05) and worse PF (Pinteraction = .003). Moderator effects of baseline aerobic fitness, muscle strength, and QoL differed by intervention timing. During treatment, effects on aerobic fitness were greater for patients with better baseline aerobic fitness (Pinteraction = .002). Post-treatment, effects on upper (Pinteraction < .001) and lower (Pinteraction = .01) body muscle strength and QoL (Pinteraction < .001) were greater in patients with worse baseline values.

Conclusion:

Although exercise should be encouraged for most cancer patients during and post-treatments, targeting specific subgroups may be especially beneficial and cost effective. For fatigue and PF, interventions during and post-treatment should target patients with high fatigue and low PF. During treatment, patients experience benefit for muscle strength and QoL regardless of baseline values; however, only patients with low baseline values benefit post-treatment. For aerobic fitness, patients with low baseline values do not appear to benefit from exercise during treatment.

PMID:
30299508
PMCID:
PMC6454466
[Available on 2019-10-09]
DOI:
10.1093/jnci/djy161

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