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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

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

Physical exercise in cancer patients during and after medical treatment: a systematic review of randomized and controlled clinical trials

R Knols, NK Aaronson, D Uebelhart, J Fransen, and G Aufdemkampe.

Review published: 2005.

CRD summary

This review assessed exercise for improving functioning and psychological well-being in people with cancer during and after medical treatment. The authors concluded that exercise may have benefits, but that the available research is of moderate quality. The conclusions are in line with the evidence presented and appear appropriately cautious.

Authors' objectives

To assess the effectiveness of physical exercise for improving the physical functioning and psychological well-being of people with cancer during and after medical treatment, and to examine the methodological quality of studies in this area.

Searching

MEDLINE, CINAHL, the Cochrane Library, Cancerlit, and PEDro were searched (all to June 2004); the search terms were reported. The authors also checked the reference lists of identified studies and contacted experts in the field for unpublished data. There were no language restrictions.

Study selection

Study designs of evaluations included in the review

Randomised and non-randomised controlled trials were eligible for inclusion.

Specific interventions included in the review

Studies were eligible for inclusion in the review if they examined physical exercise after surgery or during or after chemotherapy, radiotherapy, hormonal therapy, or combinations thereof. Exercise had to aim to improve endurance or muscular strength; walking, swimming, weight training, and cycling were mentioned as eligible interventions. Relaxation exercises, such as yoga, were excluded. Exercise could take place in hospital or home settings.

Participants included in the review

The authors did not report any inclusion criteria for the participants, apart from people undergoing surgery, chemotherapy, radiotherapy or hormonal therapy for cancer. The included studies comprised people with breast cancer, bone marrow and peripheral stem cell transplant, and mixed solid tumours.

Outcomes assessed in the review

Eligible studies included at least one of the following outcomes: oxygen consumption per unit of time, body composition, walking distance, psychological distress, self-reported health-related quality of life, fatigue, and exercise levels or levels of physical activity. The authors did not define a primary outcome for the review.

How were decisions on the relevance of primary studies made?

One author performed the initial search to identify eligible studies. A second person verified the search. Any disagreements about inclusion were resolved by consensus.

Assessment of study quality

The authors used a list of Delphi criteria to assess validity, including randomisation, allocation concealment, specification of eligibility criteria, similarity of groups at baseline, blinding of the assessors, reporting,and intention-to-treat analyses. Two reviewers examined methodological quality using Delphi criteria. A third reviewer was available to arbitrate in the event of disagreement.

Data extraction

The authors did not state how the data were extracted for the review, or how many reviewers performed the data extraction.

Methods of synthesis

How were the studies combined?

The studies were combined in a narrative summary. They were divided according to when they assessed exercise (i.e. during treatment versus after treatment) and were also grouped according to disease type (breast cancer, bone marrow and peripheral stem cell transplant, and other solid tumours).

How were differences between studies investigated?

Differences between the studies were discussed in the text.

Results of the review

The review included 34 studies with 1,844 participants (range: 12 to 199): 27 randomised controlled trials (RCTs) and 7 non-randomised controlled clinical trials (CCTs). Seventeen RCTs and 5 CCTs examined exercise during treatment, while 10 RCTs and 2 CCTs examined exercise after treatment.

The majority of the included studies were of moderate methodological quality. There was variation in the type and duration of the exercise interventions. Most studies found improvements in physical indicators, psychological well-being, and overall health-related quality of life for exercise compared with control groups, regardless of disease type and whether exercise was taken during or after treatment. However, these findings were not consistent across all studies.

Authors' conclusions

The authors concluded that, although the quality of studies in the review was moderate, people with cancer may benefit from exercise during and after treatment.

CRD commentary

The authors described the review question and inclusion criteria in some detail, although there was a lack of clarity in the inclusion criteria for participants. No language or publication restrictions were applied, which reduces the risk of language and publication bias in the review. The search protocol and assessment process seemed rigorous and the authors detailed the methodological quality of the studies. It appears that the methodological assessment was used to help describe studies in the review rather than as a way of excluding studies of low quality, because an exploration of quality was an objective of this review.

The narrative summary appears appropriate given the heterogeneity of the included studies. However, the authors did not take steps to highlight the better quality evidence, and this made the synthesis more difficult to interpret. The authors focused on commenting on the methodological quality of available studies rather than the practical implications of exercise during and after cancer treatment. The conclusions were broad, but are in line with the evidence presented and appear appropriately cautious.

Implications of the review for practice and research

Practice: The authors did not state full implications for practice. They argued that exercise can be effective in reducing symptoms and improving the physical and psychological well-being of people with cancer, although positive results have not always been observed consistently across all studies. The effectiveness of exercise may vary according to the type of cancer, the nature and duration of the exercise programme, and the participants' lifestyles.

Research: The authors stated that future RCTs should use larger samples, appropriate comparison groups, comparable outcome measures, and focus on adherence to exercise and effects on survival.

Bibliographic details

Knols R, Aaronson N K, Uebelhart D, Fransen J, Aufdemkampe G. Physical exercise in cancer patients during and after medical treatment: a systematic review of randomized and controlled clinical trials. Journal of Clinical Oncology 2005; 23(16): 3830-3842. [PubMed: 15923576]

Indexing Status

Subject indexing assigned by NLM

MeSH

Exercise; Exercise Therapy; Humans; Neoplasms /physiopathology /psychology /therapy; Quality of Life; Randomized Controlled Trials as Topic

AccessionNumber

12005003707

Database entry date

30/11/2006

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: 15923576

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