Effects and moderators of exercise on muscle strength, muscle function and aerobic fitness in patients with cancer: a meta-analysis of individual patient data

Sweegers, Maike G.; Altenburg, Teatske M.; Brug, Johannes; May, Anne M.; Vulpen, Jonna K. van; Aaronson, Neil K.; Arbane, Gill; Bohus, Martin; Courneya, Kerry S.; Daley, Amanda; Galvão, Daniel A.; Garrod, Rachel; Griffith, Kathleen A.; Harten, Wim H. van; Hayes, Sandra C.; Herrero-Román, Fernando; Kersten, Marie José; Lucía, Alejandro; McConnachie, Alex; Mechelen, Willem van; Mutrie, Nanette; Newton, Robert U.; Nollet, Frans; Potthoff, Karin; Schmidt, Martina E.; Schmitz, Kathryn H.; Kh, Schulz; Sonke, Gabe S.; Steindorf, Karen; Stuiver, Martijn M.; Taaffe, Dennis R.; Thorsen, Lene; Twisk, Jos W. R.; Velthuis, Miranda J.; Wenzel, Jennifer; Winters-Stone, Kerri M.; Wiskemann, Joachim; Paw, Mai J. Chin A; Buffart, Laurien M.

doi:10.1136/bjsports-2018-099191

Cited by 82 publications

(50 citation statements)

References 76 publications

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“…Furthermore, patients in this study who completed the Chester Step Test were significantly younger and had less comorbidity than patients who did not complete the test. The mean hand grip strength for women and men in this study was comparable to the grip strength found in healthy elderly [33] and in slightly younger patients with different types of cancer during or after treatment [31]. The 14 times standing during the 30-second chair-stand test, was slightly lower than the 17 times reported in patients during or following treatment for different types of cancer [31], which might be explained by the younger age in the latter study.…”

Section: Discussionsupporting

confidence: 67%

“…The mean hand grip strength for women and men in this study was comparable to the grip strength found in healthy elderly [33] and in slightly younger patients with different types of cancer during or after treatment [31]. The 14 times standing during the 30-second chair-stand test, was slightly lower than the 17 times reported in patients during or following treatment for different types of cancer [31], which might be explained by the younger age in the latter study. Overall, results showed that newly diagnosed patients with HNC before treatment have lower levels of physical activity, cardiorespiratory fitness and lower body muscle function compared with the general population and survivors with various types of cancer, but comparable hand grip strength.…”

Section: Discussionsupporting

confidence: 67%

“…Furthermore, unhealthy lifestyle habits like smoking and alcohol drinking which are specific for this tumor type tend to cluster with physical inactivity [29]. The estimated cardiorespiratory fitness level (mean 27.9 ml/kg/min) of patients in this study was lower than the measured VO 2 max of 33.7 ml/kg/min reported in healthy populations [30], but higher than the directly measured VO 2 max of 23.7 ml/kg/min in patients with cancer during or following treatment [31]. However, previous research has shown that submaximal exercise tests, especially in participants with low levels of physical fitness, overestimate the actual measured exercise capacity [32].…”

Section: Discussioncontrasting

confidence: 63%

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Demographic, clinical and lifestyle-related correlates of accelerometer assessed physical activity and fitness in newly diagnosed patients with head and neck cancer

et al. 2019

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Introduction: Objective measurements of levels of physical activity and fitness in patients with head and neck cancer (HNC) are lacking. Furthermore, demographic, clinical and lifestyle-related correlates of low levels of physical activity and fitness in patients with HNC are unknown. This study aims to investigate the levels of accelerometer that assessed physical activity and fitness in patients with HNC and to identify their demographical, clinical and lifestyle-related correlates. Methods: Two hundred and fifty-four patients who were recently diagnosed with HNC and participated in the NETherlands QUality of life and Biomedical cohort studies In head and neck Cancer (NET-QUBIC) study were included. Physical activity (accelerometer), cardiorespiratory fitness (Chester Step Test), hand grip strength (hand dynamometer) and lower body muscle function (30-second chair-stand test) were assessed. Multivariable linear regression analyses with a stepwise forward selection procedure were used. Results: Patients spent 229 min/d in physical activity of which 18 min/d in moderate-to-vigorous physical activity. The mean predicted VO 2 max was 27.9 ml/kg/min, the mean hand grip strength was 38.1 kg and the mean number of standings was 14.3. Patients with lower educational level, more comorbidity and higher tumor stage spent significantly less time in physical activity. Older patients, females and patients with a higher tumor stage had significantly lower cardiorespiratory fitness levels. Older patients, females, patients with more comorbidity, patients with normal weight and patients who have never smoked had significantly lower hand grip strength. Older patients, patients with lower educational level, smokers and patients with more comorbidity had a significantly lower function of lower body muscle. Conclusions: Pre-treatment levels of physical activity, cardiorespiratory fitness and lower body muscle function are low in patients with HNC. Based on this study, exercise programs targeted and tailored to patients with low levels of physical activity and fitness can be developed.

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Section: Discussionsupporting

confidence: 67%

Section: Discussionsupporting

confidence: 67%

Section: Discussioncontrasting

confidence: 63%

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Demographic, clinical and lifestyle-related correlates of accelerometer assessed physical activity and fitness in newly diagnosed patients with head and neck cancer

et al. 2019

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“…Patients may underestimate how the treatment might affect their ability to exercise on their own. Also, current evidence indicates that exercise under supervision yields better outcomes . Therefore, even for currently active patients, regular evaluation of activity levels is needed, and referral to exercise programming could be valuable.…”

Section: What Oncology Clinicians Can Do Now: Assess Advise and Refermentioning

confidence: 99%

“…Also, current evidence indicates that exercise under supervision yields better outcomes. 10,[43][44][45][46][47] Therefore, even for currently active patients, regular evaluation of activity levels is needed, and referral to exercise programming could be valuable. The provider's willingness to discuss exercise during patient visits expresses confidence in the benefits of regular exercise during and after treatment.…”

Section: Step 3: Refermentioning

confidence: 99%

Exercise is medicine in oncology: Engaging clinicians to help patients move through cancer

Schmitz

Campbell

Stuiver

et al. 2019

CA A Cancer J Clinicians

532

465

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Multiple organizations around the world have issued evidence‐based exercise guidance for patients with cancer and cancer survivors. Recently, the American College of Sports Medicine has updated its exercise guidance for cancer prevention as well as for the prevention and treatment of a variety of cancer health‐related outcomes (eg, fatigue, anxiety, depression, function, and quality of life). Despite these guidelines, the majority of people living with and beyond cancer are not regularly physically active. Among the reasons for this is a lack of clarity on the part of those who work in oncology clinical settings of their role in assessing, advising, and referring patients to exercise. The authors propose using the American College of Sports Medicine's Exercise Is Medicine initiative to address this practice gap. The simple proposal is for clinicians to assess, advise, and refer patients to either home‐based or community‐based exercise or for further evaluation and intervention in outpatient rehabilitation. To do this will require care coordination with appropriate professionals as well as change in the behaviors of clinicians, patients, and those who deliver the rehabilitation and exercise programming. Behavior change is one of many challenges to enacting the proposed practice changes. Other implementation challenges include capacity for triage and referral, the need for a program registry, costs and compensation, and workforce development. In conclusion, there is a call to action for key stakeholders to create the infrastructure and cultural adaptations needed so that all people living with and beyond cancer can be as active as is possible for them.

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Cardio-Oncology Rehabilitation for Cancer Survivors With High Cardiovascular Risk

Viamonte,

Joaquim,

Alves

et al. 2023

JAMA Cardiol

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ImportanceCardiovascular disease is a leading cause of morbidity in cancer survivors, which makes strategies aimed at mitigating cardiovascular risk a subject of major contemporary importance.ObjectiveTo assess whether a center-based cardiac rehabilitation (CBCR) framework compared with usual care encompassing community-based exercise training (CBET) is superior for cardiorespiratory fitness improvement and cardiovascular risk factor control among cancer survivors with high cardiovascular risk.Design, Setting, and ParticipantsThis prospective, single-center, randomized clinical trial (CORE trial) included adult cancer survivors who had exposure to cardiotoxic cancer treatment and/or previous cardiovascular disease. Enrollment took place from March 1, 2021, to March 31, 2022. End points were assessed at baseline and after the 8-week intervention.InterventionsParticipants were randomly assigned in a 1:1 ratio to 8 weeks of CBCR or CBET. The combined aerobic and resistance exercise sessions were performed twice a week.Main Outcomes and MeasuresThe powered primary efficacy measure was change in peak oxygen consumption (V̇o2) at 2 months. Secondary outcomes included handgrip maximal strength, functional performance, blood pressure (BP), body composition, body mass index (BMI; calculated as weight in kilograms divided by height in meters squared), lipid profile, plasma biomarker levels, physical activity (PA) levels, psychological distress, quality of life (QOL), and health literacy.ResultsA total of 75 participants completed the study (mean [SD] age, 53.6 [12.3] years; 58 [77.3%] female), with 38 in the CBCR group and 37 in the CBET group. Participants in CBCR achieved a greater mean (SD) increase in peak V̇o2 than those in CBET (2.1 [2.8] mL/kg/min vs 0.8 [2.5] mL/kg/min), with a between-group mean difference of 1.3 mL/kg/min (95% CI, 0.1-2.6 mL/kg/min; P = .03). Compared with the CBET group, the CBCR group also attained a greater mean (SD) reduction in systolic BP (−12.3 [11.8] mm Hg vs −1.9 [12.9] mm Hg; P &lt; .001), diastolic BP (−5.0 [5.7] mm Hg vs −0.5 [7.0] mm Hg; P = .003), and BMI (−1.2 [0.9] vs 0.2 [0.7]; P &lt; .001) and greater mean (SD) improvements in PA levels (1035.2 [735.7] metabolic equivalents [METs]/min/wk vs 34.1 [424.4] METs/min/wk; P &lt; .001), QOL (14.0 [10.0] points vs 0.4 [12.9] points; P &lt; .001), and health literacy scores (2.7 [1.6] points vs 0.1 [1.4] points; P &lt; .001). Exercise adherence was significantly higher in the CBCR group than in the CBET group (mean [SD] sessions completed, 90.3% [11.8%] vs 68.4% [22.1%]; P &lt; .001).Conclusion and RelevanceThe CORE trial showed that a cardio-oncology rehabilitation model among cancer survivors with high cardiovascular risk was associated with greater improvements in peak V̇o2 compared with usual care encompassing an exercise intervention in a community setting. The CBCR also showed superior results in exercise adherence, cardiovascular risk factor control, QOL, and health literacy.Trial RegistrationClinicalTrials.gov Identifier: NCT05132998

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Effects and moderators of exercise on muscle strength, muscle function and aerobic fitness in patients with cancer: a meta-analysis of individual patient data

Cited by 82 publications

References 76 publications

Demographic, clinical and lifestyle-related correlates of accelerometer assessed physical activity and fitness in newly diagnosed patients with head and neck cancer

Demographic, clinical and lifestyle-related correlates of accelerometer assessed physical activity and fitness in newly diagnosed patients with head and neck cancer

Exercise is medicine in oncology: Engaging clinicians to help patients move through cancer

Cardio-Oncology Rehabilitation for Cancer Survivors With High Cardiovascular Risk

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