Effect of a multimodal high intensity exercise intervention in cancer patients undergoing chemotherapy: randomised controlled trial

Abstract

Objective To assess the effect of a multimodal group exercise intervention, as an adjunct to conventional care, on fatigue, physical capacity, general wellbeing, physical activity, and quality of life in patients with cancer who were undergoing adjuvant chemotherapy or treatment for advanced disease. Results Adjusted for baseline score, disease, and demographic covariates, the intervention group showed an estimated improvement at six weeks for the primary outcome, fatigue, of −6.6 points (95% confidence interval −12.3 to −0.9, P=0.02; effect size=0.33, 0.04 to 0.61). Significant effects were seen on vitality (effect size 0.55, 95% CI 0.27 to 0.82), physical functioning (0.37, 0.09 to 0.65), role physical (0.37, 0.10 to 0.64), role emotional (0.32, 0.05 to 0.59), and mental health (0.28, 0.02 to 0.56) scores. Improvement was noted in physical capacity: estimated mean difference between groups for maximum oxygen consumption was 0.16 l/min (95% CI 0.1 to 0.2, P<0.0001) and for muscular strength (leg press) was 29.7 kg (23.4 to 34.9, P<0.0001). No significant effect was seen on global health status/quality of life. Conclusion A supervised multimodal exercise intervention including high and low intensity components was feasible and could safely be used in patients with various cancers who were receiving adjuvant chemotherapy or treatment for advanced disease. The intervention reduced fatigue and improved vitality, aerobic capacity, muscular strength, and physical and functional activity, and emotional wellbeing, but not quality of life. Trial registration Current Controlled trials ISRCTN05322922.

Effect of physical exercise on muscle mass and strength in cancer patients during treatment—A systematic review

“…More moderate effects were found by Adamsen and colleagues [30] for leg extension (0.5; CI 0.3 to 0.8) and chest press (0.3; CI 0.1 to 0.6) and by Wiskemann and colleagues [36] for isometric strength in upper body (SMD 0.2; CI -0.3 to 0.6) and lower body (SMD 0.3; CI -0.1 to 0.8).…”

“…Of these, three trials used aerobic exercise (AE) alone { [29];Mello, 2003 #17;Monga, 2007 #7}, while seven trials used AE and resistance exercise (RE) in a combined intervention (CAE) [30][31][32][33][34][35][36]. Four trials compared AE or RE against UC [37][38][39][40].One trial compared two different RE interventions (three or five days per week) against usual care [41].…”

“…Effect sizes in favour of AE compared to UC were small in two trials by Courneya and colleagues [37] and Segal and colleagues [40] for the outcomes chest press (SMD 0.0; CI -0. Effect sizes were moderate to small both for upper and lower body strength in favour of CAE compared with UC in three trials [30,33,36]. Effect sizes were largest in the study by Jarden and colleagues [33] for both leg extension (SMD 1.7; CI -3.5 to 6.9) and chest press (0.8; CI -5.5 to 7.1).…”

“…For muscle strength outcomes, moderate to large effects were demonstrated in the trials on breast and prostate cancer patients [30,31,[37][38][39][40] and in trials on HSCT patients [29,32,33,36] but not in patients with advanced stage IV cancer [35], where effects on grip strength were small.…”

“…Estimations of one repetition maximum (1RM) for upper and lower body strength were most frequently used [30][31][32][33][37][38][39][40]. Chest press (involving major muscles of the chest, shoulders and triceps), seated row (involving the Lattisimus Dorsi and the Rhomboid muscles, predominantly) and leg extension (involving all major leg muscle groups such as Quadriceps, Hamstrings and Gluteus maximum), were most commonly used.…”