The Effect of Exercise on Quality of Life, Fatigue, Physical Function, and Safety in Advanced Solid Tumor Cancers: A Meta-analysis of Randomized Control Trials

Abstract

Background. People with metastatic cancers experience poor quality of life (QoL), fatigue, and decreased physical function. Exercise improves these symptoms in the curative setting, but the efficacy and safety of exercise in the metastatic setting is uncertain.Methods. Prospective, randomized trials of moderate/high-intensity aerobic exercise or resistance training vs. control in patients with advanced/metastatic solid cancers were identified from prior reviews and updated using a search of PubMed. The mean and SD for validated outcome measures (QoL, physical function, and fatigue) were extracted for intervention and control groups at baseline and postintervention. The Mann-Whitney test was used to evaluate the effect of exercise on the pooled change between baseline and postintervention. Safety was evaluated qualitatively.Results. Sixteen trials were analyzed. Among patients with scores at the mean or 2SD above, exercise was not associated with significant or clinical difference in QoL or fatigue. In patients with baseline scores 2SD below mean, exercise was associated with nonsignificant difference meeting minimal clinical important difference in QoL (À2.8 vs. 4.6, P ¼ 0.28). For function, patients at the mean had nonstatistically significant, but clinically meaningful difference in the six-minute walk test (6-MWT) (14.7 vs. 29.0 m, P ¼ 0.44). In patients 2 SD below the mean, there was a clinically meaningful difference in two patient-reported functional subscales (0.1 vs. 5.3, P ¼ 0.076 and 0.44 vs. 8.5, P ¼ 0.465) and a clinically meaningful improvement in the 6-MWT (À7.5 vs. 27.0 m, P ¼ 0.34), although none of these associations met statistical significance. There were no differences in falls, fractures, or pain.Discussion. Exercise is associated with clinically meaningful improvements in QoL, function, and 6-MWT in some patients with metastatic cancer. Despite poor reporting of safety, there was no signal of increased harm from exercise in this setting.

Level of Exercise Influences the Severity of Fatigue, Energy Levels, and Sleep Disturbance in Oncology Outpatients Receiving Chemotherapy

“…As noted in the introduction, findings from several systematic reviews and metaanalyses, [26][27][28][29][30][31][32][33][34] suggest that multimodal exercise interventions are effective in decreasing fatigue. This study is the first to evaluate the relationships between levels of exercise and selfreports of morning and evening fatigue, as well as decrements in morning and evening energy.…”

“…[23] Given that an alteration in inflammatory responses associated with the administration of CTX is one of the hypothesized mechanisms for both fatigue and sleep disturbance, a number of randomized clinical trials have evaluated the efficacy of exercise for these symptoms. In terms of fatigue, across several systematic reviews and meta-analyses of patients undergoing active treatment as well as cancer survivors, [26][27][28][29][30][31][32][33][34] the findings suggest that multimodal exercise interventions that include aerobic, resistance, and stretching exercises are effective in decreasing fatigue. While less well studied and often evaluated as a secondary outcome, [35][36][37][38] findings from four systematic reviews suggest that regular exercise results in decreases in sleep disturbance.…”

High-intensity interval training in the prehabilitation of cancer patients—a systematic review and meta-analysis

“…A substantial proportion of these patients suffer from typical adverse effects of the disease itself and its treatments (e.g., fatigue, deconditioning), causing disruption in all aspects of quality of life (QoL). Regular strength and endurance training potentially mitigates tumor-and treatment-related adverse effects and consequently have beneficial effects on QoL, physical fitness, and cancer-related fatigue [3][4][5]. Furthermore, exercise has been demonstrated to reduce all-cause, cancer-related, and cardiovascular disease mortality [6,7].…”

Exploring the Potential Role of the Gut Microbiome in Chemotherapy-Induced Neurocognitive Disorders and Cardiovascular Toxicity

“…Animal models, as well as clinical studies on elite athletes and healthy subjects, indicate the positive effect of physical activity on gut microbiota diversity and the production of beneficial metabolites [ 206 , 207 ]. Importantly, several clinical trials concerning cancer survivors have reported an association between exercise and clinically meaningful improvements in quality of life [ 208 ] and mortality [ 209 ]. However, the relationship between exercise and gut microbiota in cancer survivors requires further investigation.…”