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2012
KCE REPORT 1
SUPPOPART 1:
85C
ORTIVEEXERCISE
E TREATE TREATM
TMENTENT
T FOR CCANCERR
www.kce.fgoov.be
Belgian He
Executive
ealth Care KTh20th
Board
PrCEprPrEnPrGePrRe Re Re Int Pr
Pr
Ho So Ho
Knowledge Che Belgian Healt002 under the suhat support the p
resident EO - National Instresident) resident of the Fenvironment (vice president of the Feeneral Administraroducts epresentatives of
epresentatives of
epresentatives of
termutualistic Age
rofessional Organ
rofessional Organ
ospital Federation
ocial Partners
ouse of Represen
Centre h Care Knowled
upervision of theolitical decision
titute for Health an
deral Public Servpresident) deral Public Serv
ator of the Federal
the Minister of Pu
the Minister of So
the Council of Mi
ency
nisations - represe
nisations - represe
ns
ntatives
ge Centre (KCE)e Minister of Pubmaking on healt
nd Disability Insur
ice Health, Food C
ice Social Securitl Agency for Medi
ublic Health
ocial Affairs
nisters
entatives of physic
entatives of nurses
) is an organizatiblic Health and Sth care and healt
rance (vice
Chain Safety and
y (vice president)cines and Health
cians
s
ion of public inteSocial Affairs. KCth insurance.
Actual Me
Pierre GilleJo De Coc
Dirk Cuype
Frank VanXavier De
Bernard LaMarco SchOlivier de Ri De RiddJean-NoëlDaniel DevMichiel CaPatrick VeXavier BreMarc MoenJean-PierrMichel FouMyriam HuJohan PauJean-ClauRita ThysPaul PalstLieve Wier
erest, created onCE is in charge
mbers
et ck
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n MassenhoveCuyper
ange hetgen Stexhe der Godin vos
allens rertbruggen
enez ns re Baeyens ulon ubinon uwels de Praet
erman rinck
n the 24th of Deceof conducting s
Substitute Membe
Benoît Collin
Chris Decoster
Jan Bertels Greet Musch
François Perl Annick Poncé Karel Vermeyen Lambert StamataFrédéric Lernoux Bart Ooghe Frank De Smet Yolande Husden Geert Messiaen Roland Lemye Rita Cuypers Ludo Meyers Olivier Thonon Katrien KestelootPierre Smiets Leo Neels Celien Van Moerk
ember tudies
ers
akis
t
kerke
Control Manageme
Contact
ent
Gove
ChiefAssis
Mana
BelgiDoorbBouleB-100Belgi T +32F +32info@http://
ernment commissi
f Executive Officestant Chief Execut
agers Program Ma
an Health Care Kbuilding (10th Flooevard du Jardin B00 Brussels um
2 [0]2 287 33 88 2 [0]2 287 33 85
@kce.fgov.be /www.kce.fgov.be
ioner
r tive Officer
anagement
Knowledge Centreor) otanique, 55
e
Yv
RaJe
ChKr
(KCE)
ves Roger
af Mertens ean-Pierre Closon
hristian Léonard ristel De Gauquierr
2012
KCE REPORT 1GOOD CLINICA
SUPPOPART 1: KIRSTEN HOL
85C AL PRACTICE
ORTIVEEXERCISE
DT HENNINGSEN
E TREATE TREATM
N, ANJA DESOM
TMENTENT
ER, SOPHIE HAN
T FOR C
NSSENS, JOAN V
CANCER
VLAYEN
R
www.kce.fgoov.be
COLOPHOTitle:
Authors:
External expert
External validat
Conflict of intere
Layout:
Disclaimer:
Publication date
Domain:
MeSH:
NLM Classificat
Language:
Format:
ON
ts:
tors:
est:
e:
tion:
Supp
Kirste
AhmAnneLeuvDidie
JeroeJean
Fees
Ine V
The comneceSubsa corepoFinaOnlyalso
09 O
Good
Neop
QZ 2
Engli
Adob
portive treatment f
en Holdt Henning
ad Awada (Instituemarie Coolbrandven), Robert Parider Vander Steiche
en Mebis (Limburn-Pierre van den B
s or other compen
Verhulst
external expertments were disc
essarily agree wisequently, a (finansensus or a vo
ort and did not nelly, this report ha
y the KCE is respunder the full re
October 2012
d Clinical Practice
plasms; Chemothe
266
ish
be® PDF™ (A4)
for cancer – Part
sen (KCE), Anja D
ut Bordet), Sabiendt (UZ Leuven), Judaens (UZ Leuvel (Fondation Cont
gs Oncologisch CBerg (Meander Me
nsation for writing
ts were consultcussed during mth its content. al) version was s
oting process beecessarily all thras been approveponsible for erroesponsibility of th
e (GCP)
erapy, Adjuvant; R
1: exercise treatm
Desomer (KCE), S
n Bauwens (UZ Bulie Degée (Instituen), Marc Peeterstre le Cancer)
Centrum), Emmanedisch Centrum, N
a publication or p
ted about a (pmeetings. They
submitted to theetween the validaee agree with its
ed by common asors or omissionshe KCE.
Radiotherapy; Exe
ment
Sophie Hanssens
Brussel), Tom Boteut Bordet), Frédérs (UZA), Ward R
nuel Simons (RugsNederland)
articipating in its d
preliminary) versdid not co-auth
e validators. The ators. The validas content. ssent by the Exe that could pers
ercise Therapy
s (UZ Brussel), Jo
erberg (UGent), Jric Duprez (UGen
Rommel (Vlaamse
school - Ecole du
development: Ann
sion of the sciehor the scientific
validation of theators did not co-
ecutive Board. ist. The policy re
an Vlayen (KCE)
Jan Bourgois (UGnt), Johan Mentene Liga tegen Kan
dos CHU Brugma
nemarie Coolbran
entific report. Tc report and did
e report results f-author the scien
ecommendations
Gent), n (UZ nker),
ann),
ndt
Their d not
from ntific
s are
Legal depot:
Copyright:
How to refer to
this document?
D/20
KCE http:/
HoldttreatmRepo
This
12/10.273/61
reports are publis//kce.fgov.be/cont
t Henningsen K, ment. Good Cliniort 185C. D/2012/
document is avai
shed under a “by/tent/about-copyrig
Desomer A, Hancal Practice (GCP/10.273/61.
lable on the webs
/nc/nd” Creative Cghts-for-kce-repor
nssens S, VlayenP). Brussels: Belg
site of the Belgian
Commons Licencets.
n J. Supportive trgian Health Care
Health Care Kno
e
reatment for cancKnowledge Cent
owledge Centre.
cer – Part 1: exetre (KCE). 2012.
ercise KCE
KCE Report 185
FORE
5C
EWORD The KCE recommendradiotherapcancer typeYet, other, importanceno reason interventionThe presensupportive tThese four in a transvecancer in th
Jean-PierreAssistant C
Exercise t
already publishdations are often py and surgery. Ofes.
more supportive for the well-beingat all, even on t
ns are proven to bnt report about etreatment for patiereports do not co
ersal way for all che most human an
e CLOSON Chief Executive Of
treatment for adult
hed many repolimited to diagno
f course, these ar
e interventions ag of the patient duhe contrary, to s
be effective, whenexercise treatmenents undergoing concern just one spcancer types. We nd tolerable way f
fficer
t cancer patients
rts with clinicalostic procedures re the intervention
are also frequenturing the very bur
show no interest , and for which cant introduces a scurative treatmentpecific cancer type
hope that they wfor their patient.
recommendatioand therapeutic
ns that are used to
tly used in daily rdensome treatmein these interven
ancer type. series of four ret for their cancer.e. They evaluate
will be a useful aid
ons about cancinterventions, suo stop or eradicat
practice, and apent for their cance
ntions. The quest
ports that evalua
the use of these d for all professio
Raf MChief E
cer. However, thch as chemotherte the tumour for m
ppear to be of her. Therefore, theion is which of th
ate different type
supportive treatmnals that fight aga
ERTENS Executive Officer
i
hese rapy, most
huge ere is hese
es of
ments ainst
ii
EXECCUTIVE SSUMMAR
Exercise t
RY
treatment for adult
ITpcmcstroCpgcgScinsw••
••Trecptyin
t cancer patients
NTRODUCThere is a wide bphysical activity iscancer patients dmedical needs, echemotherapy or specific recommerivial, since the deof the Belgian NatCollege of Oncoloprovides scientificguidelines. Until colorectal cancegastrointestinal caSince many guidecare, which are ofnto the question supportive care ofwill be covered: Exercise treat Treatment o
radiotherapy; Psychosocial Treatment of c
The present reporecommendations
chemo- and/or physiotherapy targype, e.g. lymphoen prostate cancer
CTION body of evidence beneficial for hea
deserve to get aspecially during tradiotherapy. Butndations in our cevelopment of gutional Cancer Planogy. KCE collaborc support in the
now guidelines er, testicular cancer and cervicalelines already nowften not cancer typand to develop af cancer patients
tment during chemf adverse even support; cancer-related part aims to formularelative to exerciradiotherapy fo
geted to specific edema in breast patients, are out
and a large conalth. Likewise, eveample support, inthe difficult periot, can we be morcancer guidelinesidelines is one of n 2008-2010 and rates with the Cojoint developmewere develope
cancer, pancre cancer (www.kcew cover different pe specific, it was
a separate series under treatment.
motherapy and/or nts related to
ain. ate, on the basis se treatment for aor cancer. Exesymptoms relate
cancer patients oof the scope of th
KCE Report 1
sensus in societyerybody will agreencluding for theirod when they undre precise and in
s? The question ithe main action pone of the tasks o
ollege of Oncologyent of clinical prad on breast caatic cancer, ue.fgov.be). aspects of supp
s decided to go deof four reports oThe following as
radiotherapy; chemotherapy a
of scientific evidadult patients receercise treatmened to a certain caor urinary incontinhe present report.
185C
y that e that r non dergo clude is not points of the y and actice ancer, upper
ortive eeper
on the spects
and/or
ence, eiving nt or ancer nence
KCE Report 185
METHODThe following reWhat is the effactive curative The following o1. Quality of
as FACT sSee text bo
2. CardiopulmVO2max, hwalk tests)
3. Fatigue (aPiper Fatigsubscales,
4. Safety of events).
Text box 1: Sc
FACT
WHOQOL-BRE
EQ-5D
SF-36
EORTC-C30
FACIT
5C
DS esearch question ffect of exercise ttreatment? utcomes are conslife (as measured
scales, WHOQOL-ox); monary function heart rate, Metabo; s measured by v
gue Scale, Brief FFACIT-F, Multidiexercise treatme
cales to mesure Q
Function
EF WHO qu
EuroQol
Short Fo
EuropeaTreatme
Function
was addressed intreatment for adu
sidered: d by validated sca-BREF, QOL EQ-
(as measured olic Equivalence o
validated scales Fatigue Inventory, mensional Fatigueent (i.e. frequenc
Quality of Life
nal Assessment of
uality of life assess
-5D instrument
orm Health Survey
an Organisationnt of Cancer- Qua
nal Assessment of
Exercise t
n this review: ult cancer patient
ales or instrumen-5D, SF-36, EORT
by absolute or of Task or 6 or 12
or instruments, FACT-F or FACT
e Inventory); cy and type of
f Cancer Therapy
sment instrument
y
n for Researcality of Life-C30
f Chronic Illness T
treatment for adult
ts during
nts, such TC-C30.
relative 2 minute
such as T fatigue
adverse
ch and
Therapy
AthtrwdincTanth•
•
Sdo(sSTsuGre
t cancer patients
Active treatment eherapy (for breareatment” period weeks post-surgediagnosis until 3 wntervention had continue after this The literature seaanalyses. Howeveno recent systemhose developed fo to analyse t
systematic rev to perform a
inclusion of alSystematic reviewdatabases: OVID of Systematic ReDARE) and Healt
searched in: OVSearches were runThe AMSTAR inssystematic reviewusing the CochraGRADE system wecommendations
encompassed radast or prostate was defined as t
ery, or one weeweeks after the lto begin within period.
arch initially focuer, after an evalua
matic review had or the present repthe individual RCviews, and full literature se
l relevant studiesws and meta-anaMedline and PreM
eviews, Databaseth Technology As
VID Medline, Prn between Decemstrument was ap
ws. Risk of bias fne Collaboration’
was used to assig.
diotherapy and chcancer) was e
the period from dk after the last ast chemotherapthe period defin
sed on systematation of the reviewused exactly the
port. ConsequentlyCTs from the r
arch for RCTs in. alyses were searMedline, EMBASEe of Abstracts ossessment (HTA) reMedline, EMBAmber 2011 and Fepplied for the crfor the included R’s tool for assess
gn the levels of ev
emotherapy. Horexcluded. The “adiagnosis until eit
radiotherapy or y, cycle. The exe
ned above, but
tic reviews and mws, it was obviouse same definitiony, it was decided: reference lists o
n order to ensur
rched in the folloE, Cochrane Dataof Reviews of E
database. RCTs ASE and CENT
ebruary 2012. itical appraisal oRCTs was determsing risk of biasvidence and grad
iii
mone active ther 3
from ercise could
meta-s that ns as
of the
e the
owing abase ffects were
TRAL.
of the mined . The
des of
iv
RESULTSEffectivenessA total of 33 Rbeing most copossible to comaerobic exercismuscle strengthcancer types deffectiveness otable below.
Safety In about half treatment was treatment seem
S s
RCTs were identifiommon (12 studimpare institution-bse (e.g. walkinghening). This comdue to a limited of exercise treatm
of the included available. From
ms to be safe in pa
ied with studies oies). For breast based with home, cycling) with r
mparison was not pnumber of trials.
ment are presente
studies, data onthese studies, w
atients undergoing
Exercise t
on breast cancer cancer it was t
e-based interventiresistance exercipossible for the re
The conclusionsed by cancer typ
n the safety of e conclude that g treatment for ca
treatment for adult
patients herefore ons and se (e.g.
emaining s on the pe in the
exercise exercise ncer.
t cancer patients KCE Report 1185C
KCE Report 185
Cancer type
Breast cancer
Prostate cance
Lung cancer
Colorectal can
Haematologica
Haematopoietictransplantation
Lymphoma
Acute myelogenleukemia
Mixed cancer p
5C
N
1
er 4
1
ncer 2
al cancers
c stem cell 4
1
nous 1
populations 8
N studies Con
2 •
•
•
•
4 •
•
2 •
•
4 ••
•
•
•
8 •
Exercise t
nclusions
Conflicting evidenof exercise treatresistance exerciConflicting evideevidence) Evidence suggesfunction (low leveConflicting eviden
Conflicting evidefatigue (very low
A combination ohave an effect on
The evidence su(very low level of There are indicat
Exercise treatmeConflicting evidelevel of evidence
It is plausible thaafter 6 months afIt is plausible th(moderate level o
Exercise treatme
Conflicting evidefatigue (very low
treatment for adult
nce (i.e. a mix ofment on quality se (very low level
ence on the effec
sts that aerobic eel of evidence) nce on the effect o
nce on the effeclevel of evidence)
f preoperative hon quality of life and
ggests that exercevidence)
tions that exercise
nt does not seemnce on the effect )
t exercise treatmefter the end of exehat exercise treatof evidence)
nt seems to have
nce on the effeclevel of evidence)
t cancer patients
studies reporting of life, regardlessl of evidence) ct of exercise tre
exercise is superi
of exercise treatm
ct of exercise trea)
ospital-based andd cardiopulmonary
cise treatment has
e treatment has no
m to have a significof exercise treat
ent has a significaercise treatment (mtment has a sign
a temporary effe
ct of exercise trea)
a positive effect s of it being inst
eatment on cardio
ior to resistance
ment on fatigue (ve
atment on quality
d postoperative hoy function (low lev
s no effect on qu
o effect on fatigue
cant effect on quatment on cardiopu
ant effect on qualimoderate level of nificant effect on
ct on fatigue (very
atment on quality
and studies with nitution- or home-
opulmonary funct
exercise in impro
ery low level of ev
y of life, cardiopu
ome-based exercvel of evidence)
uality of life or car
e (low level of evid
lity of life (very lowulmonary function
ity of life, althoughevidence) cardiopulmonary
y low level of evid
y of life, cardiopu
no effect) on the based, aerobic a
tion (very low lev
oving cardiopulmo
vidence)
ulmonary function
cise does not see
rdiopulmonary fun
dence)
w level of evidencn and fatigue (ver
h the effect disap
y function and fa
ence)
ulmonary function
v
effect and/or
vel of
onary
n and
em to
nction
ce) ry low
pears
atigue
n and
vi
CONCLUIn this study, wof exercise treaand/or radiotheFor most canceexcept for brmethodologicalheterogeneousdifferent treatmthese scales, th• For most
benefits cardiopulmreporting aexception patients, wincluded ou
• Neither didquality of lsymptoms.safe duringreported on
A generalizatiodue to the abostudies. Moreorecommendationews is that thharmful during c
SIONS we analysed the patment for adult crapy. er types, only a sreast cancer. M limitations. Mor, both in terms of
ment regimens), ahey report conflictcancer types, wof exercise t
monary function ana positive effect awas one single
which reported stautcomes. d we find consislife or cardiopulm. Furthermore, thg adjuvant therapyn exercise-related
on of the results aove-mentioned pover, the available
on in favour of a here is no reasoncancer treatment.
published RCTs ocancer patients u
small number of Most of these reover, the inclustudy populations
and in terms of oing results:
we found no contreatment, inclund fatigue; i.e. thnd of studies repstudy (of moderaatistically significa
stent evidence thmonary function, ohere was some ey for cancer patie
d adverse events. and conclusions opulation differene evidence did nparticular exercisn to fear that phy.
Exercise t
n the benefits anundergoing chemo
RCTs could be instudies suffere
uded studies wes (different canceroutcome scales.
nsistent evidence uding quality oere was a mix oforting no effect. Tate quality) in lymant positive result
hat exercise wouor would increaseevidence that exeents, although not
might not be app
nces across the ot allow us to ex
se intervention. Tysical exercise w
treatment for adult
d harms otherapy
ncluded, ed from ere very r stages, Across
on the of life, f studies The only mphoma ts on all
uld harm e fatigue ercise is all trials
propriate included xpress a he good
would be
t cancer patients KCE Report 1185C
KCE Report 185
RECO
a These rec
5C
OMMEND
commendations are
DATIONS
under the sole resp
Exercise t
Sa
Clinical rec• In the
treatmundergof a spthat pevideninto ac
• As thecance(weak
Agenda fo• Since
of quafor can
• For ouvalidatspecif
• For fuoutcom
ponsibility of the KC
treatment for adult
commendations absence of co
ment on quality going active treapecific type of ex
physical activity nce). Hence, it is ccount. ere is no consisr patients underrecommendatio
or the research cothere is a lack o
ality of life, cardioncer patients unutcomes such ated scales and tfic instrument to ture studies it isme measures ba
CE
t cancer patients
for the healthcaonsistent eviden
of life, cardiopatment, we cannxercise treatmenis beneficial foadvisable to tak
stent evidence er treatment, they n; very low level
ommunity of consistent andopulmonary funcdergoing active
as quality of lifehe research comrender the resul
s crucial to pre-dased on clinical s
are providers ce on the shortulmonary functiot formulate mo
nt, over and abovor health (weak ke the local conte
either that exercshould not be d
l of evidence).
d high-quality evction and fatiguetreatment, large
e and fatigue, remmunity should alts comparable.
define main outcosignificance.
t-term beneficiaion and fatigue re precise recomve the generally recommendatio
ext and the prefe
cise treatment wdiscouraged to d
idence on the efe) and on safety high-quality RC
esearchers shouagree on a gene
omes and the m
al effects of exefor cancer pat
mmendation in faaccepted couns
on; very low leverences of the pa
would be harmfudo physical activ
ffectiveness (in tof exercise treatTs are needed.
uld use standardric and on a dise
agnitude of effec
vii
ercise tients avour seling vel of atient
ul for vities.
terms tment
dized, ease-
ct for
KCE Report 185
TABL
5
LE OF COONTENTLIST LIST
122.1
2.22.32.42.52.62.72.833.13.244.1
4.2
Exercise t
TS OF TABLES ......OF ABBREVIAT
SCIENTIFIC INTRODUCTMETHODS ...SCOPING ....2.1.1 Meth2.1.2 ReseDEFINITIONSLITERATURESELECTION SELECTION QUALITY APGRADING OFFORMULATIOSEARCH RESYSTEMATICRANDOMIZEEVIDENCE RBREAST CAN4.1.1 Qua4.1.2 Card4.1.3 Fatig4.1.4 SafePROSTATE C4.2.1 Qua
treatment for adult
............................TIONS ...................REPORT .............ION .............................................................................
hodology ..............earch questions aS ..........................E SEARCH ..........CRITERIA ...........PROCESS ..........PRAISAL ............F EVIDENCE .......ON OF RECOMMSULTS ................C REVIEWS ........
ED CONTROLLEDREPORT ..............NCER ..................lity of Life .............
diopulmonary funcgue .......................ety ........................CANCER .............lity of Life .............
t cancer patients
............................
............................
............................
............................
............................
............................
............................and outcomes ..............................................................................................................................................................................
MENDATIONS .............................................................
D TRIALS ................................................................................................ction ....................................................................................................................................
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1
. 4
. 5
. 7
. 7
. 8
. 8
. 8
. 8
. 8
. 9
. 9 10 10 10 12 13 13 14 15 15 15 25 28 30 30 30
2
4.3
4.4
4.5
4.6
566.16.277.1
Exercise t
4.2.2 Card4.2.3 Fatig4.2.4 SafeLUNG CANC4.3.1 Qua4.3.2 Card4.3.3 Fatig4.3.4 SafeCOLORECTA4.4.1 Qua4.4.2 Card4.4.3 Fatig4.4.4 SafeHAEMATOLO4.5.1 Qua4.5.2 Card4.5.3 Fatig4.5.4 SafeMIXED CANC4.6.1 Qua4.6.2 Card4.6.3 Fatig4.6.4 SafeDISCUSSIONRECOMMENCLINICAL RERESEARCH AAPPENDICESAPPENDIX 1
treatment for adult
diopulmonary funcgue .......................ety ........................ER .......................lity of life ..............
diopulmonary funcgue .......................ety ........................AL CANCER ........lity of Life .............
diopulmonary funcgue .......................ety ........................OGICAL CANCERlity of life ..............
diopulmonary funcgue .......................ety ........................CER POPULATIOlity of life ..............
diopulmonary funcgue .......................ety ........................N...........................DATIONS ...........
ECOMMENDATIOAGENDA .............S..........................: QUALITY APPR
t cancer patients
ction ....................................................................................................................................ction ....................................................................................................................................ction ............................................................................
RS ....................................................ction ............................................................................
ONS..................................................ction ....................................................................................................................................
ONS .............................................................................
RAISAL INSTRUM
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KCE Report
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t 185
32 33 35 35 35 35 35 36 36 36 36 36 38 38 38 40 42 44 45 45 47 51 55 55 57 57 57 58 58
KCE Report 185
5
7.2
7.37.4
Exercise t
7.1.1 AMS7.1.2 CochAPPENDIX 27.2.1 Syst7.2.2 RandAPPENDIX 3APPENDIX 47.4.1 Brea7.4.2 Pros7.4.3 Lung7.4.4 Colo7.4.5 Haem7.4.6 MixeREFERENCE
treatment for adult
STAR ....................hrane Collaboratio: SEARCH SYNTtematic reviews ....domized controlle: GRADE PROFIL: EVIDENCE TAB
ast cancer ............state cancer .........g cancer ...............orectal cancer ......matological cance
ed cancers ...........ES ........................
t cancer patients
............................on’s tool for asses
TAX BY DATABAS............................
ed trials ................LES BY INTERVEBLES ...................................................................................................................................ers ...............................................................................
............................ssing risk of bias .SE ................................................................................
ENTION AND OU................................................................................................................................................................................................................................
............................
............................
............................
............................
............................TCOME ..............................................................................................................................................................................................................................................
.......................... 5
.......................... 6
.......................... 6
.......................... 6
.......................... 6
.......................... 7
.......................... 7
.......................... 7
.......................... 8
.......................... 9
.......................... 9
.......................... 9
........................ 10
........................ 11
3
58 60 62 62 65 70 74 74 88 93 94 96 06 17
4
LIST OF TTABLES TableTableTableTableTableTablein patTablein patTablein patTablein patTableand pTableTableTableTableTableTableTablehaemTablehaemTablecell trTableTableTable
Exercise t
e 1 – In- and exclue 2 – Levels of evie 3 – Down- or upe 4 – Strength of re 5 – Factors that e 6 – Effect of insttients with breast e 7 – Effect of homtients with breast e 8 – Effect of aertients with breast e 9 – Effect of resitients with breast e 10 – Effect of cophysical subscalese 11 – Effect of exe 12 – Effect of exe 13 – Effect of exe 14 – Effect of exe 15 – Effect of exe 16 – Effect of exe 17 – Effect of exmatopoietic stem ce 18 – Effect of exmatopoietic stem ce 19 – Effect of exransplantation .....e 20 – Effect of exe 21 – Effect of exe 22 – Effect of ex
treatment for adult
usion criteria ........idence according grading the eviderecommendationsinfluence the stre
titution-based execancer.................
me-based exercisecancer.................obic interventionscancer.................istance interventiocancer.................
ombined aerobic as of QOL in patien
xercise treatment xercise treatment xercise treatment xercise treatment xercise treatment xercise treatment xercise treatment cell transplantationxercise treatment cell transplantationxercise treatment ............................
xercise treatment xercise treatment xercise treatment
t cancer patients
............................to the GRADE sy
ence according to s according to the ength of a recommercise on quality of............................e on quality of life............................s on quality of life ............................ons on quality of l............................and resistance intents with breast caon cardiopulmonaon fatigue in patieon quality of life inon cardiopulmonaon fatigue in proson fatigue in patieon quality of life inn ..........................on cardiopulmonan ..........................on fatigue in patie............................on quality of life inon cardiopulmonaon fatigue in mixe
............................ystem ...................the GRADE systeGRADE system ..
mendation.............f life (QOL) and p............................
e (QOL) and physi............................(QOL) and physic............................ife (QOL) and phy............................erventions on quancer .....................ary function in patents with breast can prostate cancer ary function in prostate cancer patienents with colorectan patients undergo............................ary function in pat............................
ents undergoing h............................n mixed cancer poary function in mixed cancer populat
............................
............................em ...............................................................................
physical subscales............................ical subscales of Q............................cal subscales of Q............................ysical subscales o............................ality of life (QOL) ............................tients with breast cancer ..................patients..............
ostate cancer patients .......................al cancer .............oing ............................tients undergoing ............................
haematopoietic ste............................opulations ...........xed cancer populaions ....................
KCE Report
............................
.......................... 1
.......................... 1
.......................... 1
.......................... 1s of QOL .......................... 1QOL .......................... 1
QOL .......................... 2of QOL .......................... 2
.......................... 2cancer ............... 2.......................... 2.......................... 3ents ................... 3.......................... 3.......................... 3
.......................... 3 .......................... 4em .......................... 4.......................... 4ations ................. 4.......................... 5
t 185
. 9 11 11 12 12
16
18
21
23
24 26 29 31 32 34 37
39
41
43 46 49 52
KCE Report 185
LIST OF A
5
ABBREVIAATIONS
Exercise t
ABBREVIATION95%CI ADL ADT AMSTAR BFI bpm CG EORTC-QLQ-C3EQ-5D FACIT FACIT-F FACT FACT-AN FACT-B FACT-C FACT-F FACT-G FACT-GP FACT-P GRADE HR HSCT HTA IG ITT KCE LASA
treatment for adult
N DEFINITI95% confActivities AndrogenQuality aBrief FatiBeats peControl g
30 EuropeanEuroQol-FunctionaFunctionaFunctionaFunctionaFunctionaFunctionaFunctionaFunctionaFunctionaFunctionaGrading oHeart rateHaematoHealth teInterventiIntention Belgian HLinear An
t cancer patients
ION fidence interval of daily living
n depression therappraisal tool to asgue Inventory r minute
group n Organisation for-5D instrument al Assessment of al Assessment of al Assessment of al Assessment of al Assessment of al Assessment of al Assessment of al Assessment of al Assessment of al Assessment of of Recommendatie
opoietic stem cell tchnology assessmion group to treat
Healthcare Knowlenalogue Scales of
apy ssess systematic r
r Research and T
Chronic Illness TChronic Illness TCancer TherapyCancer Therapy Cancer Therapy Cancer Therapy Cancer Therapy Cancer Therapy Cancer Therapy Cancer Therapy ions Assessment,
transplantation ment
edge Centre f Assessment
reviews
reatment of Canc
herapy herapy-Fatigue
- Anemia scale - Breast Cancer - Colorectal Canc- Fatigue - General - General Populat- Prostate Cancer, Development an
er- Quality of Life
cer
tion r d Evaluation
5
-C30
6
Exercise t
MD MET min MOS NSCLC POMS QOL RCT SD SDS SF-36 SR STAI TOI-AN VAS VO2max WHOQOL-BREF
treatment for adult
Mean diffMetabolicMinutesMedical ONon-smaProfile of Quality ofRandomiStandardSymptomShort ForSystematSpielbergTrial OutcVisual anMaximal
F WHO qua
t cancer patients
ference c Equivalent of Ta
Outcome Study all cell lung cancerf Mood States f life zed controlled tria
d deviation m distress scale rm Health Surveytic review ger’s state-trait ancome Index-Anemnalogue scale Oxygen Consumpality of life assess
ask
r
al
nxiety inventory mia
ption sment instrument
KCE Reportt 185
KCE Report 185
SCIE
5
NTIFIC RREPORT
Exercise t
T
treatment for adult
1TBCpgcgSctocatosTrerecsinpTth
t cancer patients
1 INTRODThe development Belgian National College of Oncoloprovides scientifiguidelines. Up to cancer, colorectagastrointestinal caSince many canccare, which are ofo develop a sepacancer patients reaspects will be coo chemotherapy support, and treatmThe present reporecommendations eceiving active c
cancer. Exercise symptoms, e.g. ncontinence in ppresent report. This report is intenhe supportive car
DUCTION of care pathway
Cancer Plan 20ogy. KCE collaborc support in tthis date guidel
l cancer, testicuancer and cervicalcer-specific guideften not specific trate series of fou
eceiving active trevered by this seriand/or radiother
ment of cancer-rert aims to formularelative to exerc
urative treatmenttreatment or phylymphoedema in
prostate cancer p
nded to be used be of cancer patien
ys is one of the 08-2010 and onerates with the Cohe developmentines were jointly
ular cancer, panc cancer (www.kcelines also cover to a certain cancer reports on the seatment for their ies: treatment of arapy, exercise treelated pain. ate, on the basiscise treatment fort (chemo- and/or ysiotherapy for sn breast cancerpatients, are out
by health care pronts during active t
main items withie of the tasks o
ollege of Oncologyt of clinical pra developed on bcreatic cancer, ue.fgov.be). aspects of supp
er type, it was desupportive care of
cancer. The folloadverse events reeatment, psychos
of scientific evidr adult cancer paradiotherapy) for
specific cancer-rer patients or ur
of the scope o
ofessionals involvreatment.
7
n the of the y and actice breast upper
ortive cided adult
owing elated social
ence, tients
r their elated rinary
of the
ved in
8
2 METH2.1 Scopin2.1.1 MethoOn 8 Novembethe basis of a wresearch quespresented to aclinical practiceby the KCE in validated by the
2.1.2 ReseaFor exercise trbeing of primary• Which evid
during activThe reason forguidelines deveAdditionally, thduring the perireferred to as tthis period was of these RCTscollaboration wfocus on canceExercise treatmpsychosocial multidisciplinarypsychosocial su
ODS g
odology er 2011, a stakehweb-survey condutions and outco
an expert group ie. A final selectioncollaboration with
e experts via ema
arch questions areatment the folloy interest:
dence exists on eve curative treatmfocusing on the a
eloped by the KCEe experts expresod immediately fthe “rehabilitation found1. This revie
s measured outcoith the content exr patients during a
ment as part of asupport was cy programs will upport.
holder meeting toucted prior to the mmes related to in order to discun and prioritizationh a content experil.
and outcomes owing research q
xercise programsment? active treatment pE focus on this pessed an interest following treatmenn” period. One syew included four omes within the
xpert, it was conseactive treatment. a multidisciplinaryonsidered to bbe discussed in
Exercise t
ok place at the Kmeeting, a list of pexercise treatme
uss themes of intn of outcomes wart (Sophie Hansse
question was def
s for adult cancer
period is that moseriod.
in the effect of nt – a period som
ystematic review cRCTs. However, scope of our pro
equently decided
y program also ibe out-of-scope. n a separate re
treatment for adult
KCE. On potential ent was terest to as made ens) and
fined as
patients
st cancer
exercise metimes covering only two oject. In to solely
nvolving These
eport on
Tw•
•
•
•
2Dfrcaduwc(wthwpEsTmc
t cancer patients
The list of outcomwith the content ex Quality of Lif
EQ-5D, SF-36 Cardiopulmon
heart rate, ME Fatigue (Pipe
FACT fatigue or similar instr
Safety (expreintervention o
2.2 DefinitionDefinitions for the rom the literatureclose collaborationaligned with the cudefined as being funtil one week aftweeks after the cancer type or tincluding breast c
were not considerhe definitions dewithin the period dperiod. Exercise treatmensetting and measuThe results in chamixed cancer popcancer types.
mes to be studiedxpert and ranked fe (measured by 6, EORTC-C30, Fnary function (meaET or 6 or 12 minuer Fatigue Scalesubscales, FACIT
rument); essed as adverr relapse).
ns “active treatment
e, including a ren with the contenurrent Belgian conrom diagnosis unter the last radiatlast chemotheraptreatment form. cancer patients anred to be on activscribed above. T
defined and descr
nt included all exured by the defineapter 4 are descpulations contains
d was similarly daccording to impoFACT scales, W
FACIT scale or simasured by absoluute walk tests); e, Brief Fatigue T-F, Multidimensi
rse events relat
” phase were devcent Dutch syste
nt expert to ensurntext. The “active til 3 weeks post-stion treatment or py treatment. ThPatients being
nd patients on ADve treatment unleThe exercise inteibed above, but co
xercise interventiod outcomes.
cribed per cancers the RCTs with
KCE Report
efined in collaborortance: WHOQOL-BREF, milar instrument); ute or relative VO2
Inventory, FACTonal Fatigue Inve
ted to the exe
veloped with inspirematic review2 are our definitions treatment” period
surgery, from diagfrom diagnosis u
his was regardleon hormone the
DT for prostate cass they also fell w
ervention had to ould continue afte
ons performed in
r type. The sectioat least two diff
t 185
ration
QOL
2max,
-F or entory
rcise-
ration nd in were
d was gnosis until 3 ss of erapy
ancer) within begin er this
n any
on on ferent
KCE Report 185
2.3 LiteratuFor all researchmeta-analyses.systematic revisystematic revie• OVID Med• EMBASE (• Cochrane D• DARE (Wil• HTA datab• National GDepending on additional searcfollowing source• OVID Med• EMBASE (• CENTRAL Medline and EMwere run on 13run on 27 Febsearched on 2was run in 16 January 201
5
ure search h topics, the searc If guidelines weiew of the literatuew. The followingline and PreMedli(Embase.com) Database of Systeey)
base (Wiley) uideline Clearinghthe quality and
ch for randomizees were used: line and PreMedli(Embase.com) (Wiley)
MBASE searches 3 December 2011bruary 2012. The9 February 2012Medline on 12 2. Detailed searc
ch first focused ore identified that ure, they were in sources were usne
ematic Reviews (W
house. d currency of thed controlled trials
ne
for systematic re. The search in te National Guide
2. The search forJanuary 2012
ch strategies can b
Exercise t
n systematic reviewere clearly bas
ncluded and treated:
Wiley)
e identified revies (RCTs) was do
views and meta-ahe Cochrane Libreline Clearinghour primary studies
and in EMBAbe found in appen
treatment for adult
ews and sed on a ted as a
ews, an one. The
analyses rary was use was
(RCTs) ASE on ndix 2.
2T
T
Sc
P
InO
D
L
t cancer patients
2.4 SelectionThe selection crite
Table 1 – In- and
Selection criteria
In
Population Atrwtrrc
ntervention EOutcome Q
sDesign M
gLanguage E
criteria eria are summariz
exclusion criteri
nclusion criteria
Adult cancer patiereatment is defineweeks post-surgerreatment) or fromadiation treatmen
chemotherapy treaExercise-programsQuality of life, cardsafety Meta-analysis, sysguideline, HTA, RCEnglish, Dutch, Fr
ed in Table 1.
ia
a
nts during active ed as being from dry (regardless of c diagnosis until on
nt or from diagnosatment s performed in andiopulmonary func
stematic review, eCT ench
treatment. Active diagnosis until 3 cancer type and ne week of last is until 3 weeks o
ny setting ction, fatigue and
evidence-based
9
f last
10
2.5 SelectiFor the selectHenningsen) pDoubtful casesand consensusfirst selection, tBefore assessinappraisal was appraisal were:• Searched i• Data of sea• Quality ap
looking at tReviews not meAfter a review ono recent systewas completelConsequently, primary studiesperform an addinclusion of all rto that of systeabstract (AD), abstracts (AD), Doubtful cases
on process tion of systematperformed a firsts were discussed was achieved withe full-text of the ng the methodolo
performed of e n Medline and at arch mentioned ppraisal of includthe quality of appreeting these criterof the finally selecematic review hadly comparable tit was decided t
s from the refereditional literature relevant studies. Tematic reviews. Ta second selectiowhich was also dwere discussed w
ic reviews, one t selection based with a second rth a third revieweselected abstractsgical quality of ea
each full-text. Th
least one other d
ded primary studraisal and the useria were excludedcted systematic re defined the studyto the definitionto select relevantnce lists of the ssearch for RCT
The selection proThe first selectionon was based ondiscussed with thewith the third revie
Exercise t
reviewer (Kirsted on title and areviewer (Anja Dr (Joan Vlayen). As was retrieved.
ach review, a quice criteria of the
atabase
dies performed ed tool) d from further revieeviews it was evidy population in a w used for this t and potentially systematic reviews in order to enscess of RCTs wa
n was based on n the full-text of se second revieweewer (JV).
treatment for adult
en Holdt abstract. esomer)
After this
ck critical e critical
(not yet
ew. dent that way that
review. relevant
w and to sure the s similar title and selected r (KHH).
2Fwk••
•
Fait‘uCreowaina
2DteFincw
t cancer patients
2.6 Quality apFor the quality apwas used (see apkey for labelling a Item 3: Was a Item 7: Was t
documented? Item 9: Were
appropriate?For the quality apassessing risk of tem includes threunclear risk of biaCochrane Handboegarding detectio
outcomes (e.g. suwas labelled as loaccording to the cndividual study, tappendix 4).
2.7 Grading oData extraction wemplate for evideFor each clinical ndividual treatmeconclusion using twas down- or upgr
ppraisal ppraisal of systemppendix 1). Three
review as high qua comprehensive lhe scientific quali
? e the methods us
ppraisal of RCTsbias3 was used
ee categories: ‘lowas’. For each criteook3 were used. on bias and attribjective and objeow risk of bias, ucriteria described the risk of bias is
of evidence was done by onnce tables (see aquestion, conclu
nt outcomes. A lethe GRADE systeraded based on p
matic reviews, theitems of this che
uality: literature search pty of the included
sed to combine t
, the Cochrane C(see appendix 1w risk of bias’, ‘herion the definitioIf applicable, risktion bias were active outcomes). Aunclear risk of bia
in the Cochrane s reported in the
ne reviewer usinppendix 4).
usions were formevel of evidence em4 (Table 2). T
predefined criteria
KCE Report
e AMSTAR instruecklist were consid
performed? studies assessed
the findings of st
Collaboration’s to). Judgement of high risk of bias’ns as described ik of bias for the assessed per claAt the end, each as or high risk ofHandbook3. For
evidence tables
ng the standard
mulated at the levwas assigned to he quality of evid(Table 3).
t 185
ument dered
d and
tudies
ol for each , and in the items
ass of study f bias each (see
KCE
vel of each
dence
KCE Report 185
Table 2 – Leve
Quality level High
Moderate
Low
Very low
Table 3 – DowStudy designRCT
Observational
5
els of evidence ac
Definition We are very conestimate of the We are moderalikely to be closthat it is substanOur confidence substantially difWe have very lilikely to be subs
n- or upgrading QualityHigh Modera
study Low Very lo
ccording to the G
nfident that the trueffect
ately confident in te to the estimate ntially different in the effect estim
fferent from the esttle confidence in stantially different
the evidence accy of evidence
ate
ow
Exercise t
GRADE system
ue effect lies close
he effect estimateof the effect, but t
mate is limited: thestimate of the effethe effect estimatfrom the estimate
cording to the GLower if Risk of bias: -1 Serious -2 Very serious Inconsistency: -1 Serious -2 Very serious Indirectness: -1 Serious -2 Very serious Imprecision: -1 Serious -2 Very serious Publication bias:-1 Likely -2 Very likely
treatment for adult
e to that of the
e: the true effect isthere is a possibil
e true effect may bect te: the true effect e of the effect
RADE system Higher if Large effect: +1 Large +2 Very large Dose respons+1 Evidence o All plausible co+1 Would redu+1 Would sugg
t cancer patients
MethodologRCTs withouobservationa
s ity
RCTs with imflaws, indirecobservationa
be RCTs with veseries is
e: of a gradient
onfounding: uce a demonstrategest a spurious ef
gical quality of suut important limitaal studies mportant limitationct, or imprecise) oal studies
ery important limit
ed effect ffect when results
upporting evidentions or overwhel
ns (inconsistent reor exceptionally st
tations or observa
s show no effect
nce ming evidence fro
esults, methodologtrong evidence fro
ational studies or c
11
om
gical om
case
12
2.8 FormulBased on the rewas prepared btogether with th2 weeks prior toccasion (22 Mchanged if imdiscussion meegrade of recomthe GRADE symore circulated
Table 4 – Strsystem
Grade Defin
Strong The dunde
Weak The dunde
lation of recometrieved evidenceby a small workinhe evidence tableto the face-to-fac
May 2012) to discuportant evidenceetings a second dmmendation was ystem (Table 4 ad to the guideline d
rength of recom
nition
desirable effects oesirable effects, or
desirable effects oesirable effects, or
mmendations e, a first draft of ung group (KH, ADs was circulated t
ce meeting. The euss the first draft.e supported this draft of recommen
assigned to eacnd Table 5). Thedevelopment grou
mmendations acc
of an intervention r clearly do not
of an intervention r probably do not
Exercise t
pdated recommenD, SH, JV). This fto the expert grouexpert group met. Recommendatio
change. Based ndations was preph recommendatioe second draft wup for final approv
cording to the
clearly outweigh
probably outweig
treatment for adult
ndations first draft up about t on one ons were
on the pared. A on using
was once val.
GRADE
the
gh the
T
F
Bdue
Qe
Vp
Ca
t cancer patients
Table 5 – Factors
Factor
Balance betweendesirable and undesirable effects
Quality of evidence
Values and preferences
Costs (resource allocation)
s that influence t
Comment
n The larger theundesirable estrong recommthe gradient, trecommendat
The higher thelikelihood that
The more valugreater the unthe higher therecommendat
The higher thegreater the relikelihood that
he strength of a
e difference betweffects, the higher mendation is warrthe higher the liketion is warranted
e quality of evident a strong recomm
ues and preferencncertainty in valuee likelihood that a tion is warranted
e costs of an intersources consumet a strong recomm
KCE Report
recommendatio
een the desirable the likelihood tha
ranted. The narrowelihood that a wea
nce, the higher themendation is warra
ces vary, or the es and preferenceweak
rvention – that is, ed – the lower themendation is warra
t 185
n
and t a wer
ak
e anted
es,
the e anted
KCE Report 185
3 SEARC3.1 SystemThe searches y
Database Cochrane DataMedline PreMedline EMBASE DARE HTA databaseNational GuideAfter a review ofull-text review.papers fulfilled systematic reviecomprised a cConsequently ireference lists search on priminclusion of all r
5
CH RESULmatic reviews yielded the followin
abase of System
eline Clearinghoof title and abstra Based on the futhe inclusion cri
ews it became evcomparably defint was decided toof the systemat
mary studies durirelevant studies.
LTS
ng number of hits
matic Reviews
use ct (2 931 hits) 68
ull-text (and the qteria1,2,5-25. After
vident that no recened study populo select relevant tic reviews and tng the full period
Exercise t
per database:
Number of hits89
1 68523
1 0666161
papers were seleuick critical appraa review of the
ent systematic revation for this gprimary studies fto perform an add in order to ens
treatment for adult
9536
6
ected for aisal) 24 selected
view fully uideline. from the dditional sure the
t cancer patients 13
14
3.2 RandoThe search for 44 primary studThe additional fulfilled the incselected for the
Database CENTRAL Medline PreMedline EMBASE
mized controlleprimary studies t
dies of which 25 fusearch for primaclusion criteria.
e report26-59.
ed trials hrough the refereulfilled inclusion crry studies revealeThus, in total 3
Exercise t
ence lists initially rriteria. ed 67 studies of
33 primary studie
Number of hits132191
22 088
treatment for adult
revealed
which 8 es were
2
28
t cancer patients KCE Reportt 185
KCE Report 185
4 EVIDE4.1 Breast A total of 12 stour predefined 242, with a meintensity seatedexercise progra
4.1.1 Qualit
4.1.1.1 InstFive RCTs repinterventions44,4
remaining had measurement sWHOQOL-BREEstimates of thephysical subscaTwo small studoverall QOL. Oand the other found no signifiOne small stud(p<0.001, WHOeffect on physsubscale45.
5
ENCE REPOcancer
tudies on breast coutcomes were
ean of 92 womed exercise prograams at targeted he
ty of Life
titution-based inported quality of 45,49,53,56. One stuan either moderascales varied an
EF and SF-36 withe effect of institutiales of QOL differdies reported a
One study found tstudy at 12 weecant effect on ovedy found a positiOQOL-BREF subsical subscales44,5
ORT
cancer patients aincluded. Samplen. Interventions am48 to progresseart rate or maxim
terventions life (QOL) measuudy had a low ate44,45,49,53,56 or hd included FACT
h some studies usion-based exercisred widely across positive effect ofthe effect at 5 weeks (FACT-G)44. erall QOL at any mve effect on a pscale “physical”)49
53,56. One study d
Exercise t
assessing one or e size ranged froranged from a mive aerobic or re
mal repetitions45.
ures for institutiorisk of bias53, w
high risk of bias44
T-G, FACT-B, FAsing more than onse on quality of lifethe studies (Table
f supervised exereeks (WHOQOL-The three larger
measure point45,53
hysical subscale 9. Three studies fdid not report a
treatment for adult
more of om 22 to moderate
sistance
on-based while the
,49. QOL ACT-AN, e scale. e and on e 6). rcise on BREF)49 r studies 3,56.
of QOL found no physical
C•
•
t cancer patients
Conclusions Conflicting e
exercise treapatients (ver2007, Mutrie
Conflicting eexercise treabreast cance2005, Hwang
evidence is availaatment on overry low level of e2007, Hwang 200
evidence is availaatment on physer patients (ver
g 2008, Mutrie 200
able on the effecrall quality of lievidence; Camp08, Segal 2001).able on the effecsical subscales ry low level of 07, Segal 2001).
ct of institution-bife in breast ca
pbell 2005, Cour
ct of institution-bof quality of lievidence; Cam
15
based ancer rneya
based fe in
mpbell
16
Table 6 – Effec
Study N
Courneya 200745
N=
Mutrie 200753
N=
Segal 200156
N=
Hwang 200849
N=
Campbell 200544
N=
* Data on the 83
ct of institution-b
Overall
=242 No effec(measurfor any ointerventest (meand at 6
=203 No effecany meaEffect foweeks (months
=123* No effecFACT-B
=40 PositiveWHOQO
=22 Positive(p=0.46)No effec
women receiving ch
based exercise o
QOL
ct on overall QOLred by FACT-AN) of the two
ntion arms at post-edian 17 weeks) 6-months follow-up
ct for FAGT-G at asure point or FACT-B at 12 p=0.0007) and 6 (p=0.039)
ct for FACT-G andB
effect for OL-BREF (p<0.00
effect FACT-G ) ct for FACT-B
hemotherapy are re
Exercise t
on quality of life (
Physical su
-
p
No physical reporting
No effect for “Physical” (Fmeasure poi
d No effect for functioning” institution-bafor patients rchemotherapoutcome)
01)Positive effe(WHOQOL-B“physical”)
No effect for being” subsc
eported.
treatment for adult
(QOL) and physi
bscale
subscale
subscale FACT-G) at any nt
“physical (SF-36) in
ased study arm receiving py (primary
ct, p<0.001 BREF subscale
“physical well-cale (FACT-B)
t cancer patients
cal subscales of
Measure point
Baseline Post-test (med17 weeks) 6-months followup
Baseline 12 weeks 6 months (folloup)
Baseline 26 weeks
Baseline 5 weeks
Baseline 12 weeks
f QOL in patients
t(s) Interventio
ian
w-
RET (resistrepetitions amaximum AET (aerobergometer, VO2max Control groasked not to
w-
45 min of mweekly + anControl gro
Supervisedexercise at 2 other weeTwo controdirected execare i.e. ge
Exercise 3 xaerobic exeadjusted maControl grocould contin
Supervisedadjusted heControl gro
s with breast can
on characteristics
tance arm): 3 x weat 60-70% of one
bic arm): 3 x weektreadmill or ellipti
up received usuao initiate exercise
moderate level gron additional exercup received usua
arm: exercise 3 xprescribed pace)
ekdays l groups, one grouercise and one grneral advice
x weekly for 50 mercise). Heart rateaximum up performed shonue their normal a
exercise 2 x weeeart rate maximumup received usua
KCE Report
ncer
s
eekly 2 sets of repetition
kly on cycle cal at 60% of
l care and were e program
oup exercise 2 x cise session at homl care
x weekly (walking + exercise at hom
up performed selfroup received usu
min (stretching and: 50-70% of age
oulder exercises aactivities
ekly at 60-75% agm l care
t 185
me
me
f-al
d
and
e
KCE Report 185
4.1.1.2 HomSix RCTs (inclhome-based inlimitations. Foustudies had a h5D, EORTC Cstudies using mEstimates of thsubscales of QOOne study founlinear growth rquadratic growtOne 3-arm stusupervised inte(FACT-B, FACThome-based intOne study founat 3 months (pmonths (p=0.02Three studies measures for Qmeasured as le48 and one studstudy it was noon the SF-36 su
5
me-based intervuding a total of 4nterventions43,47,48
ur studies had ahigh risk of bias48,5
C30, FACT-G, FAmore than one scahe effect of homeOL differed acrossnd a positive effecrate difference bth rate difference udy compared a ervention or usualT-G), but an effetervention arm annd a positive effecp=0.006) and on 2). Neither of theshad an unclear
QOL43,48,51. One ofess decline in ovedy suggested no eot possible to asseubscale “Physical
ventions 453 patients) rep8,51,56,58. All studa moderate risk 58. QOL measuremACT-B, SF-36 a
ale. e-based exercise s the studies (Tabct on overall QOLbetween groups between groups (home-based exel care and found ect on SF-36 “phnd not in the supect on generic heaEORTC C30 “ph
se effects remaineor limited reportif these studies su
erall QOL (p=0.02effect for exerciseess whether there Functioning“ or n
Exercise t
ported QOL measdies had method
of bias43,47,51,56 ament scales includand FACIT-F wit
on QOL and on ble 7). L (FACT-G), meas(t70=3.76, p<0.0(t70=2.64, p=0.01ercise interventionno effect on over
hysical functioningervised interventioalth-related QOL hysical functionin
ed after 6-months4
ing of group comuggested a positiv254) in the exercise on overall QOL43
e was a suggestenot51.
treatment for adult
sures for dological and two ded EQ-th some
physical
sured as 01) and 1)58.
n with a rall QOL g” in the on arm56. (EQ-5D)
ng” at 3-47. mparison ve effect se group 3. In one ed effect
C•
•
t cancer patients
Conclusions Conflicting e
exercise treapatients (verHeadley 2004
Conflicting eexercise treabreast canceHaines 2010,
evidence is avaatment on overry low level of ev4, Segal 2001, Waevidence is avaatment on physer patients (very Headley 2004, M
ailable on the efrall quality of lividence; Cadmuang 2011).
ailable on the efsical subscales low level of evid
Mock 2005, Sega
ffect of home-bife of breast ca
us 2009, Haines 2
ffect of home-bof quality of li
dence; Cadmus 2l 2001).
17
based ancer 2010,
based fe of 2009,
18
Table 7 – Effec
Study N
Segal 200156
N=
Mock 200551
N=
Haines 201047
N=
ct of home-based
Overall Q
=123* No effectFACT-B
=119 No repor
=89 Positive ehealth-re5D) at 3 No effect(EQ-5D)
d exercise on qu
QOL
t for FACT-G and
rting of overall QO
effect on generic elated QOL (EQ-months (p=0.006)t on generic QOLat 6 months
Exercise t
uality of life (QOL
Physical sub
Effect on SF-functioning” (patient receivchemotherapoutcome)
OL Unclear repocomparison m36 “Physical subscale)
)
Positive effecC30 physicalsubscale (p=months No effect on physical funcat 6-months
treatment for adult
L) and physical s
bscale
-36 “Physical (p=0.03) for ving py (primary
orting of group measures (SF-Functioning”
ct on EORTC l functioning
=0.02) at 3-
EORTC C30 ctioning subscale
t cancer patients
subscales of QOL
Measure point
Baseline 26 weeks
Baseline After interventioIntervention lendependent on leadjuvant therapweeks of radiot3-6 months of chemotherapy)
Baseline, 3, 6 amonths follow-u
L in patients with
t Inte
SelfweeprogTwosuprece
on ngth was ength of py (either 6 therapy or
Pre50-7with30 mConmaiPos39%28%
and 12-up
HommobprogexeConandPar3 m
h breast cancer
ervention charac
f-directed arm: Exekly performing a gram o control groups: opervised exercise eived usual care i
escription to exerc70% of maximumh 15 minutes walkmin as training prontrol group was enintain usual activitssible dilution of tr% of usual care gr% of the exercise g
me-based strengtbility and cardiovagram; recommend
ercises harder eventrol group participd flexibility activitierticipant adherenc
months than in the
KCE Report
cteristics
xercise at home 5progressive walk
one group performand one group .e. general advice
ise 5-6 x weekly a heart rate, startin
k that increased toogressed ncouraged to ty level reatment effect asroup exercised angroup did not
h, balance, shouldascular enduranceded to make ery 2-4 weeks pated in relaxationes ce higher in the firs
second 3 months
t 185
x ing
med
e
at ng o
s nd
der e
n
st s
KCE Report 185
Wang 201158
N=
Cadmus 200943
N=
Headley 200448
N=
* Data on the 83 **Results provide*** Only data from**** The mean debin/discuss/msg.c
5
=72 FACT-G the 2 grodifferent rate (t70=and quad(t70 = 2.6
=50*** Unclear r(FACT-Bgroup comeasureAuthors ssignifican
=32 StatisticsendpointOverall Qdeclined Exercise slower ragroup (p=graphicaresults)
women receiving ched in text and graphm IMPACT study arecrease of -1.5 poincgi?msg=1592).
change between oups significantly at linear growth =3.76, p <0.001) dratic growth rate 64, p=0.011)**
reporting of QOL B and FACT-G)
mparison s suggest no nce
s between s not provided
QOL (FACIT-F) for both groups group declining a
ate than control =0.0254, only l presentation of
hemotherapy are rehs only. re retrieved. nts in the exercise g
Exercise t
No reporting subscales
Unclear repocomparison mSF-36 subscAuthors sugg(p<0.05) favogroup****
at
Insufficient dStatistics betnot providedPhysical wellsubscale): exdeclining at athan control, graphical preresults)
eported.
roup did not reach c
treatment for adult
of physical
orting of group measures on ale “physical” gest significance ouring usual care
ata reporting tween endpoints
l-being (FACIT-F xercise group a slower rate (p=0.0252, only
esentation of
clinical significance
t cancer patients
4 measure poinsurgery baselin24 hours prior tof chemotherapday of expectedwhich is 7-10 dchemotherapy and end of 6-weintervention (tim
Baseline 6 months
Baseline At the beginnincourse of chemfor 12 weeks (afour measurem
(information retriev
nts; Pre-ne (time 1), to first day py (time 2), d nadir, ays after (time 3) eeks
me 4)
6-w3 to
Lowhea60%
Con
30 mInstof ppartConbut to th64%exe
g of each motherapy a total of
ments)
30 musinProinteConexeany
ved from http://www
weeks, home-baseo 5 sessions per w
w to moderate inteart rate maximum %
ntrol group receive
min of activity 5 dtructed to maintainpredicted maximumticipant received wntrol group could ethe study program
hese patients % of participants mercising 150 min p
min of seated exeng a commercially
ogram consisted oensity repetitive mntrol group receiveercises but were py usual physical ac
w.sf-36.org/cgi-
ed, walking prograweek
ensity measured b(HR max) from 40
ed usual care
ays weekly. n activity at 60-80m heart rate. Eacweekly phone callexercise if they chm was not availab
met the goal of per week
ercise 3 x weekly y available video of 20 min moderateotion exercise ed no specific
permitted to continctivity
19
am,
by a 0 to
0% h ls hose ble
e-
nue
20
4.1.1.3 AerNine RCTs rinterventions43-4
remaining had aQOL measureWHOQOL-BREone scale. Estimates of thesubscales of QO
Overall qualityTwo studies foOne of these stas linear growtgrowth rate d(N=40) found aBREF (p<0.001One small studoverall QOL melarger study (N(p=0.0007) andTwo studies fouby FACT-AN anTwo other studmeasures for Qmeasured as lesuggested no e
robic interventionreported quality 45,48,49,51,53,56,58. Onan either moderatement scales inEF, FACIT-F and
e effect of aerobicOL differed widely
y of life ound a positive etudies (N=72) fouth rate difference ifference betweea positive effect 1)49. dy (N=22) found easured by FACTN=203) found a d 6 months (p=0.0und no effect of and (FACT-G + FAies had an unclea
QOL43,48. One of ess decline in QOeffect for exercise
ns of life (QOL)
ne study had a lote43,45,51,56 or high ncluded FACT-GSF-36 with some
c exercise on quay across the studi
ffect of aerobic end a positive effebetween groups
en groups (p=0.0on overall QOL
a positive effecT-G (p=0.46), but
positive effect fo39) and no effect
aerobic exercise oACT-B), respectivear or limited reporthese studies su
OL in the exercison overall QOL43
Exercise t
measures for w risk of bias53, wrisk of bias44,48,49,
G, FACT-B, FAe studies using mo
lity of life and on pes (Table 8).
exercise on overact for FACT-G, m(p<0.001) and q
011)58. The othemeasured by WH
t of aerobic exeno effect for FACor FACT-B at 12for FACT-G53.
on overall QOL mely45,56. rting of group comggested a positiv
se group48 and on.
treatment for adult
aerobic while the 58.
ACT-AN, ore than
physical
all QOL. measured quadratic er study HOQOL-
rcise on CT-B44. A 2 weeks
measured
mparison ve effect ne study
POmO(bTbTmpoSwOm
t cancer patients
Physical subscalOne small study (Nmeasured by WHOOne study found SF-36) for patien
but not for patientsTwo studies did nby “physical” (FACTwo studies had measures for physpositive effect on other study suggeSF-36 subscale “pwhether there wasOne study did nmeasure45.
le of quality of lifN=40) found a poOQOL-BREF subsan effect of aero
nts in a self-direcs in a supervised not find an effect CT-GP)53 and by “
an unclear or lsical QOL subscaphysical well-bei
ested an effect (p<physical”. In anoths a suggested effeot include a phy
fe ositive effect of aescale physical (p<obic exercise on
cted (home-based(institution-basedfor physical QOLphysical well-beinlimited reporting ales. One of thesng (FACIT-F sub<0.05) in favour oher study it was nect or not51. ysical QOL subs
KCE Report
robic exercise on<0.001)49.
“physical functiod) study arm (p=0) study arm56.
L subscales, measng” (FACT-B)44.
of group compae studies sugges
bscale; p=0.0252)of the control grounot possible to as
scale as an out
t 185
QOL
oning” 0.03),
sured
arison sted a . The up on ssess
come
KCE Report 185
Table 8 – Effec
Study NCourneya 200745
N=
Mutrie 200753
N=
Mock 200551
N=
Segal 200156
N=
Wang 201158
N=
5
ct of aerobic inte
Overall =242 No effec
measure
=203 No effecmeasureEffect fo(p=0.000(p=0.039
=119 No repor
=123* No effecFACT-B
=72 FACT-G2 groupsat linear
erventions on qu
QOL ct (FACT-AN) at ae point
ct for FAGT-G at ae point r FACT-B at 12 w07) and 6 months 9) rting of overall QO
ct for FACT-G and
change betweens significantly diffegrowth rate (t70=
Exercise t
ality of life (QOL
Physical ny No physic
any
weeks
No effect G) at any
OL Unclear r36 “Physisubscale measures
d No effect functionininstitutionpatients rchemothePositive e“Physicalfor patienreceiving
the erent =3.76,
No reportsubscales
treatment for adult
L) and physical s
subscale cal subscale repo
for Physical (FACy measure point
reporting of MOS Sical Functioning” group compariso
s
for “physical ng” (SF-36) in n-based study armreceiving erapy effect on SF-36 functioning” (p=0
nt in self-directed achemotherapy
ting of physical s
t cancer patients
ubscales of QOL
Measure prting Baseline
Post-test (weeks) 6-months
CT- Baseline 12 weeks6 months
SF-
n
Baseline After intervInterventiodependenadjuvant th6 weeks oor 3-6 monchemothe
m for
0.03) arm
Baseline a
4 measuresurgery ba1), 24 hou
L in patients with
point
(median 17
follow-up
A
(follow-up)
vention on length was t on length of herapy (either
of radiotherapy nths of rapy) and 26 weeks
e points; Pre-aseline (time rs prior to first
h breast cancer
Intervention chaAET (aerobic armcycle ergometer, beginning at 60%
See Table 6
See Table 7
Supervised arm: e(walking exercise+ expected to exeother weekdays Self-directed arm5 x weekly. Particprogressive walki60% of maximal oControl group recgeneral advice See Table 7
aracteristics m): 3 x weekly on
treadmill or elliptic% of VO2max
exercise 3 x weeke at prescribed pacercise at home 2
: Exercise at homcipants performedng program at 50
oxygen uptake ceived usual care
21
cal
kly ce)
me a
0-
i.e.
22
Study N
Cadmus 200943
N=
Hwang 200849
N=
Headley 200448
N=
Campbell 200544
N=
* Data on the 83 ** Results provide*** Only data from**** The mean debin/discuss/msg.c
Overall p<0.001rate (t70
=50*** Unclear (FACT-BcomparisAuthors significa
=40 Positive BREF (p
=32 Statisticsnot provOverall Qdecline fExerciseslower ra(p=0.025presenta
=22 Positive (p=0.46)No effec
women receiving ched in text and graphm IMPACT study arecrease of -1.5 poincgi?msg=1592)
QOL ) and quadratic gr
0=2.64, p=0.011)**
reporting of QOLB and FACT-G) grson measures. suggest no nce
effect for WHOQOp<0.001)
s between endpoiided QOL (FACIT-F) for both groups e group declining aate than control g54, only graphical ation of results)
effect FACT-G ) ct for FACT-B hemotherapy are rehs only. re retrieved. nts in the exercise g
Exercise t
Physical rowth *.
roup Unclear rcomparis36 subscaAuthors s(p<0.05) fgroup****
OL- Positive e(WHOQO“physical”
nts
at roup
InsufficienStatistics not providPhysical wsubscale)declining control (pgraphicalresults) No effect being” su
eported.
roup did not reach c
treatment for adult
subscale
reporting of group on measures on Sale “physical”
suggest significanfavoring usual car
* effect, p<0.001 OL-BREF subscale”) nt data reporting. between endpoin
ded well-being (FACIT): Exercise group at a slower rate t
p=0.0252, only presentation of
for “physical wellbscale (FACT-B)
clinical significance
t cancer patients
Measure pday of che(time 2), dexpected n7-10 days chemotheand end ointerventio
SF-
ce re
Baseline 6 months
e Baseline 5 weeks
nts
T-F
han
Baseline At the begcourse of cfor 12 weefour meas
- Baseline 12 weeks
(information retriev
point emotherapy ay of nadir, which is after
rapy (time 3) f 6-weeks
on (time 4)
ginning of each chemotherapy eks (a total of urements)
ved from http://www
Intervention cha
See Table 7
See Table 6
See Table 7
See Table 6
w.sf-36.org/cgi-
KCE Report
aracteristics
t 185
KCE Report 185
Conclusions • Conflicting
on overallof evidenHeadley 22001,Wang
• Conflictingon physic(very lowCourneya2001, Mutr
4.1.1.4 ResOne three-arme(FACT-AN) for observed no eintervention or reported45.
Table 9 – Effec
Study
Courneya 200745
5
g evidence is av quality of life fo
nce; Cadmus 202004, Hwang 2g, 2011). g evidence is aval subscales of
w level of evide2007, Headley
rie 2007).
sistance intervened RCT, with a mr a resistance exeffect on overal
at 6-months fol
ct of resistance i
N O
N=242 Npwfo
vailable on the efor breast cancer 009, Campbell
2008, Mock 200
vailable on the efquality of life forence; Cadmus 2004, Hwang 2
ntions moderate risk of bxercise interventiol QOL for resisllow-up. No phys
nterventions on
Overall QOL
No effect (FACT-Apost-test (median weeks) or at 6-moollow-up
Exercise t
ffect of aerobic epatients (very lo2005, Courneya
05, Mutrie 2007
ffect of aerobic er breast cancer p2009, Campbel
008, Mock 2005
ias, reported overon (Table 9). Thtance exercise asical QOL subsc
quality of life (Q
Phys
AN) at 17
onths
No p
treatment for adult
exercise ow level a 2007, 7 Segal
exercise patients ll 2005, 5, Segal
rall QOL he study at post-ale was
QOL) and physica
sical subscale
hysical subscale
t cancer patients
al subscales of Q
Meas
reporting BaselPost-tweeks6-mon
QOL in patients w
sure point
line test (median 17 s) nths follow-up
with breast cance
Intervention c
RET (resistancsets of repetitioestimated one Control group and were askeexercise progra
er
characteristics
ce arm): 3 x weekons at 60-70% of repetition maximureceived usual ca
ed not to initiate am
23
kly,
um are
24
Conclusion • Very little
overall quevidence;
4.1.1.5 ComOne RCT, with resistance exeoverall effect osubscale “physpersist at the 6
Table 10 – Effecancer
Study
Haines 201047
evidence existsality of life for bCourneya 2007)
mbined aerobic a moderate risk
ercise interventionn QOL (EQ-5D) a
sical functioning” months assessm
ect of combined
N O
N=89 Ph5N(
s on the effect obreast cancer pa.
and resistance eof bias, deployedn (Table 10). That 3 months (p=0at 3 months (p=ent47.
aerobic and res
Overall QOL
Positive effect on ghealth-related QO5D) at 3 months (pNo effect on geneEQ-5D) at 6 mont
Exercise t
f resistance traiatients (very low
exercise intervend a combined aerohe authors obse.006) and on the 0.02). The effect
sistance interven
Phys
generic L (EQ-p=0.006) ric QOL ths
Positphys(p=0No ephysat 6-m
treatment for adult
ning on level of
ntions obic and rved an EORTC
t did not
ntions on quality
sical subscale
tive effect on EORical functioning su.02) at 3-monthsffect on EORTC Cical functioning sumonths
t cancer patients
y of life (QOL) an
Meas
RTC C30 ubscale
C30 ubscale
Baselmonth
nd physical subs
sure point
line, 3 and 6 hs
scales of QOL in
Intervention c
See Table 2
KCE Report
n patients with b
characteristics
t 185
breast
KCE Report 185
Conclusion • Very little
and resistsubscaleslevel of ev
4.1.2 CardioFour RCTs repVO2max, heart institution-basepatients undermoderate risk VO2max measurelative VO2maxand maximum the 12-minute wEstimates of thefunction differedFour RCTs repcapacity measucancer patientreported an efexercise compap=0.004; VO2 mexercise compa0.01-0.18], p=0Similarly, one measured by thhad covered a the usual care gRCT found no Vcontrol or for aonly patients un
5
evidence existstance exercise
s of quality of lifvidence; Haines 2
opulmonary funcported changes rate [HR] or aerobd or home-basedrgoing adjuvant of bias45,56 and
ures included abx (ml/kg/min)45,56. HR (beats/min)50
walk test55. e effect of exercisd across the studi
ported changes inured by a walk tes undergoing adffect on both abared with usual caml/kg/min: MD 1.8ared with resistan0.035; VO2 ml/kg/RCT found an ehe 12-minute walgreater distance
group (p=0.002 foVO2 effect for a sea supervised interndergoing adjuvan
s on the effect intervention on fe for breast ca2010).
ction in cardiopulmonabic capacity measd exercise intervetherapy. Two otwo studies had
bsolute VO2max (Heart rates were
. One RCT meas
se interventions onies (Table 11).
n VO2max, heart rest after exercisedjuvant therapy. bsolute and relatare (VO2 l/min: MD8 [95%CI 0.5-3.2], nce exercise (VO/min: MD 1.6 [95%effect for an aerolk test. After 6 min the test than t
or difference betwelf-directed intervervention arm comnt therapy were co
Exercise t
of a combined quality of life
ncer patients (v
ary function (chasured by a walk teentions for breastof these studies a high risk of (ml/min or l/min)4
e measured as ressured aerobic cap
n cardiopulmonary
rate measures ore interventions fo
One three-armetive VO2max for D 0.13 [95%CI 0.0
p=0.006) and forO2 l/min: MD 0.09 %CI 0.3-2.9), p=0
obic exercise inteonths the exercisthe resistance gro
ween groups)55. Oention arm compa
mpared with contronsidered56.
treatment for adult
aerobic and on
very low
anges in est) after t cancer
had a bias50,55. 45,50 and sting HR pacity by
y
r aerobic or breast ed RCT
aerobic 04-0.22], r aerobic
[95%CI 0.014)45.
ervention se group oup and ne other
ared with rol when
SV
C•
•
t cancer patients
Similarly, one smaVO2max or heart r
Conclusions Conflicting e
on cardiopulbreast cance2007, Segal 2
Evidence sugexercise in im(low level of
all RCT (N=41) foate measures afte
evidence exists omonary functioner patients (ver2001, Schwartz 2ggests that aeromproving aerobevidence; Courn
ound no significaner an exercise inte
on the effect of en (VO2max, heartry low level of 2007, Kim 2006).bic exercise is sic capacity in br
neya 2007, Schw
nt group differencervention50.
exercise intervet rate or walk tesevidence; Cour
superior to resistreast cancer patartz 2007).
25
ce for
ntion st) for rneya
tance tients
26
Table 11 – EffeStudy N
Courneya 200745
N
Segal 200156
N
ect of exercise trN Absolu
(ml/mi
N=242 Effect fexercisusual cin l/minMD 0.10.04-0 Effect fexercisresistameasuunadju(95%Cp=0.03 No efferesistaversus
N=123* Not rep
reatment on cardute VO2max n or l/min)
for aerobic se versus care measured n; unadjusted 13 (95%CI .22, p=0.004)
for aerobic se versus ance exercise ured in l/min; usted MD 0.09 CI 0.01-0.18, 35)
ect for ance exercise s usual care ported
Exercise t
diopulmonary funRelative VO2max(ml/kg/min)
Effect for aerobicexercise versus ucare; unadjusted (95%CI 0.5-3.2, p=0.006) Effect for aerobicexercise versus resistance exerciunadjusted MD 1(95%CI 0.3-2.9, p=0.014)
No effect for self-directed interventarm compared wcontrol* No effect for supeintervention arm compared with co
treatment for adult
nction in patientsx Other
cardiofunctiomeasu
c usual MD 1.8
c
ise; .6
Not rep
-tion
with
ervised
ontrol*
Not rep
t cancer patients
s with breast can
pulmonary on ures
Me
ported BaPo17 6-m
ported Ba26
ncer easure point
seline st-test (median weeks)
months follow-up
seline weeks
Intervention c
See Table 6
See Table 8
KCE Report
characteristics
t 185
KCE Report 185
Schwartz 200755
N
Kim 200650 N
* Data on the 83 ** The p-value re*** 11 of 74 randothrombophlebetisof these 33 wome**** Only interven
5
N=66 Not rep
N=41*** No sigdifferen(ml/min
women receiving cheflects the significanomized women withs (n=2), non-exercisen participated or pntion group showed
ported
nificant group nce in VO2max n)****
hemotherapy are rent difference betweehdrew from the studse related injuries (nartly participated in
d significant positive
Exercise t
Not reported
Not reported
eported. n the three groups.
dy for reasons includn=1) or death (n=1).
the exercise intervechanges in VO2 pe
treatment for adult
After 6 aerobicgroup hcoveredistanc-minute(p=0.02
No signgroup dresting maximurate (beats/
ding personal proble Another 22 womenention. Study reportak and resting HR o
t cancer patients
months the c exercise had d greater
ce on the 12 e walk test 2)**
Ba
6 minte
nificant difference in or
um heart
/min)****
Ba8 winte
ems (n=2), problemn did not complete ets on 41 women. over time but measu
seline
months (post-ervention)
seline weeks (post-ervention)
s at home (n=2), preither pre- or post-in
ures did not reach s
Aerobic arm: hinstructed to cactivity they enor jogging) and30 min four da
Resistance armexercise at howeek using Thband and tubinwere instructedusual activities
Institution baseindividually preexercise 3 dayIntensity correof individuals hControl group including genebenefits of exe
roblems related to cntervention exercise
significance in group
home-based, hoose an aerobicnjoyed (e.g. walkind exercise for 15-ays per week
m: instructed to me four days per
hera-Band resistanng. Control group d to continue withs
ed, supervised anescribed aerobic ys weekly for 30 msponding to 60-70heart rate reservereceived usual ca
eral information onercise
chemotherapy (n=3)e tests. It is unclear
p difference.
27
c ng
nce
h
nd
min 0%
e are n
, if any
28
4.1.3 FatiguEight RCTs onoutcome measuremaining hadFatigue measuMulti-dimensionF, FACIT-F subSix of the studdeployed a comother RCT waresistance trainwere institution-Estimates of thstudies and didinstitution- or hexercise type cStudies are sumreporting, suggpatients. One control group hdecrease in fatifatigue level ((p<0.05)49. Onegroup had lessgroup (p=0.007aerobic, home-F at two out ochemotherapy days after cheobserved (p<0.point 4) the stud
ue n exercise treatmures on fatigue. O an either modrement scales vanal fatigue inventobscale “Fatigue”, Bdies were on aembined aerobic as a three-arm st
ning intervention a-based44,45,49,53 ane effect of exercis not seem to be dome-based. Neithchosen for the trimmarized in Tablgested an effect
aerobic and inshad an increase igue and that ther(measured by Be small home-bass decline in fatig78), measured bybased RCT found
of three measure (measure point 2
emotherapy (mea001) and, similardy suggested an e
ment for breast cOne study had a lo
erate45,47,51 or hried and includedory, FACT-AN suBrief Fatigue Inverobic interventionnd resistance exetudy with an aer
arm and a control nd four were homese treatment on fadependent on wheher did the resultsial (aerobic, resise 7. Two RCTs, bof exercise on f
stitution-based stin fatigue, that thre was a significa
Brief Fatigue Invesed study sugges
gue over time coy the FACIT-F sd an effect on fati
points: 24 hours2) no effect was oasure point 3) aly, at the end of teffect on fatigue (
Exercise t
cancer patients ow risk of bias53, wigh risk of bias4
d the Piper Fatiguubscale “Fatigue”,ntory and FACT-Fns44,48,49,51,53,58. Oercise interventionrobic interventiongroup45. Four of t
e-based47,48,51,58.atigue differed acether the intervens seem to depend
stance or a combboth with insufficifatigue for breasttudy suggested the exercise grou
ant difference in thentory) between sted that the inte
ompared with theubscale “Fatiguegue measured bys prior to the firsobserved for fatigun effect for fatigthe intervention (mp<0.001).
treatment for adult
reported while the 44,48,49,58. e Scale, FACIT-
F. ne RCT n47. One arm, a the trials
cross the tion was d on the
bination). ent data t cancer that the p had a he mean
groups ervention e control ”48. One
y FACIT-st day of ue, 7-10 gue was measure
Fpbaa
C•
•
•
t cancer patients
Five RCTs foundpatients44,45,47,51,53.based44,45,53 and haerobic interventioan intervention wit
Conclusions Conflicting e
fatigue for bMutrie 2007, 2005, Headle
The evidencewas superiorversa.
The evidencsuperior to re
d no effect of e. These RCTs home-based interons44,51,53, aerobicth both aerobic an
evidence exists obreast cancer pa
Courneya 2007ey 2004, Hwang 2e did not indicatr to home-based
ce did not indicesistance exerci
exercise on fatigwere a combi
rventions47,51, andc versus resistannd resistance elem
on the effect of eatients (very low, Mock 2005, Ha
2008, Wang 2011te whether institd exercise in red
cate whether aese in reducing fa
KCE Report
ue for breast caination of institud additionally a mce interventions45
ments combined47
exercise treatmew level of evideaines 2010, Cam).
tution-based exeducing fatigue or
erobic exercise atigue or vice ve
t 185
ancer ution-
mix of 5 and
7.
nt on ence;
mpbell
ercise r vice
was rsa.
KCE Report 185
Table 12 – Effe
Study
Courneya 2007
Mutrie 200753
Mock 200551
Haines 201047
Wang, 201158
Hwang 200849
Headley 20044
5
ect of exercise tr
N F
745 N=242 N“(
N=203 N(
N=119 Np
N=89 NFt“
N=72 FStp
N=40 IgddF
8 N=32 Ip
reatment on fatig
Fatigue
No effect for fa“Fatigue”) for any(median 17 weeks
No effect for fati(post-intervention)
No effect for fatigpost-intervention*
No effect for any mFatigue was measthat includes sca“reduced activity”,FACIT-F: Significant differenthe “nadir”, (time 3program (time 4: p
nsufficient data isgroup had a incredecrease in fatigdifference in theFatigue Inventory)nsufficient data rprovided
Exercise t
gue in patients w
atigue (measuredy of the two intes) and at 6-month
igue (measured ) and at 6-months
gue (measured b
measures of fatigusured by “Multidimles on “general f “reduced motivat
nces between the3: p<.001) and at p<.001)**
s provided. Figurease in fatigue, tha
gue and that thee mean fatigue ) between groupsreporting. Statisti
treatment for adult
with breast cance
d by FACT-AN ervention arms ats follow-up
by FACT-F) at s follow-up
by Piper Fatigue
ue at 3 and 6 monmensional fatigue fatigue”, “physication” and mental f
e 2 groups detectthe end of the
e suggests that that the exercise groere was a signiflevel (measured (p<0.05) cs between endp
t cancer patients
er
Meas
subscale t post-test
BasePost-6-mo
12 weeks Base12 w6 mo
Scale) at BaseAfterIntervlengtweekof ch
nths inventory”
al fatigue”, fatigue”
Base3 mo6 mo
ed only at 4 baseday oexpeafter 6-we
he control oup had a ficance in
by Brief
Base5 we
points not BaseAt th
sure point
eline -test (median 17 wonths follow-up eline
weeks onths (follow-up) eline r intervention vention length wath of adjuvant thks of radiotherapemotherapy)
eline onths onths
measure pointeline (time 1), 24 hof chemotherapy
ected nadir, whicchemotherapy (ti
eeks intervention (eline eks
eline he beginning of
weeks)
as dependent on herapy (either 6 y or 3-6 months
ts; Pre-surgery hours prior to first
(time 2), day of ch is 7-10 days me 3) and end of
(time 4)
each course of
Intervention characteristics
See Table 6
See Table 6
See Table 7
See Table 7
f
f
See Table 7
See Table 6
fSee Table 7
29
s
30
Campbell 2005
* Possible dilution** Results provide
4.1.4 SafetyAdverse eventscancer patientsobserved duringreporting of advof the included
Conclusion • There is
treatment Hwang 200
4.2 ProstatA total of four sof our predefine121 with a memoderate intenprogressive aeand maximal re
4.2.1 QualitThree RCTs recancer patientsmoderate risk measurement sFACT-P with so
Gfm
544 N=22 N
n of treatment effeced in text and graph
y s were reported is. All five RCTs rg the trial43,45,48,49
verse events44, 50,
studies.
evidence that e(low level of ev
08, Mutrie 2007,
te Cancer studies on prostaed outcomes wereean of 66 men. nsity, continuous robic or resistanc
epetitions57.
ty of Life ported QOL meass undergoing adj
of bias46,57 andscales varied andome studies using
Graph suggests tfatigue over timemeasured by FACNo effect for fatigu
ct as 39% of usual chs only.
n five of the 12 Rreported that no a,53.The remaining,51,55,56,58. Relapse
exercise is safevidence; CourneHaines 2010).
ate cancer patiente included. SampInterventions ranwalking exercise
ce exercise progra
sures for exercisejuvant therapy46,5
d one study a d included SF-36,g more than one s
Exercise t
that intervention e compared with CIT-F subscale “Faue measured by P
care group exercised
RCTs included oadverse events h
six RCTs did note was not reporte
e during breast eya 2007, Headle
ts assessing one ple size ranged froged from a hom59 to an institutioam at targeted he
e interventions in 52,57. Two studies
high bias risk5
, QLQ-C30, FACTscale.
treatment for adult
group had less control group (p
atigue” Piper Fatigue Sca
d and 28% of the ex
n breast ad been t include d in any
cancer ey 2004,
or more om 21 to
me-based on-based eart rate
prostate s had a 52. QOL T-G and
EQOoc2foOa(oOeQop
C•
•
t cancer patients
decline in p=0.0078),
chemfour m
le Base12 w
xercise group did no
Estimates of the eQOL differed acrosOne three-armed of aerobic exerciscancer patients57. 24 weeks (p=0.01or neither resistaOne other RCT wian effect for exep=0.022) 46. Fina
overall QOL, measOne RCT suggeexercise on SF-36QLQ-C30 “physicaon FACT-P “physiphysical subscale
Conclusions Conflicting e
quality of lievidence; Se
Conflicting ephysical sub(very low lev
motherapy for 12 measurements)
eline weeks
ot.
ffect of exercise oss the studies (TaRCT suggested a
se on overall QOThis effect was
5). The same stuance nor aerobic ith a combined reercise on QOLally, one RCT fosured by FACT-P
ested an effect 6 “physical healthal”46. One RCT sucal well-being” (pmeasures 57.
evidence exists ofe in prostate
egal 2009, Galvaoevidence exists obscales of quality
el of evidence; G
weeks (a total of
on QOL and on phable 13). an effect of resist
OL (measured byfound both at 12dy did not find anexercise when m
esistance and aeromeasured by Sund an effect fo(p=0.006)52. of combined ae
h composite” (p=0uggested an effec
p<0.001). One RC
on the effect of ecancer patients
o 2010, Monga 20on the effect of exy of life in prostaGalvao 2010, Mon
KCE Report
f
See Table 6
hysical subscales
tance exercise buy FACT-G) in pro weeks (p=0.017
n effect on overallmeasured by FACobic intervention fF-36 “general her aerobic exercis
erobic and resis0.02), but no effect for aerobic exe
CT did not include
exercise treatmes (very low lev007). xercise treatmen
ate cancer patiennga 2007).
t 185
of
ut not ostate ) and QOL CT-P. found ealth” se on
tance ect on ercise QOL
nt on el of
nt on nts
S
S2
G2
M2
KCE Report 185
Table 13 – Effe
Study N
Segal 200957
N=12
Galvao 201046
N=57
Monga 200752
N=2
* 37.9% of exerci** Results provide
5
ect of exercise tr
QOL
21 Positive effecare at 12-wG; MD 4.76Positive effecare at 24-wFACT-G; MNo effect fomeasured bNo effect foany measur
7* Positive effemeasured b(95%CI 1.9
1 Positive effemeasured bp=0.006
ise group and 39.3%ed in text only.
reatment on qual
ect of resistance iweeks (midpoint) 6 (95%CI 0.86-8.6ect of resistance iweeks (post-interv
MD 4.34 (95%CI 0or aerobic intervenby FACT-G at anyor FACT-P in anyre point
ect for exercise vsby SF-36 “genera
9-23.9), p=0.022
ect for exercise vsby FACT-P; MD 1
% of control group w
Exercise t
lity of life in pros
intervention vs. usmeasured by FAC
65), p=0.017 intervention vs. usvention) measured.88-7.80), p=0.01ntion vs. usual cary measure point y intervention arm
s. usual care l health”; MD 12.9
s. usual care 3.8 (SD ±10.1),
were on radiation be
treatment for adult
state cancer pati
Physical s
sual CT-
sual d by 5 re
m at
Not reporte
9 Positive effexercise veusual care measured “physical hcomposite”(95%CI 0.8p=0.02 No effect foC30 “physi(p=0.062)*
Positive effFACT-P “pwell-being”(SD ± 2.0),
efore trial. 27.6% of
t cancer patients
ents
subscale Meas
ed BaseMidpoweekPost-(24 w
fect for ersus
by SF-36 health ”; MD 5.0 81-9.2),
or QLQ-ical” *
BasePost-(12 w
fect for physical ”; MD 3.6 , p<0.001
BasePost-week
f exercise group and
sure point(s) I
line oint (12
ks) intervention
weeks)
RerrA3t5Ut
line intervention
weeks)
ICaTm8C
line intervention (8
ks)
SwaaC
d 21.4% of control g
Intervention cha
Resistance exerciexercising 3 x perrepetitions at 60-7repetition) Aerobic training g3 x per week on atreadmill, or ellipti50-60% of VO2 peUsual care group to initiate exercise
Institution-basedCombined progresaerobic exercise 2The aerobic compmin of cardiovasc85% maximum heControl group: usu
Supervised aerobweekly for 8 weekaerobic exercise (at targeted heart rControl group: sta
group were on radia
racteristics
ise training group r week (2 x 8-12 70% of 1 maximum
roup (AET) exerca cyclo-ergometercal trainer beginn
eak (UC); UC was as
e
ssive resistance a2 x weekly for 12 wponent included 1cular exercise at 6eart rate ual care
bic exercise prograks consisting of 40(walking on a trearate andard care
tion during trial.
31
(RET)
m
cising ,
ning at
ked not
and weeks. 5-20 5% to
am 3 x 0 min admill)
32
4.2.2 CardioThree RCTS refunction measucancer patientstwo had a high VO2max measumetabolic equivheart rate as rperformed a moEstimates of tfunction differed
Table 14 – Effe
Study
Segal 200957
Windsor 20045
Monga 200752
*No significant di
opulmonary funceported changes ured by a walk tes. One of these stbias risk52,59.
ures included relavalents (MET 3.5 resting HR and eodified shuttle testthe effect of exd across the studi
ect of exercise tr
N N=121
59 N=66
N=21
ifference between g
ction in VO2max, heartst after exercise tudies had a mod
ative VO2max (mlml O2·kg−1·min−1
exercise HR (beat pre- and post int
xercise interventioies (Table 14).
reatment on card
CardiopulmonPositive effect ointervention ver(post-interventioVO2max: MD 1p=0.041 No effect of theversus usual caNo effect of exeNo effect of exerate Significant diffeshuttle-test distintervention (p=
Effect of exercisfunction measuO2·kg−1·min−1p=0.006
groups were observe
Exercise t
t rate or cardiopuinterventions for
derate risk of bias
/kg/min)57 and re)52. One study m
ats/min) and, addtervention59. ons on cardiopu
diopulmonary fun
ary function of the resistance rsus usual care aton) measured by .5 (95%CI 0.06-3.
e aerobic interventare (p=0.052) ercise on resting hercise on exercise
erence between grtance at the end o=0.0025)*
se on cardiopulmored by MET (MET
1) ; MD 2.8 (SD ±1
ed at baseline.
treatment for adult
ulmonary prostate
s57, while
spective measured ditionally,
ulmonary
Oc0eoeHc
C•
nction in prostat
Mea
t 24-weeks relative .0),
tion
BasePostwee
heart rate e heart
roups in of
BasePostwee
onary T=3.5 ml 1.8),
BasePostwee
t cancer patients
One three-armed Rcardiopulmonary f0.06-3.0; p=0.041)exercise57. One oton MET (mean 2.8effect of exercise oHowever, the samcovered in a shuttl
Conclusion Conflicting e
cardiopulmolevel of evide
te cancer patient
asure point eline t-intervention(24 ks)
eline t-intervention (4 ks)
eline t-intervention (8 ks)
RCT observed anfunction in men wi). The same studyther RCT observe8; SD ± 1.8; p=0.0on neither resting
me study did obserle-test post-interv
evidence exists onary function inence; Segal 2009
ts
Intervention See Table 13
Home-basedwalking 3 dayradiotherapy.rate Control groupactivities but fatigue See Table 13
n effect for resistanith prostate cancey did not find an ed an effect after a
006)52. Finally, onenor exercise hea
rve a between-groention (p=0.0025)
on the effect of en prostate cance9, Windsor 2004,
characteristics3
, moderate-intensys weekly for 30 m Heart rate 60-70
p were not discouwere advised to r
3
KCE Report
nce exercise on er (MD 1.5; 95%Ceffect for aerobic an aerobic intervee RCT observed nrt rate measures.
oup effect on dista)59.
exercise treatmeer patients (veryMonga 2007).
sity, continuous min during % of maximum he
raged to perform rest if they becam
t 185
I
ntion no
ance
nt on y low
eart
e
KCE Report 185
4.2.3 FatiguFour RCTs repocancer patientsmoderate risk Fatigue measuInventory (BFI)subscale “fatiguEstimates of the(Table 15). One three-arme(MD 4.64, 95%95%CI 0.87-7.measured by Fresistance exer24 weeks (MDpositive effect opositive effect wthe other studySD ± 2.1, p<0.any measure po
5
ue orted fatigue meas undergoing adjuof bias46,57 and rement scales va, revised Piper Fue”. e effect of exercis
ed RCT observedCI 1.47-7.80, p=035, p=0 .010) oACT-F after 12 wrcise maintained aD 4.78, 95%CI:1of exercise treatmwas measured by y the effect was m001)52. One RCToint (Brief Fatigue
asures for exerciseuvant therapy46,52
two studies hadaried and includeatigue Scale (PF
se on fatigue differ
d a positive effect 0.004) and resistan fatigue in me
weeks (mid-point)5
a significant effec.77-7.78, p=0.00
ment on fatigue. InQLQ-C30 subsca
measured by PipeT found no effect e Inventory)59.
Exercise t
e interventions in 2,57,59. Two studie a high risk of
ed FACT-F, Brief S-revised) and Q
red across the stu
for both aerobic ence exercise (me
en with prostate 57. In the same stuct after the interve02). Two RCTs n one of these stuale “fatigue” (p=0.r Fatigue Scale (Mof exercise on fa
treatment for adult
prostate es had a bias52,59. Fatigue
QLQ-C30
udies
exercise ean 4.11,
cancer, udy only
ention, at found a
udies the .21)46. In MD -4.3, atigue at
C•
t cancer patients
Conclusion Conflicting e
fatigue in prSegal 2009, W
evidence exists orostate cancer pWindsor 2004, Ga
on the effect of epatients (very loalvao 2010, Mon
exercise treatmeow level of evide
ga 2007).
33
nt on ence;
34
Table 15 – EffeStudy N
Segal 200957
N
Windsor 200459
N
Galvao 201046
N
Monga 200752
N
* 37.9% of exerci** Results provide
ect of exercise trN Fatigue
N=121 Positive (midpoinPositive intervenPositive (midpoinNo effecinterven
N=66 No effec
N=57* Positive
N=21 Positive
ise group and 39.3%ed in text only.
reatment on fatige
effect of the resisnt) measured by F effect of the resistion) measured by effect of the aeront) measured by Fct of the aerobic intion)
ct of exercise on B
effect on QLQ-C
effect of exercise
% of control group w
Exercise t
gue in prostate c
stance interventioFACT-F; MD 4.11 stance interventioy FACT-F; MD 4.7
obic intervention vFACT-F; MD 4.64ntervention versus
Brief Fatigue Inven
30 subscale “fatig
e on Piper Fatigue
were on radiation be
treatment for adult
ancer patients
n versus usual ca(95%CI 0.87-7.35n versus usual ca78 (95%CI 1.77-7
versus usual care , (95%CI 1.47-7.8s usual care at 24
ntory at any meas
gue”, p=0.21**
e Scale : MD -4.3
efore trial. 27.6% of
t cancer patients
are at 12-weeks 5), p=0.010 are at 24-weeks (p7.78), p=0.002 at 12-weeks
80), p=0.004 4-weeks (post-
sure point
(SD ± 2.1), p<0.0
f exercise group and
Measure
post-
Baseline12 weeks 24 weeks interventio
BaselinePost-interv4 weeks aradiotheraBaselinePost-intervweeks)
001 BaselinePost-interv
d 21.4% of control g
point
(midpoint) (post-
on)
vention (week 4)after ended apy (week 8)
vention (12
vention (8 weeks)
group were on radia
KCE Report
Intervention characteristicSee Table 13
See Table 14
See Table 13
) See Table 13
tion during trial.
t 185
cs
KCE Report 185
4.2.4 SafetyAdverse eventscancer patientparticipants exdeemed serioureported that noThe remaining Relapse was no
Conclusion • Limited ev
cancer pa2010).
4.3 Lung cThe evidence overy limited. Twsame single RC
4.3.1 QualitArbane et al.2(NSCLC) underpreoperative howas continued was measured measured preohad a moderateThere were no preoperative asbased programintervention grcomponents of between the twin exercise grocomponent: MDhealth: MD 6.5 time.
5
y s were reported ints. One of thesxperienced adverss (i.e. resulting ino adverse eventstwo RCTs did no
ot reported in any
vidence exists atients (very low
ancer on the effects of exwo systematic revCT27. No additiona
ty of life 27 included 53 prgoing lung resectospital-based exeafter discharge iusing the EORT
operatively and afte risk of bias. significant chang
ssessment and tm) and no significroup (p-values the questionnaire
wo groups (functionup vs. 2.7 [95%C
D -2.5 [95%CI -7.8[95%CI -7.7 to 2
n two of the four Rse RCTs (N=12se events relaten hospitalization had occurred duot include reportiny of the included st
on the safety ow level of eviden
xercise treatmentviews10, 23 were idal RCTs were foun
patients with nontion. The exerciseercise (strength ain a 12-week homTC-QLQ-C30 queter the 12-week h
ges in overall QOhe assessment acant differences not provided).
e no significant dnal component: MCI -4.7 to 10.0] in8 to 2.9] vs. -3.2 [20.7] vs. 2.2 [95%
Exercise t
RCTs included on 21) reported thaed to exercise; oor disability)57. O
uring testing or exng of adverse evetudies.
of exercise in pce; Segal 2009,
in lung cancer padentified that inclund.
n-small cell lunge intervention consand mobility trainime-based progra
estionnaire, and whome program. Th
L over time (betwafter the 12-weekbetween the conAlso, for the
ifferences could bMD 2.0 [95%CI -5.n control group; s95%CI -8.3 to 2.1
%CI -5.2 to 9.6]) a
treatment for adult
prostate at three one was
One RCT xercise46. ents52,59.
prostate Galvao
atients is uded the
cancer sisted of ing) and m. QOL
was only he study
ween the k home-
ntrol and different
be found 5 to 9.3]
symptom ]; global
and over
Indb
C•
4Incindgincp
C•
4Fre
t cancer patients
n the absence distinguish the pobased program.
Conclusions A combinatio
home-based of life in pati2011).
4.3.2 Cardiopun the same studycapacity and meantervention and cday postoperativegroup returned tontervention groupcapacity was foupostoperatively).
Conclusions A combinatio
home-based capacity in Arbane 2011)
4.3.3 FatigueFatigue is one of eported separatel
of an assessmeossible effects of
on of preoperatiexercise does nents with lung c
ulmonary functioy27 cardiopulmonaasured with the control group a sely (p<0.05). At o the preoperatip a slightly (non-nd (from 466.6m
on of preoperatiexercise does npatients with lu).
the subdomains ly by Arbane et al
ent at dischargef the hospital-bas
ve hospital-basenot seem to havecancer (low level
on ary function was six minute walk
ignificant decline 12 weeks postoive level of aer-significant) incre
m at baseline to
ve hospital-basenot seem to haveung cancer (low
of the EORTC-Q.27.
e it is impossibsed versus the h
ed and postopere an effect on qu of evidence; Ar
expressed by aeking test. In bothwas found at the
operatively the coobic capacity. In
eased level of ae480.2m at 12 w
ed and postopere an effect on aew level of evide
QLQ-C30, but wa
35
ble to home-
rative uality rbane
erobic h the e fifth ontrol n the erobic weeks
rative robic ence;
as not
36
4.3.4 SafetyTwo a priorichanges reportrequiring additiodependency cacomplications iexercise interve
Conclusions • The evide
cancer pat
4.4 Colorec4.4.1 QualitOnly one study QOL in colorepatients with cogroup (n=33). Aa considerable (67.7% in the cit is unclear hbaseline. The eexercise progexercises. QOLhigh risk of biasNo differences were there diffeanalysis compa(measured at performance stdecreased treaa significant d(p=0.038) and Tcould indicate QOL.
y defined postope
ted by radiologistonal ventilator suare) were reportin the control grention. Relapse w
ence suggests thtients (low level
ctal cancer ty of Life was found report
ectal cancer patieolorectal cancer tAll patients underwamount was pote
control group vs. 6how many patienexercise intervenram with indiv
L was measured s. in QOL were fou
erences in changearing a group of pa
baseline and ptatus) and a grodmill time showeddifference at poTrial outcome indean association b
erative complicatt as pneumonia, pport and or neceted in the activeroup, but these
was not reported in
hat exercise treaof evidence; Arb
ting on the effectsents. Courneya to an exercise growent surgery with
entially receiving c63.9% in the internts actually weretion consisted of
vidualized cardiousing the FACT-C
und between bothe in QOL over timarticipants with anost-intervention tup of participantd no significant diost-intervention aex (p=0.044). The
between change
Exercise t
tions (defined arespiratory compessitating a returne group comparewere not related
n the study.
atment is safe fbane 2011).
s of exercise treatet al.32 randomizoup (n=69) and a
hin the past 3 monchemotherapy at irvention group). He on active treatf a 16-week homovascular and fC scale. The stud
h groups at baseme. However, an n increased treadto indicate the ts with an unchafferences at base
assessment for ese significant diffin fitness and ch
treatment for adult
s X-ray plications n to high ed to 3 d to the
for lung
tment on zed 102 a control nths and nclusion
However, tment at
me-based flexibility dy had a
line, nor ancillary mill time physical
anged or eline, but FACT-C ferences hange in
C•
4CcTtrusrainb
C•
4TcpgeoFpbAggs
t cancer patients
Conclusions The evidenc
cancer patieevidence; Co
4.4.2 CardiopuCourneya et al.32
cardiopulmonary fTest) in colorectareadmill until 70%until voluntarily indseconds to reach ate was found ntervention assesbpm [95%CI 3.2 to
Conclusions The evidenc
cancer patienlow level of e
4.4.3 FatigueTwo RCTs evaluatcolorectal cancer ppatients with colorgroup (n=59). All pelective abdominaof a mix of aerobicFatigue was measpostoperatively onbias. At baseline alreadgroups was foundgroup 2.7 cm [95%score of the cont
ce suggests thants has no effec
ourneya 2003).
ulmonary functioalso reported on
function (measural cancer patients% of the age-preddicated by the parthis maximum. Nbetween the cossment (differenco -8.6], p=0.361).
ce suggests thants has no effecevidence; Courne
ted the effect of epatients (Table 16rectal cancer to anpatients were ageal colorectal surgec and strength traisured preoperativen a visual analogu
dy a significant did (intervention gro%CI 1.5-4.2], p=0.rol group increas
at exercise treact on quality of l
on n the effects of red with the Mods. The test consiicted maximum hrticipant, and is scNo significant diffentrol and intervee in mean chang
at exercise treact on cardiopulmeya 2003).
exercise treatment6). Houborg et al.3n intervention groud at least 60 yearry. The exercise iining of upper andely and on day 7, e scale. The stud
ifference in fatiguoup 3.8 cm [95%03). Postoperativ
sed 2.3 cm more
KCE Report
atment in colorlife (very low lev
exercise treatmedified Balke Treaists of walking oeart rate is reach
cored by the numberence in resting ention group at ge from baseline
atment in colormonary function
t on fatigue in 38 randomized 119up (n=60) or contrrs and underwent ntervention consi
d lower extremities30 and 90 y had a low risk o
ue score between%CI 2.5-5.1] vs. co
ely at day 7 the fae than the interve
t 185
rectal vel of
nt on admill n the
hed or ber of heart post-: -2.7
rectal (very
9 rol
sted s.
of
n both ontrol atigue ention
KCE Report 185
group (p=0.000change in fatiguCourneya et alFACT instrumeintervention anintervention ass
Conclusions • There are
patients h2006, Cou
Table 16 – Effe
Study
Houborg 200638
Courneya 200332
5
07). At day 30 aue were found bet.32 assessed fatigent. They found nd control group sessment (p=0.81
indications that as no effect on rneya 2003).
ect of exercise tr
N Fatig
N=119 VisuaPostoincrea(p=0.0Postono sigbetwefatigu
N=102 FACTPost-ichangintervdiffere(p=0.8
and day 90 no tween both group
gue using the 13-no significant dat baseline (p=0).
exercise treatmfatigue (low leve
reatment on fatig
ue
al Analogue Scaleoperative day 7: mase in control grou0007)
operative day 30 agnificant differenceeen groups in chae score
T-C intervention (diffege from baseline tention): no significence between gro810)
Exercise t
significant differes. item Fatigue Scadifferences betw0.579) and at th
ent in colorectalel of evidence; H
gue in patients w
Measu
more up
and 90: es nge in
Pre-opoperatand da
rence in to post-cant
oups
At basinterveweeks
treatment for adult
ences in
le of the een the he post-
l cancer Houborg
with colorectal ca
ure point
perative, post-tive day 7, day 30ay 90
seline, post-ention (after 16 s)
t cancer patients
ancer
Intervention
Control group(45 min/sessioIntervention gmobilizations,50-80% of ononce a week t
Control groupintervention Intervention gflexibility exerpredicted headirector
characteristics
p: stretching and tion)
group: Institution-b, strength and aere repetition maximthe physiotherapis
p: asked not to init
group: a home-basrcises (3-5 times part rate maximum)
ightening and rela
based + continuedrobic training, 45 mmum 6 times a west home visit
tiate any structure
sed, personalizedper week for 20-30) + weekly telepho
axation exercises
d at home mix of min/session, load eek (+ filling in dia
ed exercise during
d cardiovascular a0 min, 65-75% of one call by project
37
of ary),
g
nd
t
38
4.4.4 SafetyHouborg et al.38
were related tosafety data32. R
Conclusions • The evide
colorectal
4.5 Haema4.5.1 Qualit
4.5.1.1 Pattran
Two RCTs evalundergoing allo(Table 17). Baumann et cancers) undercontrol group). training duringassessments, questionnaire abias.
y 8 reported on advo the exercise intRelapse was not re
ence suggests patients (low lev
atological cancety of life
tients undergoingnsplantation luated the effect o
ogeneic haematop
al.28 included 4rgoing allogeneic The exercise inte
g hospitalization. QOL was m
at admission and
verse events, but ntervention. Courneported in the incl
that exercise vel of evidence;
ers
g haematopoieti
of exercise treatmpoietic stem cell tr
7 patients (maiHSCT (n=17 in
ervention includedNext to physi
measured with at discharge. The
Exercise t
none of the compneya et al. did noluded studies.
treatment is sHouborg 2006).
ic stem cell
ent on QOL in paransplantation (HS
nly with haemaexercise group,
d strength and encal and anthropthe EORTC-Q
e study had a hig
treatment for adult
plications ot report
safe for
tients SCT)
tological n=16 in
ndurance pometric
QLQ-C30 h risk of
Othinre6cfugeJugaaCNhdapg
C•
t cancer patients
Of the 47 initially heir exercise progn both groups delated complicatio
68.6; change: 7.7change: -9.9%) unctioning decregroup p=0.005 aneffects were foundJarden et al.39 incundergoing allogegroup). The exercadjuvant multimodand psycho-educaC30 questionnaireNo significant diffhealth status, nor discharge: physicaat follow-up (3-p=0.325, global hglobal health statu
Conclusions In patients
transplantatisignificant efunctioning (2009).
randomized patiegram until the da
deceased during ons. QOL increas
7%) and decreasewithout reachi
ased significantlynd control group d (no p-value mencluded 42 patientseneic HSCT (n=21cise intervention dal program of phation. QOL was e. The study had afference was fouduring hospitalisaal functioning p=0
and 6-months ealth status p=0.
us p=0.603 respec
undergoing allon, exercise treeffect on overa(very low level o
ents, 33 patients wy of hospital dischospitalization bsed in the interveed in the control ng statistical sy over time in bp=0.002). No sig
ntioned). s (mainly with ha1 in intervention gincluded a struc
hysical exercise, also measured w
a high risk of bias.nd in physical f
ation (difference b0.089, global healt
after discharge:.841 and physicactively).
logeneic haemaeatment does n
all quality of lifof evidence; Ba
KCE Report
were able to comcharge. Seven pabecause of transention group (63.group (62.5 vs.
significance. Phyboth groups (exegnificant time by g
aematological cangroup, n=21 in coctured and superprogressive relax
with the EORTC-. functioning and gbetween admissionth status p=0.817 physical functi
al functioning p=0
atopoietic stem not seem to hafe and on phy
aumann 2011, Ja
t 185
mplete atients plant-.7 vs. 56.3;
ysical ercise group
ncers) ontrol rvised xation QLQ-
global n and
7), nor oning
0.131,
cell ave a ysical arden
KCE Report 185
Table 17 – Effe
Study
Baumann 201128
Jarden 200939
5
ect of exercise tr
N Quality o
N=47 Quality ofdifference68.6±11.2(62.5±23.mentionePhysical fin the exe20.7%, p=vs. 59.6±2
N=42 Physical fsignificandischargefollow-up months foFACT-G: and dischmonths foand 6-moFACT-ANand dischmonths foand 6-mo
reatment on qual
of life
f life (EORTC-QLQe over time in exe2, +7.7%) nor in th.9 vs. 56.3±17.6, -d) functioning: a signercise group (83.1=0.005) and in the22.9, -25.1%, p=0
functioning (EORTnt differences betwe (p=0.089), betwe(p=0.325) and be
ollow-up (p=0.131no significant diff
harge (p=0.298), bollow-up (p=0.241onths follow-up (p=N: no significant diharge (p=0.225), bollow-up (p=0.167onths follow-up (p=
Exercise t
lity of life in patie
Q-C30): no signifircise group (63.7±he control group -9.9%) (no p-value
nificant decrease ±16.9 vs. 65.9±16
e control group (70.002)
TC-QLQ-C30): noween baseline andeen baseline and etween baseline a)
ference between bbetween baseline ) and between ba=0.620) ifference betweenbetween baseline 7) and between ba=0.395)
treatment for adult
ents undergoing
Meas
cant ±19.7 vs.
es
over time 6.5, -9.6±19.2
Basefirst 2admiday bhospdisch
o d 3-months
and 6-
baseline and 3-
aseline
n baseline and 3-
aseline
Baseday aadmipost-(at di3- anfollow
t cancer patients
g haematopoietic
sure point Int
eline (during 2 days after ssion) and
before pital harge
Co(ac20staInteerg20wacontra
eline (first after ssion), -intervention ischarge), nd 6-months w-up
ComaIntecon30stretra(20
c stem cell transp
ervention charac
ontrol group: clinicctive and passive min/session, 5 da
art one day after trervention group: agometer, training imin) and ADL-tra
alking and stair climnducted by profesnsplantation until
ontrol group: usuaassage) ervention group: unsisting of 4 min wmin,<75% of maxetching exercisesining (15-20 min, 0 min, 2 days/wee
plantation
cteristics
’s standard physiomobilizations withays/week, conducransplantation untaerobic endurancentensity achieved
aining (strength, combing, 20-30 min/ssional therapist, sdischarge
l care (range of m
usual care plus mwarm-up, stationax heart rate, 5 day (15-20 min, 5 day3 days/week), pro
ek) and psycho-ed
otherapy programh low intensities cted by physiothertil day before disce training (cycle
d watt load -20%, oordination, stretc/day), twice a daystart 6 days prior t
motion, resistance
ultimodal intervenary cycling (15-ys/week), dynamicys/week), resistanogressive relaxatioducation
39
m
rapist, charge
10-ching, y, to
and
ntion,
c and nce on
40
4.5.1.2 LymOnly one studyof lymphoma patients to an patients, 44.3%consisted of abegan at 60% o15-20 to 40-45mThe study had aAt post-intervenexercise groupp=0.021; adjusPhysical functiowas significan(unadjusted grogroup differencreceived usual remained stableAt six months group was foun(p=0.121 for ph
Conclusions • In lympho
on overalleffect disaCourneya
mphoma patientsy was retrieved onpatients. Courneexercise group
% were on active aerobic exercise of peak power oumin/session). QOa low risk of bias. ntion assessment,p (unadjusted grsted group differoning, a sub-domntly better in thoup difference ine in mean changecare, the scores
e over time. follow-up a trend
nd, but the differehysical functioning
ma patients, exel quality of life aappears after 6 2009).
s n the effects of exeya et al.34 rand(n=60) or a conchemotherapy. Ttraining on a cy
utput, increased bOL was measured
, overall QOL wasroup difference rence in mean c
main of the FACThe exercise gron mean change: e: +7.2, p=0.017).s on overall QOL
d towards improvences did not reag, p=0.054 for ove
ercise seems to hand physical fun
months (mode
Exercise t
xercise treatment domized 122 lymtrol group (n=62The exercise inteycle ergometer (by 5% each week
with the FACT-A
s significantly bettin mean changechange: +7.2, p-AN scale (TOI-A
oup at post-inte+9.0, p=0.012; a
. In the control groand physical fun
ved QOL in the ach statistical signrall QOL).
have a significannctioning, althou
erate level of ev
treatment for adult
on QOL mphoma ). Of all
ervention intensity to 75%,
AN scale.
ter in the e: +9.5, =0.039).
An), also ervention adjusted oup, that nctioning
exercise nificance
nt effect ugh the
vidence;
4
4
TfurJugaacaadbDc(pdgh
C•
t cancer patients
4.5.2 Cardiopu
4.5.2.1 Patientransp
Two RCTs reporteunction in patientisk of bias.
Jarden et al.39 incundergoing allogegroup). The exercadjuvant multimodand psycho-educcapacity was meaafter admission, nand the control grdecreased in the cboth groups (p<0.0Dimeo et al.35
chemotherapy ann=33) or a contro
program of aerobdifference in maxigroups at baselinehigh risk of bias.
Conclusions Conflicting
treatment onallogeneic haimprovementrate (very low
ulmonary functio
nts undergoing hplantation ed on the effect ofts undergoing allo
cluded 42 patientseneic HSCT (n=21cise intervention dal program of phcation. The effecasured with the Vno significant differoup (p-value not control group, resu0001).
randomized nd autologous pel group (n=37). Th
bic exercise on amal heart rate in e (p=0.58) and a
evidence is avn cardiopulmonaaematopoietic stt in VO2max, wiw level of eviden
on
haematopoietic s
f exercise treatmeogeneic HSCT. Bo
s (mainly with ha1 in intervention gincluded a struc
hysical exercise, ct of exercise tVO2max. At base
erence was foundmentioned). At d
ulting in a significa
70 patients ueripheral HSCT the exercise interva bed cycle ergothe stress test wa
at discharge (p=0
vailable on theary function in tem cell transplaithout a difference; Jarden 2009,
KCE Report
stem cell
ent on cardiopulmooth studies had a
aematological cangroup, n=21 in coctured and superprogressive relaxtreatment on aeeline, i.e. the firs between the exe
discharge, the VOant difference bet
ndergoing high-to an exercise g
vention included aometer. No signias found between.84). This study h
e effect of exepatients underg
antation: a signifnce in maximal , Dimeo 1997).
t 185
onary a high
ncers) ontrol rvised xation erobic st day ercise
O2max tween
-dose group
a daily ficant
n both has a
ercise going ficant heart
KCE Report 185
Table 18 – Effe
Study
Jarden 200939
Dimeo 199735
5
ect of exercise tr
N Card
N=42 At bin VAt psign(p<0
N=70 Maxsigngrousign(p=0% ofsigngrousign(p=0
reatment on card
diopulmonary fu
baseline: no signifiO2max between b
post-intervention (anificant difference 0.001)
ximal heart rate in nificant difference ups at admission (nificant difference 0.84) f estimated maxim
nificant difference ups at admission (nificant difference 0.69)
Exercise t
diopulmonary fun
unction
icant difference both groups at discharge): between groups
stress-test: no between both (p=0.58) and no at discharge
mal heart rate: no between both (p=0.89) and no at discharge
treatment for adult
nction in patients
Measure point
Baseline (first dadmission), posintervention (at A single stage 6submaximal ex(Aastrand-Rhymergometer test)VO2max (l/min)
Baseline (befortransplantationdischarge Treadmill stressstarting at 3 kmelevation, accekm/h every third
t cancer patients
s undergoing ha
t Int
day after st-discharge)
6-min xercise test ming cycle ) to define )
ComaIntco<7strtra(20
re ), at
s-test m/h and 1.5% eleration of 1 d minute
CoIntwit50
aematopoietic ste
tervention chara
ontrol group: usuaassage) tervention group:
onsisting of 4 min w75% of max heart retching exercisesaining (15-20 min,0 min, 2 days/wee
ontrol group: not intervention group: th bed ergometer
0%, 15 repetitions
em cell transplan
acteristics
al care (range of m
usual care plus mwarm-up, stationarate, 5 days/week
s (15-20 min, 5 da 3 days/week), prek) and psycho-ed
n detail describeddaily program of a), 1 min with hear, total of 30 min p
ntation
motion, resistance
multimodal interveary cycling (15-30k), dynamic and ays/week), resistarogressive relaxatducation
d aerobic exercise (rt rate equivalent tper day
41
e and
ntion, 0 min,
ance tion
(biking to
42
4.5.2.2 LymOne study evafunction in lylymphoma patieOf all patientsintervention co(intensity beganto 75%, 15-20 program a siggroups (VO2machange: +0.43group difference
Conclusions • In lympho
on cardiolevel of ev
4.5.3 Fatigu
4.5.3.1 AcuChang et al.30
undergoing checontrol group Inventory (BFI).Patients in the eworst fatigue in7 average fatig± 2.4 in contrexercise group interference megroup (p=0.04),group versus mmean 5.6 ± 3.1(p=0.01) and fa5.6 ± 2.7 in consignificant at d
mphoma patientsluated the effect mphoma patientents to an exerciss, 44.3% were nsisted of aerobin at 60% of peak to 40-45min/sess
gnificant differencax, l/min: unadjust, p<0.001; VO2me in mean change
ma patients, exeopulmonary funcvidence; Courney
ue
ute myelogenousrandomized 22 pemotherapy to a(n=11). Fatigue . The study had aexercise group ha
ntensity and fatiguue score mean 4.ol group (p=0.02versus mean 7.5
ean 3.6 ± 2.5 in e, at day 14 averag
mean 5.8 ± 3.1 in c1 in exercise grouatigue interferencentrol group (p=0.0day 21 for avera
s of exercise treatmts. Courneya etse group (n=60) oon active chem
ic exercise traininpower output, incsion). After the 1
ce was found inted and adjusted
max, ml/kg/min: ue: +5.2, p<0.001).
ercise seems to hction measured ya 2009).
s leukemia patients with acuta walking exercis
was measured high risk of bias.ad significantly lowue interference at .1 ± 2.3 in exercis2), worst fatigue ± 2.4 in control g
exercise group vege fatigue score mcontrol group (p=up versus mean 7e mean 4.3 ± 2.8
04). However, the age and worst fa
Exercise t
ment on cardioput al.34 randomizor a control group
motherapy. The ng on a cycle ercreased by 5% ea12-week aerobic VO2max betwegroup difference
unadjusted and a
have a significanas VO2max (m
e myelogenous lese program (n=1using the Brief
wer levels of averday 7 and day 14
se group versus mscore mean 5.6
roup (p=0.02) andersus 4.6 ± 2.2 inmean 4.4 ± 2.4 in 0.01), worst fatigu7.1 ± 2.7 in contrin exercise groupdifferences beca
atigue intensity.:
treatment for adult
ulmonary zed 122 p (n=62). exercise rgometer ch week exercise en both in mean adjusted
nt effect moderate
eukemia 1) or a Fatigue
rage and 4: at day mean 5.5 6±2.7 in d fatigue n control exercise ue score ol group p versus me non-average
facg
C•
4
TpbBcctrCoemwpJugaasbCtamtro
t cancer patients
atigue score meacontrol group (p=0group versus 6.3 ±
Conclusions In patients w
seems to haevidence; Ch
4.5.3.2 Patientransp
Three RCTs repopatients undergoinbias. Baumann et al.2cancers) undergocontrol group). Thraining during hosC30 questionnaireof the EORTC-QLexercise group nomentioned) in conwas noticed (p=0.0p-value mentionedJarden et al.39 incundergoing allogegroup). The exercadjuvant multimodand psycho-educascores (EORTC-between the controColeman et al.31 randem transplanmelphalan and preatment (n=14) oof a home-based
an 4.6 ± 3.0 in ex0.1), worst fatigu± 3.8 in control gro
with acute myelogave a temporaryhang 2008).
nts undergoing hplantation orted on the effeng allogeneic HSC
28 included 47 ing allogeneic HSe exercise intervespitalization. QOLe at admission andLQ-C30 is the pao significant differentrast to the cont046). No significad). cluded 42 patientseneic HSCT (n=21cise intervention dal program of phation. They also fo-QCQ-C30), FACol and exercise grrandomized 24 pantation (chemotheperipheral blood or usual care (n=1exercise program
xercise group verse intensity meanoup (p=0.05).
genous leukemiy effect on fatigu
haematopoietic s
ect of exercise trCT. All three stud
patients (mainly SCT (n=17 in exention included stL was measured wd at discharge. Otient’s perceptionences over time wtrol group, where ant time by group
s (mainly with ha1 in intervention gincluded a struc
hysical exercise, ound no significaCT-G scores anroup. atients with multiperapy, stem cell stem cell transp10). The exercise
m with resistance a
KCE Report
sus mean 4.8 ± 3 5.7 ± 3.8 in exe
a, exercise treatue (very low lev
stem cell
eatment on fatigdies had a high r
with haematoloxercise group, n=trength and enduwith the EORTC-
One of the sub-domn on his fatigue. Iwere found (no p-
a significant increffects were foun
aematological cangroup, n=21 in coctured and superprogressive relaxnt difference in fand FACT-AN s
ple myeloma rececollection, high-
plantation) to exe intervention consand aerobic exerc
t 185
3.5 in ercise
tment vel of
ue in risk of
ogical =16 in rance QLQ-mains n the
-value rease
nd (no
ncers) ontrol rvised xation atigue cores
eiving -dose ercise sisted cises.
KCE Report 185
Fatigue was minertia adjectivetreatment on fathe analysis bedecrease in fatHowever, no p-
Conclusions • Conflicting
treatment haematopevidence;
Table 19 – Effe
Study
Baumann 201128
Jarden 200939
5
measured with thee rating scale. Fo
atigue, 14 patientsecause of its effectigue (-1.2), wher-values were prov
g evidence is on fatigue
oietic stem ceBaumann 2011,
ect of exercise tr
N F
N=47 EEd2nCin2p
N=42 FnbdbubuF
e Profile of Moodor the evaluation s receiving thalidoct on sleep. The ereas the usual ca
vided.
available on tin patients ull transplantatioJarden 2009, Co
reatment on fatig
Fatigue
EORTC-QLQ-C30Exercise group: nodifference over tim25.3 vs. 43.8 ± 22no p-value mentioControl group: signncrease over time24.5 vs. 52.8 ± 27p=0.046)
Fatigue (EORTC-Qno significant diffebetween baseline discharge (p=0.40baseline and 3-moup (p=0.302) and baseline and 6-moup (p=0.097) FACT-G: no signif
Exercise t
d States (POMS) of the effect of
omide were excludexercise group share group did no
the effect of eundergoing alloon (very low loleman 2003).
gue in patients un
Me
0 o significant
me (41.8 ± .7, +4.8%, ned) nificant
e (36.1 ± .1, +46.3%,
Badadadis
QLQ-C30): rences and 5), between
onths follow-between onths follow-
ficant
Baadint3-
treatment for adult
fatigue-exercise ded from howed a
ot (+0.3).
exercise ogeneic evel of
ndergoing haem
easure point
aseline (during firsays after admissioay before hospital scharge
aseline (first day admission), post-tervention (at disc and 6-months fol
t cancer patients
matopoietic stem
Interv
st 2 on) and
Contro(active20 minphysiobeforeInterveergom20 mincoordi30 mintherap
after
charge), llow-up
ContromassaInterveconsis30 minstretchtrainin(20 mi
cell transplantat
vention character
ol group: clinic’s se and passive mobn/session, 5 days otherapist, start one discharge ention group: aero
meter, training inten without interruptnation, stretching
n/day), twice a dapist, start 6 days p
ol group: usual caage) ention group: usuasting of 4 min warmn,<75% of max hehing exercises (15g (15-20 min, 3 din, 2 days/week) a
tion
ristics
standard physiothebilizations with lowper week, conduc
ne day after trans
obic endurance transity achieved wation) and ADL-trai, walking and staiy, conducted by p
prior to transplanta
are (range of motio
al care plus multimm-up, stationary ceart rate, 5 days/w5-20 min, 5 days/ways/week), progreand psycho-educa
erapy program, w intensities), cted by plantation until da
aining ( cycle att load -20%, 10-ning (strength, ir climbing, 20-professional ation until discharg
on, resistance and
modal interventioncycling (15-week), dynamic anweek), resistance essive relaxation ation
43
ay
ge
d
n,
nd
44
Study
Coleman 2003
4.5.3.3 LymOne study evlymphoma patieto an exercise 44.3% were onof aerobic exerof peak power 45min/session)AN scale. At poin the exercise p=0.013; adjust
N FdabmamFdabmam
31 N=24 Deg
mphoma patientsvaluated the effeents. Courneya e
group (n=60) orn active chemothercise training on aoutput, increased. Fatigue was meost-intervention asgroup (unadjuste
ted group differen
Fatigue difference betweenand discharge (p=between baseline months follow-up (and between basemonths follow-up (FACT-AN: no signdifference betweenand discharge (p=between baseline months follow-up (and between basemonths follow-up (
Decrease in fatiguexercise group, nogroup (no p-values
s ect of exercise et al.34 randomizedr a control grouperapy. The exercia cycle ergometerd by 5% each weeasured using a sssessment, fatigu
ed group differencnce in mean chang
Exercise t
Men baseline 0.298), and 3-(p=0.241) eline and 6-(p=0.620)
nificant n baseline 0.225), and 3-(p=0.167) eline and 6-(p=0.395)
ue in ot in control s mentioned)
BabeaftmotraPO
treatment on fad 122 lymphoma p (n=62). Of all pise intervention cor (intensity beganeek to 75%, 15-2sub-domain of theue was significantce in mean changge: +4.0, p=0.012
treatment for adult
easure point
aseline (app. 3 moefore transplantatiter transplantationonths after ansplantation OMS
tigue in patients patients, onsisted
n at 60% 20 to 40-e FACT-tly better ge: +4.6, 2).
C•
4Inbto(wcds
t cancer patients
Interv
onths ion), n, 3
IndividstrengControleast 3Weekl
Conclusions In lymphoma
on fatigue (m
4.5.4 Safety n the study of Cobut three adverse o a modification owith knee pain)
complications reladifferentiating the severity of pain w
vention character
dualized home-bagth resistance trainol group: usual ca3 times a week) ly phone calls for
a patients, exercimoderate level of
urneya et al.34 noevents (back, hip
of the exercise prowithdrew from th
ated to the toxiciadverse events
was for patients i
ristics
sed exercise progning and an aerob
are (remain active
both groups + we
ise seems to havf evidence; Courn
o serious adverse p and knee pain) rogram in two patihe study. Dimeoty of high-dosis related to the exn exercise group
KCE Report
gram combining bic component and walk 20 min
eekly activity log
ve a significant eneya 2009).
events were reporelated to exerciseents, while one p
o et al.35 reportedchemotherapy w
xercise treatmentp lower than in co
t 185
at
effect
orted, e lead atient d the ithout . The ontrol
KCE Report 185
group (p=0.01)cancers did not
Conclusions • Exercise
haematoloadverse ev
4.6 Mixed cSeven additiontreatment in mix
4.6.1 QualitFour RCTs repstudies had a lbias33 and the scales varied aof AssessmentFACT-AN scaleEstimates of thephysical subscaA structured ingroup), consistiseveral domainfunctioning), rebetween both gbetween both g(p=0.4229)and Adamsen et awomen with brecare (n=134). Afor advanced dactive treatmenprogram, combon QOL (mea
5
. The other studit report on advers
treatment seeogical cancers, avents (low level o
cancer populatal RCTs were incxed cancer popula
ty of life ported on the effow risk of bias26,4
fourth study hadand included Spitzt (LASA), EORTe, with some studie effect of institutiales of QOL differtervention (n=49 ing of conditionings of QOL (cognitivsulted in an overgroups41. Only atgroups (p=0.469) at week 27 (p=0.9
al.26 randomized east cancer) to e
All patients had redisease or as adnt. The exercise inbining high and loasured by EOR
ies including patie events.
ems to be saalthough many tof evidence; Cou
tions cluded reporting oations.
ffect of exercise 40, while one stud a high risk of b
zer QOL UniscaleTC-QLQ-C30, MOies using more thaion-based exercisred widely across in intervention g
g exercises with eve, physical, emo
rall lack of different week 4 a signifbut this differenc
9922). This study 269 patients wit
exercise treatmenteceived at least ondjuvant treatment,ntervention consisw intensity exerc
RTC-QLQ-C30) w
Exercise t
ents with haema
ave in patienttrials omit to reurneya 2009).
on the effects of
treatment on QOdy had a moderatias41. QOL meas
e, Linear AnalogueOS SF-36, FACITan one scale. se on quality of lifethe studies (Tableroup and n=54 ineducational instru
otional, spiritual annce in overall QOficant difference
ce disappeared athad a high risk of
th cancer (includt (n=135) or convne cycle of chemo, and were still rsted of a 6-week ises. No significa
was found for
treatment for adult
tological
ts with eport on
exercise
OL. Two te risk of urement e Scales T-F and
e and on e 20). n control uction on nd social OL score is found t week 8 f bias.
ding 119 ventional otherapy receiving exercise
ant effect exercise
caMos(S3Tpth(w0Hin(Csamgafo+Sthmn
C•
t cancer patients
compared with tassessed with twoMOS SF-36. For over time betweenshowed a signifip=0.01).
Slightly different re38 cancer patientsThe exercise inteprogram during 4 whe FACIT-F, weCohen’s d=0.26)
with a small declin0.02) and a smalHowever, the interntervention and aboth p<0.05).
Courneya et al.33 rsolid tumours to daaerobic exercise measured with thegroups (p=0.363 adjusted group dior each group se+13.4 in the exercStratification for she outcome, agemetastatic diseasenot alter the findin
Conclusions Conflicting
treatment onlevel of evideRummans 20
the control grouo different instrum
the EORTC-QLQn groups was fouicant increase i
esults were reports to exercise treaervention consisteweeks. Only sma
ere found in theand at 3-months
ne in the control gl improvement atrvention group shat 3-months follow
randomized 55 marbepoetin alfa altraining (n=26).
e FACT-AN scale,for unadjusted
fferences). Howeparately was founcise group, no p-vome baseline cha
e, sex, marital ste, current chemotgs.
evidence is avn quality of life inence; Adamsen 006).
up (p=0.4). Physments, i.e. the EOR
Q-C30 scale, nound (p=0.09), when physical func
ted by Mustian et tment (n=19) or aed of a walking ll improvements i
e exercise groups follow-up (Cohegroup at post-intet 3-months followowed a significanw-up compared w
mild-to-moderately one (n=29) or com
The mean cha, did not differ sign
group differencever, a significantnd (+20.3 for darbvalues mentionedaracteristics, suchtatus, education, therapy and prior
vailable on then mixed cancer p
2009, Mustian 2
sical functioning RTC-QLQ-C30 ano significant differereas the MOS S
ctioning with exe
t al.40, who randoma control group (n
and resistance n QOL, measuredp at post-interve
en’s d=0.41) compervention (Cohen’
w-up (Cohen’s d=0ntly better QOL at with the control g
anaemic patientsmbined with a 12-ange in QOL scnificantly betweences and p=0.637t improvement in bepoetin alfa alond in the primary sth as baseline valprimary tumour
r blood transfusion
e effect of exepopulations (very2009, Courneya 2
45
was nd the rence SF-36 ercise
mized n=19).
band d with ention pared ’s d=-0.28). post-
group
s with -week cores, n both 7 for QOL
ne vs. tudy). lue of type,
n, did
ercise y low 2008,
46
Table 20 – Effe
Study N
Rummans 200641
N
Adamsen 200926
N
ect of exercise tr
N Quality o
N=103 Baselineboth grouAt week 4both grouAt week both grouAt week both grou
N=269 Global hesignificangroups (e-2.7 to 7.Physical significangroups (e-0.4 to 5.Physical differenc(estimate7.7, p=0.
reatment on qual
of Life
: no significant difups (p=0.4829) 4: a significant difups (p=0.469) 8: no significant dups (p=0.4229) 27: no significant ups (p=0.9922)
ealth status (EORnt differences oveestimated mean d.1, p=0.4) functioning (EOR
nt differences oveestimated mean d.1, p=0.09) functioning (MOSes over time betw
ed mean differenc01)
Exercise t
lity of life in mixe
fference between
fference between
difference between
difference betwee
RTC-QLQ-C30): nor time between bo
difference 2.2, 95%
RTC-QLQ-C30): nor time between bo
difference 2.4, 95%
S SF-36): significaween both groups ce 4.4, 95%CI 1.1
treatment for adult
ed cancer popula
Measure p
n
en
Baseline, w Spitzer QOLinear Anaof AssessmQOL Assessmeconverted scale
o oth %CI
o oth %CI
ant
to
Baseline ainterventio EORTC-Qsubdomainstatus/quaphysical fuMOS SF-3physical fu
t cancer patients
ations
point
week 4, 8, 27
OL Uniscale alogue Scales ment (LASA) of
nt scores were to a 0-100
nd after n (6 weeks)
LQ-C30, n global health lity of life and nctioning
36: subdomain nctioning
Intervention ch
Control group: uIntervention groubasis, completedpsychiatrist or psphysical therapisconditioning exe20 min relaxation
Control group: a+ exercise progrIntervention grouphysical traininghours, 45 min rerepetition maximsession, 15 min bicycles, 70-2503.75 MET hoursrelaxation traininintensity sessionbody awarenessweek), massage
aracteristics
sual care up: eight 90 min-sd within 4 weeks asychologist co facst, chaplain or soc
ercises, educationn exercises
llowed freely to inram after the six wup: 6-week (9 h/w (30 min dynamic
esistance training mum test at 4 MET
cardiovascular tra0W, 85-95% maxim) for 90 min follow
ng + 2 times per wns: relaxation (30 s and restorative te (30 min twice a w
KCE Report
sessions on ambuafter enrollment, lecilitated by nurse, cial worker, 20 mial instruction and
ncrease physical aweek assessment week) high intensitc exercises at 4.5 at 70-100% of on
T hours per traininaining (stationary mum heart rate atwed by 30 min week massage. Lomin, 4 times per wraining (90 min onweek)
t 185
ulatory ed by
n
activity
ty MET e
ng
t
ow week, nce a
KCE Report 185
Mustian 200940
N
Courneya, 200833
N
4.6.2 CardioFive studies cardiopulmonarreported chancardiopulmonarrisk of bias26,40
bias37,42. Estimates of thefunction differedGriffith et al. 37
chemotherapy (n=68) or usuahome-based wa
5
N=38 Exercise baseline d=0.26) afrom basd=0.41)
Control gbaseline 0.02) butbaseline d=0.28)
Significancompareand at 3-
N=55 No signif(p=0.363p=0.637 Both grou
opulmonary funcreported on t
ry function in mnges in VO2mry function with a0, while 3 studies
e effect of exercisd across the studirandomized 126
and/or radiotheraal care (n=58). Talking intervention
group: small impand post-interven
and continued moeline to 3-months
group: small decreand post-interven
t small improvemeand 3-months fol
nt higher QOL in ed to control group-months follow-up
ficant differences 3 for unadjusted gfor adjusted grouups improved QO
ction the effect of
mixed cancer popax26,33,37, while
a walking test40,42
s had either a m
se interventions onies (Table 21). patients undergo
apy for solid tumoThe exercise inten.
Exercise t
rovements betwention (Cohen’s odest improvemens follow-up (Cohen
ease between ntion (Cohen’s d=-ents between low-up (Cohen’s
exercise group, p, at post-intervenp (all p<0.05)
between groups roup differences, p differences)
OL over time
exercise treatmpulations. Three
2 studies ev2. Two studies ha
moderate33 or high
n cardiopulmonary
oing active treatmours to exercise trervention consist
treatment for adult
en
nts n’s
-
tion
Baseline, ainterventioat 3-month
FACIT-F
Baseline (wprior to stadarbepoetipost-intervweeks afteexercise prFACT-AN s
ment on studies
valuated ad a low h risk of
y
ment with reatment ted of a
NbingdpvTtrara
t cancer patients
after n (4weeks) and
hs follow-up
within 10 days arting in alfa) and at
vention (1-2 er the 12-week rogram) scale
No significant diffebe found for the Vn post-pre changegroup. Sub-analydifference betweepatients, with a nevs. a > 9% decreaThis difference wareatment of prosandrogen deprivatadiotherapy).
Control group: ctherapy)
Intervention groutailored home-baheart rate, 7 dayresistance band progressive resis4 weeks, focuse
Control group: aprogram during iIntervention grouergometry sessiobaseline exercisbasis
erence in changeVO2max. Surprisine in the exercise gysis according toen prostate cancearly 8% increasease in VO2max in as explained by thstate cancer patietion therapy) in co
onventional medic
up: radiation theraased, progressiveys a week for 4 weprogram (modera
stance exercise, 7d on upper body)
sked not to initiateintervention perioup: aerobic exercions) 3 times per w
se capacity, for 12
e over time betwegly, the authors fogroup vs. a 5.6% o cancer type cer patients ande in VO2max in prnon-prostate canche authors by theents (radiotherapontrast to chemoth
cal care (radiation
apy + individually e walking (60-70%eeks) and therapeately intense 7 days a week for
e a structured exed ise training (cycleweek at 60-100% weeks on ambula
een both groups ound a 2.9% decrincrease in the coshowed a signi
d non-prostate carostate cancer pacer patients (p=0.e more easily toley in combinationherapy (with or w
47
n
% of eutic
r
ercise
of atory
could rease ontrol ficant ancer tients .008).
erated n with ithout
48
Adamsen et awomen with brecare (n=134). Afor advanced dactive treatmenprogram, combdifference overcontrol group group (at baseVO2max of 1.8baseline mean 1.96l/min). The more cleacomponents ofintensities trainCourneya et al.solid tumours toaerobic exercisVO2max (exprein mean chanrespectively, bcovariates, theremained signadjusted group(p=0.003) and +Mustian et al.4capacity, assesbreast and prointervention the
al.26 randomized east cancer) to e
All patients had redisease or as adnt. The exercise inbining high and lor time in VO2max(p<0.0001). The
eline mean VO2m8l/min), whereas VO2max of 1.82l
ar differences in f the exercise inings). .33 randomized 55o darbepoetin alfase training (n=26essed as ml/kg/mige +3.0 (95%CI
both p=0.001) bee mean change nificantly differenp differences in+0.22 (95%CI 0.040 evaluated the ssed with the 6-mostate cancer pae exercise group
269 patients witexercise treatmenteceived at least ondjuvant treatment,ntervention consisow intensity exercx was found betw
VO2max remainmax of 1.90 l/min
it increased in tl/min and after 6
effect can be exntervention (comb
5 mild-to-moderata alone (n=29) or 6). They found ain and l/min, unadI 1.2-4.7) and +etween both gro
over time in Vt (expressed as
n mean change8-0.37) (p=0.004)effect of exercis
inute walking testatients during radp showed small i
Exercise t
th cancer (includt (n=135) or convne cycle of chemo, and were still rsted of a 6-week cises. A significa
ween the intervented stable in theand after 6week
he intervention gweeks mean VO
xplained by the bination of high a
ely anaemic patiecombined with a
a significant differdjusted group diff
+0.21 (95%CI 0.0oups. After adjusVO2max between s ml/kg/min and +3.0 (95%CI ) respectively) . se treatment on t, in a mixed popudiation therapy. Aimprovements in
treatment for adult
ding 119 ventional otherapy receiving exercise nt mean tion and
e control ks mean group (at O2max of
different and low
ents with 12-week rence in ferences 08-0.34) sting for
groups d l/min, 1.1-5.0)
aerobic ulation of At post-aerobic
c±o-2imdnbSebca((gm1sthind
C•
t cancer patients
capacity (differen±227.84 ft, Cohenof the aerobic cap28.44 ±303.75 mprovement in thdifferent from basnon-significant incbaseline (Cohen’sSchwartz et al.42
exercise program breast cancer, pcapacity, measureat 6 and 12 monthboth p<0.05): at SD178), in resista
group mean 911.mean 1201 m (SD
85), in control grshowed the highehe resistance exen aerobic capacitdecreased to 5% f
Conclusions Conflicting
treatment opopulations 2009, Courne
ce between basn’s d=0.16), wherepacity (difference b
ft, Cohen’s d=he exercise grou
seline anymore (Ccrease in aerobi d=0.28). compared the efand versus usuarostate cancer a
ed with the 12-minhs in both exercise
6 months in aeance exercise gro1 m (SD 194), atD183), in resistanroup mean 983m est improvement ercise group (11%ty of 12% at 6 mfrom baseline valu
evidence is avon cardiopulmo(very low level
eya 2008, Mustia
seline and post-eas the control grbetween baseline
=-0.13). At 3 mup continued, butCohen’s d=0.37). c capacity was
ffects of an aeroal care in a mixedand lymphoma pnute walking test,e groups compareerobic exercise goup mean 1174.7t 12 months in ance exercise gro(SD 193). The a
(16%) in aerobic%). The control grmonths, but at 1ue.
vailable on theonary function of evidence; Grn 2009, Schwartz
KCE Report
-intervention: + 4roup showed a de
e and post-intervemonths follow-upt was not significIn the control grofound compared
obic versus a stred sample consistipatients. The ae significantly impred to the control ggroup mean 1219m (SD 191), in co
aerobic exercise gup mean 1144 maerobic exercise gc capacity, followeroup showed a de2 months the de
e effect of exein mixed ca
riffith 2009, Adamz 2009).
t 185
43.58 ecline ntion:
p the cantly oup a with
ength ing of erobic roved group 9.2 m ontrol group
m (SD group ed by ecline ecline
ercise ancer msen
KCE Report 185
Table 21 – Effe
Study N
Griffith 200937
N
Adamsen 200926
N
Courneya 200833
N
5
ect of exercise tr
N Cardiopu
N=126 ITT-analychange ((p=0.26) change inincrease Dose-resdifferencprostate (p=0.008
N=269 Significangroups (0p<0.0001control gintervent
N=55 SignificanVO2max groups (up=0.001,p=0.003)SignificanVO2max
reatment on card
ulmonary functio
ysis: no significan-8.4%) between bwith a 2.9% decren exercise group in control group
sponse analysis: se in% change preand non prostate
8, 17.45%)
nt mean differenc0.16l:min, 95%CI 1): no difference oroup, increase ovion group
nt difference in m(ml/kg/min) over tunadjusted group adjusted group d) nt difference in m(l/min) over time b
Exercise t
diopulmonary fun
on
nt difference in both groups ease in pre-post and 5.6%
significant e-post between
patients
ce between both 0.1-0.2,
over time in ver time in
ean change in time between differences
differences
ean change in between groups
treatment for adult
nction in mixed c
Measure poin
Baseline (befochemotherapypost-test (aftercancer treatmePeak oxygen udirectly measutesting (modifieincrease by 2.5min) or estimamin walk test
Baseline and a(6weeks) Peak oxygen uindirectely estistepwise work stationary exerwith workload min, increasedconsecutive m
Baseline (withistarting darbeppost-interventithe 12-week exVO2max on elecycle ergometebreath expired
t cancer patients
cancer populatio
nt
ore start y/radiotherapy), r completion of ent) uptake (VO2max) ured by treadmill ed Balke Protocol5% grade each 3 ted from the 12-
after intervention
uptake (VO2max) mated by use of capacity on
rcise cycle (starteof 67W over 8
d by 20W with eacmin)
in 10days prior to poetin alfa) and aton (1-2weeks aftexercise program)ectronically brakeder with breath-by-
d gas analysis on a
ons
Intervention
l,
Control group+ patients wecurrent level oIntervention gintervention, 20-30 min wa(cool down), telephone ca
ed
ch
Control groupactivity + exeassessmentIntervention gintensity physexercises at 4training at 70at 4 MET houcardiovascula250W, 85-95hours) for 90mtraining + 2 tisessions: relabody awarenonce a week)
t er
d -a
Control groupexercise progIntervention gergometry seof baseline exambulatory b
characteristics
p: biweekly phoneere encouraged toof activity group: home-base50-70% of maximalk followed by 5 m5 times per week ll by study nurse
p: allowed freely toercise program afte
group: 6-week (9 hsical training (30 m4.5 MET hours, 45-100% of one rep
urs per training sear training (station% maximum hearmin followed by 3mes per week maaxation (30 min, 4ess and restorativ), massage (30 m
p: asked not to initgram during intervgroup: aerobic exeessions) 3 times pxercise capacity, fasis
e calls by study nuo maintain their
ed walking mum heart rate, brmin slower walkin+ biweekly
o increase physicer the six week
h/week) high min dynamic 5 min resistance
petition maximum ession, 15 min nary bicycles, 70-rt rate at 3.75 MET0 min relaxation
assage. Low inten4 times per week, ve training (90 minin twice a week)
tiate a structured vention period ercise training (cyer week at 60-100for 12 weeks, on
49
urse
isk g
cal
test
T
nsity
n
ycle 0%
50
Study N
Mustian, 200940
N
Schwartz,200942
N
N Cardiopu(unadjustadjusted
N=38 Control g401.02, p438.27, a468.86. Mbetween mean chpost-inteExercise interventfollow-upof 43.58 post-inte396.79 bfollow-up
N=101 Aerobic e± 210, atmonths 1Resistan1021.7 ±12 monthAerobic e± 200, atmonths 9
ulmonary functioted group differengroup differences
group: at baseline post-intervention 1at 3months follow-Mean change of -2baseline and posange of 78.73 ± 4rvention and followgroup: 1894.37 ±ion 1937.95 ± 261
p 2020.59 ± 386.3± 227.84 betweenrvention, mean chetween post-inter
p
exercise group: att 6-months 1219.21201 ± 183 ce exercise group 186, at 6-monthshs 1144 ± 185 exercise group: att 6-months 911.1 ±983 ± 193
Exercise t
on nces p=0.001, s p=0.004)
1478.21 ± 1 425.28 ± -up 1 600.33 ± 28.44 ± 303.75
st-intervention, 484.12 between w-up
± 296.78, post-1.99, at 3 months 6. Mean change n baseline and hange of 133.53 ±rvention and
t baseline 1017.32 ± 178, at 12
p: at baseline s 1174.7 ± 191, at
t baseline 1035.4± 194, at 12
treatment for adult
Measure poincalibrated metmeasurement increased 5-20exhaustion
±
At baseline, poand at 3-monthAerobic capac6-min walk tes
t
At baseline, 6 months Aerobic capac12-minute walk
t cancer patients
nt abolic system, workload
0 watts/minute un
ost-intervention hs follow-up
city measured withst
months and 12
city measured withk test (m)
Intervention
ds til
h
Control groupphysical exerIntervention gprogressive rof walking prereserve and tprescription
h
Control groupAerobic exercactivities at mResistance ethera-bands o
characteristics
p: instructed not torcise program group: home-baseresistance exercisescription at 60-70therapeutic resista
p: usual care cise group: weigh
moderate intensitiexercise group: spof weight equipme
KCE Report
o initiated any new
ed aerobic and se program consis0% of heart rate ance ban exercise
t-bearing aerobic es ecific exercises went
t 185
w
sting
e
with
KCE Report 185
4.6.3 FatiguFive studies remixed cancer pwhile 3 studies Estimates of ththe studies (TabBrown et al.2intervention (n=patients receiviwith 20 minutexercises of upwith elastic banto increase enprogram), follostrategies, discafter the intervPOMS Fatiguedifference was in the analysis components of Dodd et al.36 rcancer beginnexercise duringchemotherapy consisted of anphone calls). significant differ
5
ue eported on the epopulations26,29,33,3
had either a mode effect of exercible 22). 29 compared an=49) with usual ing radiotherapy. tes of exercise
pper and lower extnd, stretching exerndurance, relaxatiowed by educacussion and suppvention (week 4) e-Inertia subscalfound between thno difference wasthe intervention.
randomized 119 wing their first chg and after chem(n=36) or usual
n individualized hoFatigue was merence in fatigue sc
effect of exercise36,40. Two studies erate33,36 or high rse interventions o
n 8-session strcare (n=54) in The multidiscipl(consisting of s
tremities progressrcises, functional ion exercises an
ational informatioport. Fatigue wasand at follow-upe, SDS Fatigue
he exercise and cs made between t
women with breahemotherapy tre
motherapy (n=44)l care (n=39). Tome-based exerceasured using Pcores was found (
Exercise t
e treatment on fahad a low risk of risk of bias29. on fatigue differed
uctured multidisnewly diagnosedinary interventionseated range of sing to resistive elower extremity ed a individualize
on, cognitive-behs measured at b
p (week 8 and 27e, LASA. No sigcontrol group. Impthe effects of the
ast, colorectal or atment to indivi, after having co
The exercise intecise program (withPiper Fatigue Sc(p=0.084).
treatment for adult
atigue in bias26,40,
d across
ciplinary d cancer n started f motion xercises xercises
ed home havioural baseline, 7) using gnificant
portantly, different
ovarian dualized
ompleted ervention h weekly cale. No
AwcfoapmdcwMmthreBthCsasfob+
C•
t cancer patients
Adamsen et al.26
women with breascare (n=134). All por advanced diseactive treatment. Tprogram, combinmeasured using fdifference in fatigcontrol group (p=0weeks. Mustian et al.40 evmixed population herapy. The exeresistance training
BFI and FACIT-Ghe exercise groupCourneya et al.33 rsolid tumours to daaerobic exercise tscale. No significaor unadjusted grobut an improveme+9.1 for darbepoet
Conclusions Conflicting
treatment onof evidence;2009, Courne
randomized 269st cancer) to exerpatients had receiease or as adjuvThe exercise intering high and lofatigue subscale ue over time wa0.02) (estimated
valuated the effecof breast and pr
rcise intervention g. Fatigue was m. Both scales shop. randomized 55 marbepoetin alfa altraining (n=26). F
ant differences weoup differences, pent over time wastin alfa alone vs. +
evidence is avn fatigue in mixe Brown 2006, D
eya 2008).
9 patients with crcise treatment (nived at least one
vant treatment, anrvention consistedow intensity exeof the EORTC Q
as found betweenMD -6.6, 95%CI
ct of exercise trearostate cancer pa
consisted of a cmeasured with twowed an improvem
mild-to-moderately one (n=29) or com
Fatigue was measere found betweenp=0.388 for adjusts noticed (mean +7.8 for the exerc
vailable on theed cancer populaDodd 2010, Ada
cancer (includingn=135) or convencycle of chemothend were still reced of a 6-week exeercises. Fatigue QLQ-C30 A signin the intervention -12.3 to -0.9) af
atment on fatigueatients during radcombined walking
wo different scalesment in fatigue le
anaemic patientsmbined with a 12-sured using FAC
n both groups (p=0ted group differenchange from bas
cise group).
e effect of exeations (very low amsen 2009, Mu
51
g 119 tional erapy eiving ercise
was ficant
n and fter 6
e in a iation g and s, i.e. vel in
s with -week
CT-AN 0.694 nces), seline
ercise level
ustian
52
Table 22 – Effe
Study N
Brown 200629
N
Dodd 201036
N
ect of exercise tr
N Fatigue
N=103 At basebetweeactivity At weekscores overall both gromentionAt weektrend tocontrol p=0.065
N=119 No signchangin
reatment on fatig
e
eline: no significanen groups, except
(p=0.0445) k 4: overall higher(p=0.047) in exerno significant diffeoups at any weekned) k 8: no significantowards better fatiggroup (POMS Fa5 and SDS Fatigu
nificant group diffeng scores over tim
Exercise t
gue in mixed can
nt difference for POMS vigor
r fatigue QOL-rcise group, but erence between k (p-values not
t differences, but gue-score in atigue-inertia ue p=0.098)
erences in the me (p=0.084)
treatment for adult
ncer populations
Measure poin
Baseline (beforadiotherapy), week 8, week POMS (profile states) fatigue-POMS (profile states) vigor-aSDS (symptomscale) FatigueLASA (linear aself assessmelevel of fatigueSTAI (spielbertrait anxiety invfeel rested (onat baseline) Each score watransformed topoint scale, a 1difference is coas clinically sig
Baseline: weeksecond chemoT2: end of cantreatment (4-6 after baseline)study (approxiyear after basePiper Fatigue S
t cancer patients
nt Int
ore week 4, 27
of mood -inertia of mood ctivity
m distress
analogue nt) average
e rger’s state-ventory) I
nly assessed
as o a 0-100 10 point onsidered gnificant
CodeIntonupexfunenho
k before otherapy, ncer
months , T3: end of mately 1 eline) Scale
CoweIntphindpeco
tervention chara
ontrol group: standescribed) tervention group: ambulatory basis
pper and lower extxercises with elastnctional lower extrdurance, relaxatio
ome program
ontrol group: usuaeekly phone calls tervention group: one calls from ex
dividualized cardioer week, heart ratentinuous exercise
cteristics
dard medical care
eight 90-min sesss, seated range oftremities progresstic band, stretchinremity exercises ton exercises and
al care (no exercisby research nurseexercise prescript
xercise trainers, coovascular/aerobice at 60-80% VO2mes
KCE Report
e (not further
sions over 4 weekf motion exercisessing to resistive g exercises, to increase a individualized
se prescription) + e tion with weekly onsisting of c exercises, 3-5 timmax, 20-30 min of
t 185
ks s of
mes
KCE Report 185
Study N
Adamsen 200926
N
Mustian 200940
N
5
N Fatigue
N=269 Significgroups 95%CI
N=38 Exercisimprovepost-intcontinubaselind=-0.58Controlbetwee(Cohenbaselin(CohenNon-siggroup, cpost-intat 3-moExercisimprovepost-intcontinubaselin
e
cant difference ove(estimated mean-12.3 to -0.9, p=0
se group (BFI): smements between btervention (Cohened modest improve to 3-months foll
8) l group (BFI): sma
en baseline and pon’s d=-0.08) but woe and 3-months fo
n’s d=0.04) gnificant lower faticompared to conttervention (p=0.07onths follow-up (pse group (FACIT-Fements between btervention (Cohened modest improve to 3-months foll
Exercise t
er time between difference -6.6,
0.02)
mall baseline and n’s d=-0.15) and vements from low-up (Cohen’s
aller improvementost-intervention orsened between ollow-up
igue in exercise trol group, at 7) but significant <0.05) (BFI) F): small baseline and n’s d=0.29) and vements from low-up (Cohen’s
treatment for adult
Measure poin
Baseline and aintervention (6 EORTC-QLQ-subdomain fat
t
Baseline, afterintervention (4at 3-months fo FACIT-F BFI
t cancer patients
nt Int
after weeks)
C30, igue
Co+ eIntphhorepsebic3.7traseawma
r weeks) and
ollow-up
CotheIntho7 dbaexbo
tervention chara
ontrol group: allowexercise program tervention group: ysical training (30
ours, 45 min resistpetition maximumssion, 15 min cardcycles, 70-250W, 75 MET hours) foraining + 2 times pessions: relaxation
wareness and restassage (30 min tw
ontrol group: converapy) tervention group: ome-based, progredays a week for 4and program (modxercise, 7 days a wody)
cteristics
wed freely to increafter the six week6-week (9 h/week0 min dynamic exetance training at 7
m test at 4 MET hodiovascular trainin85-95% maximumr 90 min followed er week massagen (30 min, 4 times torative training (9wice a week)
ventional medical
radiation therapy+essive walking (60 weeks) and thera
derately intense prweek for 4 weeks,
ase physical activk assessment k) high intensity ercises at 4.5 ME
70-100% of one ours per training ng (stationary m heart rate at by 30 min relaxat
e. Low intensity per week, body
90 min once a wee
care (radiation
+ individually tailo0-70% of heart ratapeutic resistancerogressive resista focused on uppe
53
vity
T
tion
ek),
ored te, e ance er
54
Study N
Courneya 200833
N
N Fatigued=0.45)Controlbetwee(Cohenbaselin(CohenSignificgroup, cpost-intup (p<0
N=55 No sign(p=0.69p=0.388 Both gr
e ) l group (FACIT-F)
en baseline and pon’s d=-0.09) but ime and 3-months fo
n’s d=0.29) cant lower fatigue compared to conttervention and at 0.05) (FACIT-F)
nificant differences94 in unadjusted g8 for adjusted gro
roups improved fa
Exercise t
): a decline ost-intervention
mproved between ollow-up
in exercise trol group, at 3-months follow-
s between groupsgroup differences,oup differences)
atigue over time
treatment for adult
Measure poin
s ,
Baseline (withiprior to startingdarbepoetin alpost-interventioweeks after theexercise progrFACT-AN scal
t cancer patients
nt Int
in 10days g fa) and at on (1-2 e 12-week ram) le
Coproae3 tca
tervention chara
ontrol group: askeogram during inte
erobic exercise tratimes per week atpacity, for 12 wee
cteristics
ed not to initiate a rvention periodInt
aining ( cycle ergot 60-100% of baseeks
KCE Report
structured exercistervention group: metry sessions)
eline exercise
t 185
se
KCE Report 185
4.6.4 SafetyNo adverse eve
Conclusions • No eviden
5
y ents related to the
ce is available.
e exercise interven
Exercise t
ntion were reporte
treatment for adult
ed. 5TptridofubtrlyinwepOqFaeincliInothredHacainbcin
t cancer patients
5 DISCUSThis report providphysical exercise reatment with chdentified, with stuoutcomes of effeunction and fatigbenefits of exercisrue for most cancymphoma patienncluded outcomeswhy the exercise ieffect, since the populations in termOn the contrary, wquality of life or caFurthermore, theradjuvant therapy exercise-related anterpreted with cacancer types, hmitations. n systematic revieon the quality of this report, only veemaining had an
decision was madHowever, an adeqa very limited numconcealing allocaassociated with ovnterventions, inclblinding. The optiocommonly lackingncreased risk of b
SSION des an overview
interventions inemotherapy and/
udies on breast caectiveness, inclu
gue, there was nse, with trials oftecer types with th
nts that reporteds without the repintervention in thipatients in the
ms of age or treatmwe found no consardiopulmonary fure was some efor cancer patien
adverse events. Imaution due to the heterogeneity be
ews and guidelinethe supporting every few trials had either moderate
de from the startquate method of amber of the trials. ation sequencesverestimations of luding exercise, on of blinding the g in the study
biased assessmen
of studies that nvolving cancer p/or radiation. A toancer patients beiding quality of o clear or consis
en reporting conflie exception of th
d significantly poorting of adverses cancer type prostudy did not diment type. istent evidence th
unction, or increasvidence that exents, although notmportantly, our colow number of R
etween studies
es, evidence-basevidence. Of the 33
a low risk of bias(11 studies) or hit of the project t
allocation concealInadequate meth are prone to the intervention eit is not possiblassessment of odesigns. Conse
nt and inflated trea
evaluated a rangpatients during aotal of 33 RCTs ing most commonlife, cardiopulmo
stent evidence octing results. This
he study performeositive results o
e events. It is not oduced such a poiffer from other
hat exercise hampsed fatigue sympercise is safe dt all trials reporteonclusions need
RCTs included for and methodolo
ed conclusions de3 studies assesses (4 studies), whiligh risk (18 studieto include RCTs ment was describ
hods of generatingselection bias
effect54. In behave to perform doutcome measures
equently, there iatment effect.
55
ge of active were
n. For onary n the s was ed on on all
clear ositive study
pered toms.
during ed on to be most
ogical
epend ed for le the es). A
only. bed in g and
and ioural
ouble-s was s an
56
A number of stuthus failed to tathat efficacy esvalidity of the snot based on poDue to major patient demogrreceiving activetype. A generaadherence) anpopulation diffpopulations seland/or carefullyonly include Rexercise treatmFor other cancavailable, but tconclusions. The large variefrequency andsomewhat elusbased intervenonly possible fTherefore, it iintervention. Trecommendatiothat take canceExercise studiewith Belgian exwas defined focardiopulmonarpatients undergtypes of exercoutcomes it waof exercise, i.etypes on all rem
udies failed to anaake advantage of
stimates become tstudies are the relower calculationsdifferences in disraphics it was de cancer treatme
alization of the rend conclusions ferences in cancected for the trialsy screened befor
RCTs has led toment for those cacer types, evidenthis type of evid
ety of exercise inted duration madesive. An attempt ntions and aerobifor breast canceris impossible to
To allow for theons new studies ser type, stage and es often assess mxercise and cancor cancer patientry function, fatigugoing adjuvant tr
cise without the s not possible to
e. studies had comaining outcomes
alyze data on an f randomization atoo high. Additionlatively small sam. sease- and treat
decided to only tent and to synthesults (including thmight still not cer stage and s were often recrure participation. A a selective repncer types for wnce from observaence was not ta
erventions with ree a comparisonto compare inst
ic exercise with r and did not pro
o recommend ine development ohould focus on optreatment side-ef
multiple outcome mcer specialists a ls in the acute pe and safety. Thereatment for canrisk of major adelucidate consiste
onflicting results w.
Exercise t
intention-to treat and risking the ponally, a large threample sizes that we
ment-related facttreat studies onesize studies perhe reporting of ube appropriate treatment regimeuited on a voluntaAbove this, the cporting on the efhich RCTs are aational studies maken into accoun
espect to intensityof study interv
itution-based withresistance exerc
oduce consistent favour of a pof more cancerptimal exercise mffects into account
measures. In collalist of four key ouphase, i.e. qualityere is some evidecer can perform
dverse events. Foent results on the within the various
treatment for adult
principle ossibility at to the ere often
tors and patients
r cancer ptake or due to
es. The ary basis hoice to ffects of vailable.
might be nt in our
y, mode, ventions h home-cise was
results. particular r-specific odalities t.
aboration utcomes y of life, ence that
several or other benefits
s cancer
ThTsodosthdaadodmthradTtrsSimepvfo(reafoAesrec
t cancer patients
The large varietyhampered our abilThere were a brosame outcome. Woutcome conflictindifficult to assess or a result of diffescales. Within thehere seem to be adisease-specific inand patients first aare affected by a disease-specific ioverlooked. Prefedisease-specific ameasure, cardiopuhe included studiate, timed walking
direct comparison The literature sereatment for cansystematic reviewSports Medicine amportant bias anexpert panel, whicpresent report, focvery positive concor cancer patientIKNL) recently ehabilitation64. Pa
and was identifiedound as for the pA potential explaexclusively are bastudy, enabling a mefers to systema
cancer patients bo
y in outcome mlity to compare treoad selection of
When studies deplong results were whether the effec
erence in sensitive subjective outcoa lack of agreemenstrument. It can and foremost are disease. Howevenstrument there rably, studies sh
and a generic instulmonary functionies. A decision wg tests and VO2mof these measure
earch did not idcer patients in th
w. A consensus appears to be wind therefore not ch involved manycused on RCTs wclusions and recos. The Comprehepublished eviden
art of this guidelin through our searresent report, but
anation is that thased on a criticamore in-depth anatic reviews and m
oth in the acute an
measure points aeatment effects. outcome scales oyed more than ooften reported.
ct measure was dity among the larome measures, inent on whether to
be assumed thainterested in the
er, by only assessis a risk that imould measure qu
trument. Our primn, was measured was made to inclu
ax measures, withes might not be apdentify many guhe acute phase tguideline of the idely accepted63, included in our y authors of the with positive resu
ommendations aboensive Cancer Cence-based guidee was published arch1. In general, tht more positive cohe conclusions o
al appraisal at thealysis and criticismmeta-analyses thand post-acute trea
KCE Report
across studies fu
used to measurone scale for the
It was consequdue to the interverge variety of meancluding quality ouse a generic and
at health professidimensions of life
sing quality of lifemportant domainsuality of life by b
mary objective outin a variety of wa
ude measures of h the awareness tppropriate. uidelines on exethat were based American Collegbut was subjectevidence review.RCTs included i
ults and ended upout exercise treatentre The Netherelines on oncoloas a systematic rehe same evidence
onclusions were dof the present re level of the prm. The Dutch guidat included studie
atment phase9,25.
t 185
urther
re the same uently ntion, asure
of life, d/or a onals e that
e by a s are oth a come ays in heart that a
ercise on a
ge of ted to . The n the
p with tment rlands ogical eview e was rawn. report imary deline es on
KCE Report 185
Combination oheterogeneity ofor these guidein line with oursAccording to thprograms focusscope of the document for tcollaboration wthe acute phaspecific cancerrehabilitation pfact, a controlleevaluate the eftreatment and pFinally, it shoulhealth in genertrials and metamortality and th
5
of these trials in of the used outcoelines. Nevertheles (see Chapter 6).e consulted expes on the (post-acupresent report, the cancer guideith the College of
ase encompassinr types. Nevertheeriod after cance
ed trial is being seffectiveness of mpsychological supd be stressed tharal, regardless of a-analysis showedhe risk of cardiova
a meta-analysisome scales, was ss, the Dutch rec
erts, most Belgian ute) rehabilitation as it was intend
elines that are def Oncology, guideng diagnosis, steless, a separateer treatment contet up by Belgian remultimodality treat
port) after the treaat physical activity
the health statusd a positive effe
ascular disease65, 6
Exercise t
s, partly becauseconsidered inapp
commendations a
oncological rehaperiod. This was
ded to be a sueveloped by the lines that mainly faging and treatme report focusingtinues to be releehabilitation spectment (including atment for breast y has beneficial efs of a person. Nuct of physical ac66.
treatment for adult
e of the propriate re much
bilitation s not the upportive
KCE in focus on ment of
g on the evant. In cialists to exercise cancer. ffects on umerous ctivity on
66
6
t cancer patients
6 RECOM6.1 Clinical re
• In the abseffects of function treatment,favour of agenerally for healthHence, it iof the pati
• As there iwould be not be recommen
6.2 Research
• Since thereffectiveneand fatigupatients uneeded.
• For outcoshould uscommunityinstrumen
• For future magnitudesignificanc
MMENDATIOecommendatio
sence of consistenexercise treatme
and fatigue for , we cannot forma specific type of accepted counse (weak recommeis advisable to takent into account.is no consistent eharmful for cance
discouraged tndation; very low
h agenda
re is a lack of coness (in terms of que) and on safendergoing active
omes such as qse standardized,y should agree ot to render the resstudies it is cruci
e of effect for oce.
ONS ns
nt evidence on thent on quality ofr cancer patientulate more precisexercise treatme
elling that physicaendation; very loke the local conte
evidence either ther patients under to do physicalevel of evidence)
sistent and high-qquality of life, carety of exercise treatment, large
uality of life and validated scale
on a generic and sults comparable.ial to pre-define moutcome measur
e short-term benef life, cardiopulmots undergoing ase recommendatint, over and aboval activity is bene
ow level of evidext and the prefere
hat exercise treattreatment, they sal activities. ().
quality evidence ordiopulmonary funtreatment for cahigh-quality RCT
d fatigue, researes and the rese
on a disease-sp
main outcomes anres based on cl
57
eficial onary active ion in ve the eficial ence). ences
tment hould (weak
on the nction ancer
Ts are
chers earch
pecific
nd the linical
58
7 APPEN7.1 Append7.1.1 AMST
Question
1. Was an ‘a prThe research q
2. Was there dThere should be
3. Was a compAt least two eleMEDLINE). Keyshould be suppstudy, and by re
4. Was the statThe authors shexcluded any re
NDICES dix 1: Quality aTAR
riori’ design provuestion and inclus
uplicate study se at least two inde
prehensive literatectronic sources y words and/or Mplemented by coneviewing the refer
tus of publicatioould state that theeports (from the sy
appraisal instru
vided? sion criteria shoul
election and datependent data ext
ture search perfoshould be search
MESH terms musnsulting current crences in the stud
on (i.e. grey literaey searched for reystematic review)
Exercise t
ments
d be established
a extraction? tractors and a con
ormed? hed. The report mst be stated and contents, reviewsies found.
ature) used as aneports regardless), based on their p
treatment for adult
before the conduc
nsensus procedur
must include yeawhere feasible th, textbooks, spec
n inclusion criters of their publicatiopublication status,
t cancer patients
ct of the review.
re for disagreeme
rs and databaseshe search strategcialized registers,
rion? on type. The auth language etc.
nts should be in p
s used (e.g. Cengy should be prov or experts in th
hors should state w
place.
tral, EMBASE, anvided. All searche particular field
whether or not th
KCE Report
Answer
� Yes � No � Can’t answ� Not applic
� Yes � No � Can’t answ� Not applic
nd es of
� Yes � No � Can’t answ� Not applic
ey � Yes � No � Can’t answ� Not applic
t 185
wer able
wer able
wer able
wer able
KCE Report 185
Question
5. Was a list ofA list of include
6. Were the chIn an aggregateThe ranges of severity, or othe
7. Was the scie‘A priori’ methodouble-blind, plrelevant.
8. Was the scieThe results of texplicitly stated
9. Were the meFor the pooled for homogeneitshould be taken
5
f studies (included and excluded st
aracteristics of ted form such as acharacteristics in
er diseases shoul
entific quality of ods of assessmenacebo controlled
entific quality of the methodologica in formulating rec
ethods used to cresults, a test sh
ty, I²). If heterogen into consideratio
ed and excludedtudies should be p
the included studa table, data from n all the studies d be reported.
the included stunt should be provstudies, or alloca
the included stual rigor and scientcommendations.
combine the findiould be done to e
eneity exists a raon (i.e. is it sensib
Exercise t
d) provided? provided.
dies provided? the original studieanalyzed e.g. ag
udies assessed avided (e.g., for efftion concealment
udies used approtific quality should
ings of studies aensure the studie
andom effects moble to combine?).
treatment for adult
es should be provge, race, sex, rel
and documentedfectiveness studiet as inclusion crite
opriately in formud be considered i
appropriate? s were combinab
odel should be us
t cancer patients
vided on the particevant socioecono
d? es if the author(seria); for other type
ulating conclusion the analysis an
ble, to assess theised and/or the cl
cipants, interventiomic data, diseas
) chose to includees of studies alter
ons? d the conclusions
ir homogeneity (i.linical appropriate
ions and outcomese status, duratio
e only randomizernative items will b
s of the review, an
e. Chi-squared teeness of combinin
Answer
� Yes � No � Can’t answ� Not applic
es. on,
� Yes � No � Can’t answ� Not applic
ed, be
� Yes � No � Can’t answ� Not applic
nd � Yes � No � Can’t answ� Not applic
est ng
� Yes � No � Can’t answ� Not applic
59
wer able
wer able
wer able
wer able
wer able
60
Question
10. Was the likAn assessmenttests (e.g., Egg
11. Was the coPotential source
7.1.2 Cochr
Domain
Selection bias
Random seque
Allocation con
Performance b
Blinding of papersonnel Assessments each main outoutcomes)
kelihood of publit of publication biaer regression test
onflict of interestes of support shou
rane Collaborati
ence generation
ncealment
bias
rticipants and
should be madecome (or class o
cation bias asseas should include t).
t stated? uld be clearly ack
ion’s tool for ass
Suppo
Describsequenwhethe
Describsequeninterveadvanc
for of
Describparticipinterverelating
Exercise t
essed? a combination of
knowledged in bot
sessing risk of bi
ort for judgement
be the method usnce in sufficient deer it should produc
be the method usnce in sufficient dention allocations c
ce of, or during, en
be all measures upants and personnntion a participang to whether the in
treatment for adult
f graphical aids (e
th the systematic r
ias
t
ed to generate theetail to allow an ace comparable gro
ed to conceal the etail to determine could have been fnrolment
used, if any, to blinnel from knowledgt received. Providntended blinding w
t cancer patients
e.g., funnel plot, ot
review and the inc
e allocation ssessment of oups
allocation whether
foreseen in
nd study ge of which de any informationwas effective
ther available test
cluded studies.
Review auth
Selection biasdue to inadeqsequence
Selection biasdue to inadeqto assignmen
n
Performance interventions the study
ts) and/or statistic
hors’ judgement
s (biased allocatioquate generation o
s (biased allocatioquate concealmennt
bias due to knowby participants an
KCE Report
Answer
cal � Yes � No � Can’t answ� Not applic
� Yes � No � Can’t answ� Not applic
on to interventionsof a randomised
on to interventionsnt of allocations pr
wledge of the allocnd personnel duri
t 185
wer able
wer able
s)
s) rior
cated ng
KCE Report 185
Domain
Detection bias
Blinding of ouAssessments each main outoutcomes)
Attrition bias
Incomplete ouAssessments each main outoutcomes)
Reporting bias
Selective repo
Other bias
Other sources
5
s
tcome assessmeshould be madecome (or class o
tcome data should be madecome (or class o
s
orting
s of bias
Suppo
ent for
of
Describassessparticipwhethe
for of
Describoutcomanalysireporte(compaattritionanalyse
State hexamin
State athe othIf particreview’questio
Exercise t
ort for judgement
be all measures usors from knowledpant received. Proer the intended bli
be the completeneme, including attritis. State whether
ed, the numbers inared with total rann/exclusions wheres performed by t
how the possibilityned by the review
any important conher domains in thecular questions/en’s protocol, responon/entry
treatment for adult
t
used, if any, to blindge of which intervovide any informatnding was effectiv
ess of outcome daion and exclusionattrition and exclu
n each interventiondomized participare reported, and athe review authors
y of selective outcauthors, and wha
cerns about bias e tool ntries were prespenses should be pr
t cancer patients
nd outcome vention a tion relating to ve
ata for each mainns from the usions were n group ants), reasons for any reinclusions ins
ome reporting waat was found
not addressed in
ecified in the rovided for each
Review auth
Detection biainterventions
rn
Attrition bias incomplete ou
as Reporting bia
Bias due to ptable
hors’ judgement
as due to knowledby outcome asse
due to amount, nautcome data
as due to selective
problems not cove
ge of the allocateessors
ature or handling
e outcome reporti
ered elsewhere in
61
d
of
ng
the
62
7.2 Append7.2.1 Syste
7.2.1.1 OV1 exp Ne2 Neopla3 cancer$4 tumor$5 tumour6 carcino7 neoplas8 lympho9 melano10 staging11 metasta12 metasta13 exp Ne14 exp neo15 neoplas16 non sm17 adenoc18 squamo19 nsclc.ti20 osteosa21 phyllod22 cystosa23 fibroade24 (non ad25 (non ad26 (nonsm27 plasma28 myelom29 multiple30 lympho31 lympho32 lympho
dix 2: Search smatic reviews
VID Medline eoplasms/ (232736asm Staging/ (103$.ti,ab. (863951) .ti,ab. (820330)
r$.ti,ab. (175521) oma$.ti,ab. (40779sm$.ti,ab. (85745
oma.ti,ab. (97206)oma.ti,ab. (64929)g.ti,ab. (41905) as$.ti,ab. (183033atic.ti,ab. (117234
eoplasm Metastasoplastic processestic process$.ti,ab
mall cell.ti,ab. (235carcinoma$.ti,ab. ous cell.ti,ab. (554,ab. (12889) arcoma$.ti,ab. (13es.ti,ab. (1142)
arcoma$.ti,ab. (54enoma$.ti,ab. (27dj small adj cell).tidj2 small adj2 cell
mall adj2 cell).ti,abacytoma$.ti,ab. (49ma.ti,ab. (31766) e myeloma.ti,ab. (oblastoma$.ti,ab. (ocytoma$.ti,ab. (25osarcoma$.ti,ab. (3
syntax by datab
65) 545)
98) ) ) )
3) 4) is/ (141345) s/ (298816) b. (2088) 591) (81736) 422)
3022)
44) 715) ,ab. (23591) ).ti,ab. (23800)
b. (1482) 946)
(19914) (259) 52) 3572)
Exercise t
base
treatment for adultt cancer patients
33 immunocy34 sarcoma$35 hodgkin$.t36 (nonhodgk37 or/1-36 (2638 exp Exerc39 exp Exerc40 exp Exerc41 exp Muscu42 Rehabilita43 "Physical T44 Exercise M45 "physical t46 "physical f47 motor acti48 (treatment49 (treatment50 (therapy a51 (training a52 (fitness ad53 (activity ad54 (movemen55 (treatment56 (therapy a57 (training a58 (fitness ad59 (activity ad60 (movemen61 (physical a62 rehabilitat63 or/38-62 (364 37 and 6365 meta-anal66 review.pt. 67 search:.tw68 or/65-67 (69 64 and 68
ytoma.ti,ab. (400).ti,ab. (65098) ti,ab. (47627) kin$ or non hodgk667070)
cise/ (58830) cise Therapy/ (246cise Therapy/ (246uloskeletal Manip
ation/ (16315) Therapy (SpecialtMovement Technitraining".mp. (395fitness".mp. (2094vity.mp. or Motor t adj3 exercise) {It adj3 exercise).m
adj3 exercise).mp.adj3 exercise).mp.dj3 exercise).mp. dj3 exercise).mp. nt adj3 exercise).mt adj3 physical).m
adj3 physical).mp.adj3 physical).mp. dj3 physical).mp. (dj3 physical).mp. nt adj3 physical).mand exercise).mp.ion.mp. (98440) 351321)
3 (13676) ysis.mp,pt. (5035(1707163)
w. (174318) 1843870)
8 (2608)
kin$).ti,ab. (27245
668) 668) ulations/ (10808)
ty)"/ (1843) iques/ (271)
57) 47) Activity/ (73372)ncluding Related
mp. (1965) . (23618) (9686) (671) (2519)
mp. (421) mp. (2736)
(31743) (14740)
(21202) (40715)
mp. (300) . (80606)
55)
KCE Report
5)
Terms} (8200)
t 185
KCE Report 185
70 limit 69
7.2.1.2 OV1 tumor$2 tumour3 carcino4 neoplas5 lympho6 melano7 Staging8 metasta9 metasta10 neoplas11 non sm12 adenoc13 squamo14 nsclc.a15 osteosa16 phyllod17 cystosa18 fibroade19 (non ad20 (non ad21 (nonsm22 plasma23 myelom24 multiple25 lympho26 lympho27 lympho28 immono29 sarcom30 hodgkin31 (nonho32 cancer$33 or/1-3234 "physic
5
9 to yr="2002 - 201
VID PreMedline .ab,ti. (31351)
r$.ab,ti. (7527) oma$.ab,ti. (15670sm$.ab,ti. (2990)
oma.ab,ti. (3167) oma$.ab,ti. (2194)g.ab,ti. (1846) as$.ab,ti. (7988) atic.ab,ti. (5370) stic process$.ab,t
mall cell.ab,ti. (170carcinoma$.ab,ti. ous cell.ab,ti. (237b,ti. (1139) arcoma$.ab,ti. (46es.ab,ti. (40)
arcoma$.ab,ti. (10enoma$.ab,ti. (98dj small adj cell).adj2 small adj2 cell
mall adj2 cell).ab,tiacytoma$.ab,ti. (88ma.ab,ti. (967) e myeloma.ab,ti. (oblastoma$.ab,ti. (ocytoma$.ab,ti. (5)osarcoma$.ab,ti. (7ocytoma.ab,ti. (0)
ma$.ab,ti. (2641) n$.ab,ti. (1246) dgkin$ or non hod$.ab,ti. (43124)
2 (79297) cal training".mp. (1
11" (1685)
0)
)
ti. (59) 07) (3200) 77)
69)
0) 8) ab,ti. (1707) ).ab,ti. (1712) . (92) 8)
(742) (11) ) 78)
dgkin$).ab,ti. (772
112)
Exercise t
2)
treatment for adultt cancer patients
35 "physical f36 motor acti37 (treatment38 (treatment39 (therapy a40 (training a41 (fitness ad42 (activity ad43 (movemen44 (treatment45 (therapy a46 (training a47 (fitness ad48 (activity ad49 (movemen50 (physical a51 rehabilitat52 or/34-51 (953 33 and 5254 meta-anal55 review.pt. 56 search:.tw57 or/54-56 (58 53 and 5759 limit 58 to
fitness".mp. (244)vity.mp. (259) t adj3 exercise) (2t adj3 exercise).m
adj3 exercise).mp.adj3 exercise).mp.dj3 exercise).mp. dj3 exercise).mp. nt adj3 exercise).mt adj3 physical).m
adj3 physical).mp.adj3 physical).mp. dj3 physical).mp. (dj3 physical).mp. nt adj3 physical).mand exercise).mp.ion.mp. (4218) 9491)
2 (465) ysis.mp,pt. (2791(463)
w. (14775) 16781)
7 (25) yr="2002 - 2011"
)
2720) mp. (118) . (191) (473) (46) (158)
mp. (15) mp. (191)
(763) (181)
(299) (2993)
mp. (24) . (1536)
)
(23)
63
64
7.2.1.3 EM'neoplasm'/exp 'oncogenesis aexercise OR 'mmovement ORtherapy)) ORtherapy'/exp O'locomotion'/expnear AND ('thernear AND ('th('exercise'/exp ('exercise'/exp movement)) O('rehabilitation'/e('rehabilitation'/e'physical trainin(2002:py OR 2OR 2008:py O([cochrane revie
7.2.1.4 Coc#1 MeSH d#2 MeSH d#3 cancer*#4 tumor*:#5 tumour*#6 carcino#7 neoplas#8 lympho#9 melano#10 staging#11 metasta#12 MeSH d#13 MeSH d
MBASE OR 'cancer
and malignant tramotor activity'/exp R ('exercise'/exp 'rehabilitation'/eOR 'physical thp OR locomotion rapy'/exp OR ther
herapy'/exp OR tOR exercise)) OOR exercise
OR ('exercise'/eexp OR rehabilexp OR rehabilng' OR 'physical003:py OR 2004
OR 2009:py OR ew]/lim OR [meta
chrane Library descriptor Neopladescriptor Neopla*:ti,ab ti,ab *:ti,ab
oma*:ti,ab sm*:ti,ab
oma:ti,ab oma:ti,ab :ti,ab a*:ti,ab descriptor Neopladescriptor Neopla
staging'/exp ORansformation'/exp OR 'motor activity
OR exercise exp OR rehabherapy' OR ('gOR motor AND a
rapy)) OR ('exercitherapy)) OR (p
OR (physical ANDAND near AND
exp OR exercitation)) OR (phlitation)) OR 'phl fitness'/exp OR:py OR 2005:py 2010:py OR 201analysis]/lim OR
asms explode all tasm Staging, this t
asm Metastasis exastic Processes ex
Exercise t
R 'metastasis'/eAND ('exercise'/
y' OR 'movement'AND ('therapy'/ebilitation OR 'gait'/exp OR gctivity) OR (physise'/exp OR exerchysical AND ne
D near AND activD ('movement'/e
cise AND neahysical AND neahysical training'/e
R 'physical fitnessOR 2006:py OR 11:py OR 2012:p[systematic review
rees term only
xplode tree 1 xplode tree 1
treatment for adult
xp OR /exp OR /exp OR exp OR 'physical ait OR cal AND
cise AND ar AND vity) OR exp OR r AND ar AND exp OR s') AND 2007:py
py) AND w]/lim)
######################
####
t cancer patients
#14 neoplastic#15 non small #16 adenocarc#17 squamous#18 nsclc:ti,ab#19 osteosarco#20 phyllodes:#21 cystosarco#22 fibroadeno#23 (non NEXT#24 (nonsmall #25 plasmacyt#26 myeloma:t#27 lymphobla#28 lymphocyt#29 lymphosar#30 immunocy#31 sarcoma*:#32 hodgkin*:t#33 nonhodgk#34 non hodgk#35 (#1 OR #2
#10 OR #1#18 OR #1#26 OR #2#34)
#36 MeSH des#37 MeSH des#38 MeSH des#39 MeSH des
c process*:ti,ab cell:ti,ab
cinoma*:ti,ab s cell:ti,ab oma*:ti,ab ti,ab oma*:ti,ab oma*:ti,ab T small NEXT celNEAR/2 cell):ti,ab
toma*:ti,ab ti,ab
astoma*:ti,ab toma*:ti,ab rcoma*:ti,ab ytoma:ti,ab ti,ab
ti,ab in*:ti,ab kin*:ti,ab 2 OR #3 OR #4 O11 OR #12 OR #119 OR #20 OR #227 OR #28 OR #2
scriptor Exercise escriptor Exercise Tscriptor Musculoskscriptor Rehabilita
l):ti,ab b
OR #5 OR #6 OR13 OR #14 OR #121 OR #22 OR #229 OR #30 OR #3
explode tree 1 Therapy explode tkeletal Manipulati
ation, this term onl
KCE Report
R #7 OR #8 OR #15 OR #16 OR #123 OR #24 OR #231 OR #32 OR #3
tree 1 ons explode tree ly
t 185
#9 OR 7 OR
25 OR 33 OR
1
KCE Report 185
#40 MeSH d#41 MeSH d#42 physica#43 physica#44 motor a#45 MeSH d#46 (treatm#47 (therap#48 (training#49 (fitness#50 (activity#51 (movem#52 (treatm#53 (therap#54 (training#55 (fitness#56 (activity#57 (movem#58 (physic#59 rehabili#60 (#36 O
OR #44OR #52#59)
#61 (#35 AN#62 (#61), f
5
descriptor Physicadescriptor Exercisal training:ti,ab al fitness:ti,ab activity:ti,ab descriptor Motor Aent NEAR/3 exercy NEAR/3 exercisg NEAR/3 exercis
s NEAR/3 exercisey NEAR/3 exercisement NEAR/3 exeent NEAR/3 physy NEAR/3 physicag NEAR/3 physica
s NEAR/3 physicay NEAR/3 physicament NEAR/3 phyal NEXT exercisetation:ti,ab R #37 OR #38 O4 OR #45 OR #462 OR #53 OR #5
ND #60) from 2001 to 2012
al Therapy Speciase Movement Tec
Activity, this term cise):ti,ab se):ti,ab se):ti,ab e):ti,ab e):ti,ab rcise):ti,ab
sical):ti,ab al):ti,ab al):ti,ab l):ti,ab
al):ti,ab ysical):ti,ab e):ti,ab
OR #39 OR #40 O6 OR #47 OR #4854 OR #55 OR #
2
Exercise t
alty, this term onlychniques, this term
only
OR #41 OR #42 8 OR #49 OR #50 #56 OR #57 OR
treatment for adult
y m only
OR #43 OR #51 #58 OR
7
7123456789111111111122222222
t cancer patients
7.2.2 Random
7.2.2.1 OVID exp Neoplasms
2 Neoplasm Stag3 cancer$.ab,ti. (84 tumor$.ab,ti. (795 tumour$.ab,ti. (16 carcinoma$.ab,t7 neoplasm$.ab,t8 lymphoma.ab,ti.9 melanoma.ab,ti
0 staging.ab,ti. (41 metastas$.ab,t2 metastatic.ab,t3 exp Neoplasm4 exp Neoplastic5 neoplastic proc6 non small cell.7 adenocarcinom8 squamous cell9 nsclc.ab,ti. (12
20 osteosarcoma21 phyllodes.ab,ti22 cystosarcoma$23 fibroadenoma$24 (non adj small 25 (non adj2 sma26 (nonsmall adj227 plasmacytoma
mized controlled t
Medline / (2100323) ing/ (101800) 837076) 96216) 174567) ti. (398903) i. (84170) . (94917) . (63512) 41340) ti. (178868) ti. (114774)
m Metastasis/ (138c Processes/ (292cess$.ab,ti. (2068ab,ti. (23260)
ma$.ab,ti. (79787)l.ab,ti. (54228)
2735) $.ab,ti. (12755) i. (1125) $.ab,ti. (538) $.ab,ti. (2675) adj cell).ab,ti. (23ll adj2 cell).ab,ti. (
2 cell).ab,ti. (1462a$.ab,ti. (4865)
trials
8329) 2261) 8)
)
3260) (23454) )
65
66
28 myeloma.ab29 multiple my30 lymphoblas31 lymphocyto32 lymphosarc33 immunocyto34 sarcoma$.a35 hodgkin$.ab36 (nonhodgkin37 1 or 2 or 3
15 or 16 or 27 or 2
38 exp Exercis39 exp Exercis40 exp Muscul41 Rehabilitatio42 Physical Th43 Exercise Mo44 physical tra45 physical fitn46 motor activi47 (treatment a48 (therapy adj49 (training adj50 (fitness adj351 (activity adj352 (movement 53 (treatment a54 (therapy adj55 (training adj
b,ti. (31190) yeloma.ab,ti. (1947toma$.ab,ti. (249)ma$.ab,ti. (252)
coma$.ab,ti. (3533oma.ab,ti. (397) ab,ti. (63959) b,ti. (46774) n$ or non hodgkinor 4 or 5 or 6 or 7or 17 or 18 or 19
28 or 29 or 30 or 3se/ (90515) se Therapy/ (2405oskeletal Manipulon/ (15723)
herapy Specialty/ (ovement Techniqining.mp. (3895)
ness.mp. (20540) ty.mp. or Motor A
adj3 exercise).mpj3 exercise).mp. (j3 exercise).mp. (3 exercise).mp. (63 exercise).mp. (2adj3 exercise).m
adj3 physical).mpj3 physical).mp. (j3 physical).mp. (
70) )
3)
n$).ab,ti. (26683)7 or 8 or 9 or 10 o9 or 20 or 21 or 231 or 32 or 33 or
53) lations/ (10765)
(1834) ues/ (254)
Activity/ (70785) p. (1913) (22952) 9422)
654) 2445) p. (402) . (2672) 31510) 14583)
Exercise t
or 11 or 12 or 13 22 or 23 or 24 or 234 or 35 or 36 (25
treatment for adult
or 14 or 25 or 26 556911)
555566
6666
734567891111111122
t cancer patients
56 (fitness adj3 ph57 (activity adj3 p58 (movement ad59 (physical and e60 rehabilitation.m61 38 or 39 or 40
50 or 51 or(365943)
62 37 and 61 (13263 62 (13200) 64 limit 63 to yr="65 limit 64 to rand
7.2.2.2 OVID 3 cancer$.ab,ti. (44 tumor$.ab,ti. (305 tumour$.ab,ti. (76 carcinoma$.ab,t7 neoplasm$.ab,t8 lymphoma.ab,ti.9 melanoma.ab,ti
0 staging.ab,ti. (1 metastas$.ab,t2 metastatic.ab,t5 neoplastic proc6 non small cell.7 adenocarcinom8 squamous cell9 nsclc.ab,ti. (10
20 osteosarcoma21 phyllodes.ab,ti
hysical).mp. (2078physical).mp. (394dj3 physical).mp. (exercise).mp. (79mp. (96515) 0 or 41 or 42 or 4r 52 or 53 or 54
200)
2010 -Current" (1domized controlled
PreMedline 41236) 0141) 7065) ti. (15000) i. (2928) . (2987) . (2043) 1772) ti. (7702) ti. (5133) cess$.ab,ti. (55) ab,ti. (1557)
ma$.ab,ti. (3047)l.ab,ti. (2231)
020) $.ab,ti. (460) i. (43)
88) 437) 290) 111)
3 or 44 or 45 or 44 or 55 or 56 or
823) d trial (191)
KCE Report
46 or 47 or 48 or 57 or 58 or 59 o
t 185
49 or or 60
KCE Report 185
22 cystosarcom23 fibroadenom24 (non adj sm25 (non adj2 sm26 (nonsmall a27 plasmacyto28 myeloma.ab29 multiple my30 lymphoblas31 lymphocyto32 lymphosarc33 immunocyto34 sarcoma$.a35 hodgkin$.ab36 (nonhodgkin37 3 or 4 or 5
or 19 or 30 or 31
44 physical tra45 physical fitn46 motor activi47 (treatment a48 (therapy adj49 (training adj50 (fitness adj351 (activity adj352 (movement 53 (treatment a54 (therapy adj55 (training adj
5
ma$.ab,ti. (9) ma$.ab,ti. (95)
mall adj cell).ab,ti. mall adj2 cell).ab,
adj2 cell).ab,ti. (87ma$.ab,ti. (93) b,ti. (932)
yeloma.ab,ti. (711)toma$.ab,ti. (11) ma$.ab,ti. (5)
coma$.ab,ti. (79) oma.ab,ti. (1) ab,ti. (2568) b,ti. (1179) n$ or non hodgkinor 6 or 7 or 8 or 920 or 21 or 22 oror 32 or 33 or 34 ining.mp. (118)
ness.mp. (239) ty.mp. (264)
adj3 exercise).mpj3 exercise).mp. (j3 exercise).mp. (3 exercise).mp. (43 exercise).mp. (1adj3 exercise).m
adj3 physical).mpj3 physical).mp. (j3 physical).mp. (
(1557) ti. (1562)
7)
)
n$).ab,ti. (735) 9 or 10 or 11 or 1r 23 or 24 or 25 oor 35 or 36 (7598
p. (116) (191) 459)
46) 153) p. (16) . (178) 745) 185)
Exercise t
12 or 15 or 16 or or 26 or 27 or 28 88)
treatment for adult
17 or 18 or 29 or
555566
6666
7'n'otulyOA(sp(cmlyOnOOthOlo((O
t cancer patients
56 (fitness adj3 ph57 (activity adj3 p58 (movement ad59 (physical and e60 rehabilitation.m61 44 or 45 or 46
56 or 57 or 62 37 and 61 (44563 62 (445) 64 limit 63 to yr="65 limit 64 to rand
7.2.2.3 EMBAneoplasm'/exp Ooncogenesis andumor*:ab,ti OR tuymphoma:ab,ti OOR metastatic:ab,AND small:ab,ti squamous:ab,ti A
phyllodes:ab,ti Onon:ab,ti AND sm
cell):ab,ti OR (nomyeloma:ab,ti ymphoblastoma*:OR immunocytomnonhodgkin*:ab,ti OR exercise OR 'mOR movement Oherapy)) OR 'rehaOR 'physical theocomotion OR 'therapy'/exp OR 'therapy'/exp OR
OR exercise)) OR
hysical).mp. (288)physical).mp. (277dj3 physical).mp. (exercise).mp. (14mp. (3986) 6 or 47 or 48 or 458 or 59 or 60 (905)
2010 -Current" (3domized controlled
ASE OR 'cancer stad malignant tranumour*:ab,ti OR c
OR melanoma:ab,,ti OR (neoplastic
AND cell:ab,AND cell:ab,ti) OROR cystosarcomamall:ab,ti AND nexonsmall NEAR/2
OR (multiple:ab,ti OR lymphocma:ab,ti OR saOR (non:ab,ti A
motor activity'/expOR ('exercise'/expabilitation'/exp ORrapy' OR ('gait'/emotor AND acttherapy)) OR ('extherapy)) OR (p
R (physical AND n
) 72) 23) 98)
9 or 50 or 51 or 5005)
313) d trial (2)
aging'/exp OR nsformation'/exp carcinoma*:ab,ti O,ti OR staging:ab
c:ab,ti AND proces,ti) OR adeno
R nsclc:ab,ti OR oa*:ab,ti OR fib
xt:ab,ti AND cell:abcell):ab,ti OR plaab,ti AND cytoma*:ab,ti ORarcoma*:ab,ti ORND hodgkin*:ab,t
p OR 'motor activip OR exercise AR rehabilitation ORexp OR gait ORtivity) OR (physxercise'/exp OR exphysical AND neaear AND activity)
52 or 53 or 54 or
'metastasis'/exp OR cancer*:ab,t
OR neoplasm*:abb,ti OR metastasss*:ab,ti) OR (nonocarcinoma*:ab,ti osteosarcoma*:abbroadenoma*:ab,tib,ti) OR (small NEasmacytoma*:ab,myeloma:ab,ti)
R lymphosarcomaR hodgkin*:ab,titi) AND ('exerciseity' OR 'movemen
AND ('therapy'/exR 'physical therapR 'locomotion'/expical AND near xercise AND nearar AND ('exerciseOR ('exercise'/ex
67
55 or
OR ti OR ,ti OR *:ab,ti n:ab,ti
OR ,ti OR OR
EAR/2 ti OR
OR *:ab,ti i OR e'/exp nt'/exp p OR y'/exp p OR
AND r AND e'/exp xp OR
68
exercise AND('exercise'/exp rehabilitation)) rehabilitation)) Ofitness'/exp ORAND [embase]/
7.2.2.4 CEN#1 MeSH d#2 MeSH d#3 cancer*#4 tumor*:#5 tumour*#6 carcino#7 neoplas#8 lympho#9 melano#10 staging#11 metasta#12 MeSH d#13 MeSH d#14 neoplas#15 non sm#16 adenoc#17 squamo#18 nsclc:ti,#19 osteosa#20 phyllod#21 cystosa#22 fibroade#23 (non NE
D near AND OR exercise AOR (physical A
OR 'physical trainR 'physical fitnes/lim AND [2001-20
NTRAL descriptor Neopladescriptor Neopla*:ti,ab ti,ab *:ti,ab
oma*:ti,ab sm*:ti,ab
oma:ti,ab oma:ti,ab :ti,ab a*:ti,ab descriptor Neopladescriptor Neoplastic process*:ti,ab
mall cell:ti,ab carcinoma*:ti,ab ous cell:ti,ab ,ab arcoma*:ti,ab es:ti,ab
arcoma*:ti,ab enoma*:ti,ab EXT small NEXT
('movement'/exp AND near ANDAND near AND
ning'/exp OR 'physss') AND [random012]/py
asms explode all tasm Staging, this t
asm Metastasis exastic Processes exb
cell):ti,ab
Exercise t
OR movemen ('rehabilitation'/e
D ('rehabilitation'/esical training' OR mized controlled
rees term only
xplode tree 1 xplode tree 1
treatment for adult
nt)) OR exp OR exp OR 'physical trial]/lim
############
##############
t cancer patients
#24 (nonsmall #25 plasmacyt#26 myeloma:t#27 lymphobla#28 lymphocyt#29 lymphosar#30 immunocy#31 sarcoma*:#32 hodgkin*:t#33 nonhodgk#34 non hodgk#35 (#1 OR #2
#10 OR #1#18 OR #1#26 OR #2#34)
#36 MeSH des#37 MeSH des#38 MeSH des#39 MeSH des#40 MeSH des#41 MeSH des#42 physical tr#43 physical fit#44 motor activ#45 MeSH des#46 (treatment#47 (therapy N#48 (training N#49 (fitness NE
NEAR/2 cell):ti,abtoma*:ti,ab ti,ab
astoma*:ti,ab toma*:ti,ab rcoma*:ti,ab ytoma:ti,ab ti,ab
ti,ab in*:ti,ab kin*:ti,ab 2 OR #3 OR #4 O11 OR #12 OR #119 OR #20 OR #227 OR #28 OR #2
scriptor Exercise escriptor Exercise Tscriptor Musculoskscriptor Rehabilitascriptor Physical Tscriptor Exercise Mraining:ti,ab tness:ti,ab vity:ti,ab scriptor Motor Actt NEAR/3 exercise
NEAR/3 exercise):NEAR/3 exercise):EAR/3 exercise):t
b
OR #5 OR #6 OR13 OR #14 OR #121 OR #22 OR #229 OR #30 OR #3
explode tree 1 Therapy explode tkeletal Manipulati
ation, this term onlTherapy SpecialtyMovement Techni
ivity, this term onle):ti,ab :ti,ab ti,ab i,ab
KCE Report
R #7 OR #8 OR #15 OR #16 OR #123 OR #24 OR #231 OR #32 OR #3
tree 1 ons explode tree ly
y, this term only iques, this term on
ly
t 185
#9 OR 7 OR
25 OR 33 OR
1
nly
KCE Report 185
#50 (activity#51 (movem#52 (treatm#53 (therap#54 (training#55 (fitness#56 (activity#57 (movem#58 (physic#59 rehabili#60 (#36 O
OR #44OR #52#59)
#61 (#35 AN#62 (#61), f
5
y NEAR/3 exercisement NEAR/3 exeent NEAR/3 physy NEAR/3 physicag NEAR/3 physica
s NEAR/3 physicay NEAR/3 physicament NEAR/3 phyal NEXT exercisetation:ti,ab R #37 OR #38 O4 OR #45 OR #462 OR #53 OR #5
ND #60) from 2001 to 2012
e):ti,ab rcise):ti,ab
sical):ti,ab al):ti,ab al):ti,ab l):ti,ab
al):ti,ab ysical):ti,ab e):ti,ab
OR #39 OR #40 O6 OR #47 OR #4854 OR #55 OR #
2
Exercise t
OR #41 OR #42 8 OR #49 OR #50 #56 OR #57 OR
treatment for adult
OR #43 OR #51 #58 OR
t cancer patients 69
70
7.3 AppendInstitution-bas
Outcome N st
QOL 5
QOL, physical subscale
4
Home-based e
Outcome N st
QOL 5
QOL, physical subscale
5
Aerobic exerci
Outcome N st
QOL 8
QOL, physical subscale
7
Resistance exe
Outcome N st
QOL 1
dix 3: GRADE sed exercise trea
tudies Risk of
-1
-1
exercise treatmen
tudies Risk of
-2
-2
ise treatment for
tudies Risk of
-1
-1
ercise treatment
tudies Risk of
-1
profiles by inteatment for breast
bias Inconsis
-2
-1
nt for breast can
bias Inconsis
-2
-2
r breast cancer p
bias Inconsis
-2
-2
t for breast cance
bias Inconsis
0
Exercise t
ervention and ot cancer patients
stency Imprec
0
-1
ncer patients.
stency Imprec
0
-1
patients.
stency Imprec
0
0
er patients.
stency Imprec
-2
treatment for adult
outcome s.
cision Indirect
0
0
cision Indirect
0
0
cision Indirect
0
0
cision Indirect
0
t cancer patients
tness Publica
0
0
tness Publica
0
0
tness Publica
0
0
tness Publica
0
ation bias Leve
Very
Very
ation bias Leve
Very
Very
ation bias Leve
Very
Very
ation bias Leve
Very
el of evidence
y low
y low
el of evidence
y low
y low
el of evidence
y low
y low
el of evidence
y Low
KCE Reportt 185
KCE Report 185
Combined res
Outcome N st
QOL 1
QOL, physical subscale
1
Exercise treatm
Outcome
VO2 peak, absolute
VO2 peak, relative
Other cardiopulmonafunction measures
Fatigue Safety
5
istance and aero
tudies Risk of
-1
-1
ment for breast c
N studies
2 -
2 -
ary 2 -
8 -
5 -
obic exercise trea
bias Inconsis
0
0
cancer patients
Risk of bias
In
-1 -2
-1 -2
-2 -1
-1 -2
-2 0
Exercise t
atment for breas
stency Imprec
-2
-2
nconsistency
2
2
1
2
treatment for adult
st cancer patients
cision Indirect
0
0
Imprecision I
-1 0
-1 0
-2 0
0 0
0 0
t cancer patients
s
tness Publica
0
0
ndirectness P
0 0
0 0
0 0
0 0
0 0
ation bias Leve
Very
Very
Publication bias
0
0
0
0
0
el of evidence
y low
y low
Level of evidence
Very low
Very low
Very low
Very low
Low
71
72
Exercise treatm
Outcome
QOL
QOL, physicalsubscale
Cardiopulmonfunction
Fatigue
Safety
Exercise treatm
Outcome
QOL
Exercise tolerance
Exercise treatm
Outcome
QOL
Heart rate
Fatigue
ment for prostate
N studies
3 -
2 -
ary 3 -
4 -
2 -
ment for lung ca
N studies
Ris
1 -1
1 -1
ment for colorec
N studies
Ris
1 -2
1 -2
2 -1
e cancer patients
Risk of bias In
-1 -
-2 -
-2 -
-2 -
-1 -2
ncer patients.
sk of bias Inco
0
0
ctal cancer patien
k of bias Inco
0
0
0
Exercise t
s
nconsistency
1
1
1
1
2
onsistency Im
-2
-1
nts.
onsistency Im
-1
-1
-1
treatment for adult
Imprecision
-1 0
-1 0
-1 0
-1 0
-1 0
mprecision Ind
2 0
1 -1
precision Ind
0
0
0
t cancer patients
Indirectness P
0 0
0 0
0 0
0 0
0 0
directness Pu
0
0
irectness Pub
0
0
0
Publication bias
0
0
0
0
0
ublication bias
blication bias
Level of evidence
Very low
Very low
Very low
Very low
Very low
Level of evidence
Very low
Very low
Level of evidence
Very low
Very low
Low
KCE Reportt 185
KCE Report 185
Exercise treatm
Outcome
QOL
VO2max
Heart rate
Fatigue
Exercise treatm
Outcome
QOL
VO2peak
Fatigue
Exercise treatm
Outcome
Fatigue
Exercise treatm
Outcome
QOL VO2peak
fatigue
5
ment for patients
N studies
Risk
2 -2
1 -2
1 -2
2 -2
ment for lympho
N studies
Risk
1 0
1 0
1 0
ment for leukem
N studies
Risk
1 -2
ment for mixed c
N studies
Risk
4 -2
3 -2
5 -2
s undergoing allo
k of bias Incon
0
0
0
-1
oma patients
k of bias Incon
0
0
0
ia patients
k of bias Incon
0
cancer patients
k of bias Incon
-1
-1
-2
Exercise t
ogeneic hematop
nsistency Imp
-1
-1
-1
-1
nsistency Imp
-1
-1
-1
nsistency Imp
-1
nsistency Imp
0
-1
-2
treatment for adult
poietic stem cell
precision Indir
0
0
0
0
precision Indir
0
0
0
precision Indir
0
precision Indir
0
0
0
t cancer patients
l transplantation
rectness Pub
0
0
0
0
rectness Pub
0
0
0
rectness Pub
0
rectness Pub
0
0
0
.
blication bias Le
V
V
V
V
blication bias Le
M
M
M
blication bias Le
V
blication bias Le
V
V
V
Level of evidence
Very low
Very low
Very low
Very low
Level of evidence
Moderate
Moderate
Moderate
Level of evidence
Very low
Level of evidence
Very low
Very low
Very low
73
74
7.4 Append7.4.1 Breas
Study ID
Cadmus 200943
dix 4: Evidencest cancer
Method
• Design: Doub2 arms per tridata from IMPstudy is retrie
• Sources of fuLance ArmstrFoundation, American CaSociety, SusaKomen Foundand supportepart by a GenClinical ReseCenter grant home-based intervention oConnecticut widentified throYale-New HaHospital TumRegistry
• Sample size: • Duration: 6 m
e tables
Patien
ble trial, al. Only
PACT eved. nding: rong
ncer an G. dation d in
neral arch Setting:
of women ough aven or
50 months
• Incl• Pre
womAJCcannot beg(≤2 cycphyandbegany
• ExcDiagor pcurr
• Pat• Mea
(8.2• Tre• Rad
CG• Che
CG• Rad
CheCG
Exercise t
t characteristics
usion criteria: - or post-menopamen, ages 35-75 yCC Stages 0-IIIa bncer, recently diag
yet begun or recegun adjuvant treat
weeks radiation oles chemotherapy
ysically able to exed physician consengin an exercise proy activity level clusion criteria: gnosis of other re
primary cancer everent smoker ients characteristian age (+-SD): IG2), CG=54.0 (10.9atment: diation: IG=32%, =32% emotherapy: IG=8=20% diation and emotherapy: IG=5=44%
treatment for adult
s Interve
usal years, breast gnosed, ently ment or ≤ 2 y), ercise nt to ogram,
ecurrent ent,
ics: G=54.5 9)
8%,
56%,
• Interhomintermin daystrial receeduca bincontspecinforPolamonmainat 60predHR).partirecephon
• Comwerecouldtheirchosstudactivwouavai
t cancer patients
ntion(s) Ro
rvention: me-based rvention, 30 activity 5 s/week. At start pt
eived an cational book, nder taining cialized rmation and a ar heart rate nitor (to ntain activity 0-80 % of dicted max . Each icipants
eived weekly ne calls
mparator: CG e told they d exercise on r own if they se but that the y physical
vity program ld not be lable to them
UoagcmAn
Uocm3“pAs(pfac
Results primary outcomes
Unclear reporting of QOL (FACT-B and FACT-G) group comparison measures Authors suggest no significance
Unclear reporting of group comparison measures on SF-36 subscale physical”
Authors suggest significance p<0.05) avouring usual care group
Results secondary andother outcome
• No adverse events relateto the intervention was observe
KCE Report
d es
Critical appraisal ofquality
ed
ed
• Moderateof bias
• 64% of pmeet theof exercis150 min week
• Small sasize
• Difficult toassess thstatistics provided
t 185
f
e risk
pt goal sing per
mple
o he
KCE Report 185
Study ID
Campbell 200544
Courneya 200745
5
Method
• Design: RCT,arms, pilot stu
• Sources of FuGreater GlasgNHS trust
• Setting: Largeof Scotland CCentre
• Sample size: women with bcancer
• Duration: 12 w
• Design: RCT,• Sources of Fu
Supported byfrom the CanaBreast CanceResearch Allithe CanadianResearch ChProgram, a gfrom NCIC wifunds from thCanadian Ca
Patien
, 2 udy unding: gow
e West Cancer
22 breast
weeks
• Elig• Pat
breaweradjuradi
• Pat• IG ;
(SD• CG
age• Che• Rad• Com
, 3 arms unding: y a grant adian er ance;
n airs rant ith e ncer
• Elig• Eng
spewomstagbegther
• Pat• Mea
78)
Exercise t
t characteristics
gibility criteria: ients who had recast cancer surgerre currently receivuvant iotherapy/chemotients characteristi (n=12) mean age
D+-)=48 (+/- 10) ; (n=10) mean
e=47(+/- 5) emotherapy (n=6)diotherapy (n=6) mbination (n=10)
gibility criteria: glish – or French eaking non-pregnamen ≥18 years oldge I-IIIA breast caginning first line adrapy. ients characteristian age 49.2 (rang
treatment for adult
s Interve
ceived ry and ving
herapy ics: e yrs
)
• IG: sexerweeage hearmaxweeconswarmmin and and perio
• CG: At thstudrececonspersexer
ant d with ancer djuvant
ics: ge 25-
• UC: and initiaexerdurin
• RET3 x wof 8-diff e60-7estimrep mResi
t cancer patients
ntion(s) Ro
supervised rcise 2 x kly at 60-75% adjusted rt rate
ximum for 12 ks. Classes sisted of m-up, 10-20 of exercise a cool down relaxation od. usual care.
he end of y period they
eived help in structing a sonalized rcise plan.
QSvcfagQNcv
usual care asked not to
ate an rcise program ng trial.
T(resistance): weekly 2 sets -12 rep of 9 exercises at 70% of their mated one max. istance
N(Uv(CpU3pA(CA
Results primary outcomes
QOL (FACT-G) Significant p-value group comparison avoring exercise group ( p=0.046) QOL (FACT-B): NS group comparison p-value (p=0.094)
NS for QOL FACT-An)
Unadjusted: RET vs. UC: MD 4.7 CI=-2.7-12.1),
p=0.216 AET vs. UC: MD 3.7(CI=-3.8-11.1), p=0.338, RET vs. AET: MD 1.0 CI=-6.4-8.5)
At 6 month
Results secondary andother outcome
• No effect forfatigue measured byPiper FatiguScale
• No effect forfatigue (measured bFACT-AN subscale “Fatigue”) foany of the twintervention arms at posttest (median17 weeks) aat 6-months
d es
Critical appraisal ofquality
r
y ue
• High riskbias
• Analysis some variablesappropriapoweredsmall samsize a tot19 womefinalized trial IG=1CG=9)
• No ITT analysis
r
by
or wo
t-n and
• Moderateof bias
• Allocationconceale
• No blindioutcome assessm
75
f
of
of
s not ately , mple tal of en the
10,
e risk
n ed ng of
ment
76
Study ID
Haines
Method
society. • Setting: The C
Cancer Institu(Edmonton, Athe Ottawa HIntegrated CaProgram (OttaOntario) and British ColumCancer Agen(Vancouver, BColumbia)
• Sample size: breast cancerpatients, 201 6months follo
• Duration: durapt chemother(median duraweeks, CI=9-week)
• Design: 2-gro
Patien
Cross ute Alberta), ospital
ancer awa, The
mbia cy British
242 r at
ow-up ation of rapy ation 17 24
oup • Elig
Exercise t
t characteristics
gibility criteria: wom
treatment for adult
s Interve
increwhecomthan
• AETweeergotreadelliptbegiof VOweeprog70%beyo
men • Exer
t cancer patients
ntion(s) Ro
eased by 10% n participants pleted more
n 12 rep. T(aerobic): 3 x kly on cycle
ometer, dmill or tical nning at 60% O2 max for k 1-6,
gressing to % and 80% ond week 12.
foUv(CpU7pA(C
rcise group: 3
Results primary outcomes
ollow-up: Unadjusted: RET vs. UC: MD+2.3 CI=-6.9-11.5),
p=0.620 AET vs. UC: MD 1.9(CI=-7.4-11.3), p=0.686, RET vs. AET: MD 0.4 CI=-8.6-9.4)
3-month:
Results secondary andother outcome
follow-up • Objectively
measured outcomes
• VO2 peak AEgroup supercompared wUC and RET
• Unadjusted:AET vs. UC;MD1.8, (CI=0.5-3.2)p=0.006
• Adjusted: AEvs. UC; MD 2.0, CI=0.6-3.3, P=0.004
• Unadjusted:AET vs. RETMD 1.6, CI=(0.3-2.9),p=0.014
• Adjusted: AEvs. RET; MD1.4, (CI=0.1-2.7 ), p=0.03
• Adverse events: No adverse events reported
• Participant
KCE Report
d es
Critical appraisal ofquality
ET rior with T: ;
),
ET
4 T;
4 ET D -31
• Moderate
t 185
f
e risk
KCE Report 185
Study ID
201047
5
Method
randomized controlled triablinded outcoassessment aactive (sham intervention) cgroup
• Funding: projgrant from thePrincess AlexHospital CancCollaborative
• Setting: PrincAlexandra Ho(Australia)
• Sample size: baseline, 73 amonth follow-
• Duration: 3, 612months foll
Patien
al with ome and
control
ect e xandra cer Group
cess ospital
89 at at 12--up 6 and low-up
withbreaadjuchefollocritedisehypinjuexe
• Patage55.954.2
Exercise t
t characteristics
h newly diagnosedast cancer underguvant therapy (rademo and hormonaowing surgery; exceria were severe cease, uncontrolledpertension, orthopry, participation in
ercise program ient characteristic
e intervention grou9y (SD 10.5), con2y (SD 11.5) (p=0
treatment for adult
s Interve
d going diation, l) clusion cardiac d edic
n
c: mean up trol
0.47)
homstrenshoucardenduprogmultinstrpackequi
• Contactivinter(flexrelaxactivmateprogactiv
t cancer patients
ntion(s) Ro
me-based ngth, balance, ulder mobility, iovascular urance gram; timedia ructional kage; pment. trol group:
ve sham rvention xibility and xation vities); video erial; no gression of vities
Gre(ines(7(pe0c(0Epfues(8(pe3c(2Mfage1c(pp
Results primary outcomes
Generic health-elated QOL EQ-5D nstrument): VAS exercise group superior 80.6 11.6) vs. control
74.1 (20.6), p=0.006). Utility
exercise group 0.78 (0.19) vs. control 0.84 0.17) (p=0.54)
EORTC C30: physical unctioning exercise group superior; 86.9 10.7) vs. control
86.7 (14.9) p=0.02); fatigue
exercise group 31.8 (20.1) vs. control 34.5 27.9) (p=0.12)
Multidimensional atigue inventory: general fatigue exercise group
1.9 (3.7) vs. control 12.6 (4.3) p=0.52);
physical fatigue
Results secondary andother outcome
adherence higher in firs3 months thain second 3 months
• Adverse events: musculoskeal pain 9 patients, oddratio 2.39 (95%CI 0.5889.92) (p=0.23); fal8patients, odds ratio 0.58 (95%C0.14-2.42) (p=0.48)
d es
Critical appraisal ofquality
st an
let
ds
8-
l
I
of bias • Large
number obetween-group comparis(increasechance otype I statisticaerror
• Considernumber opatients tup form oexercise during tri
• Possible beneficiaeffect of SHAM intervent
77
f
of -
sons e in of
l
rable of took of
al
al
ion
78
Study ID Method Patien
Exercise t
t characteristics
treatment for adult
s Interve
t cancer patients
ntion(s) Ro
e1c(pree9c(p6NG(ine8c(Ugv(0Epfue8c(fagv
Results primary outcomes
exercise group 0.7 (4.6) vs.
control 10.9 (4.6) p=0.51); educed activity
exercise group 9.8 (4.6) vs. control 10.4 (5.3) p=0.07)
6 months No effect on Generic QOL EQ-5D nstrument): VAS exercise group 80.4 (12.7) vs. control 79.3 14.1) (p=0.09);
Utility exercise group 0.80 (0.21) vs. control 0.83 0.18) (p=0.87)
EORTC C30: physical unctioning exercise group 83.6 (15.8) vs. control 87.5 10.8) (p=0.64); atigue exercise group 27.3 (26.4) vs. control 28.1
Results secondary andother outcome
KCE Report
d es
Critical appraisal ofquality
t 185
f
KCE Report 185
Study ID
Headley 200448
5
Method
• Design: RCT • Sources of fu
study funded 1999 HoechsMarion RoussInc. Researchfrom the ONSFoundation aUniversity of THealth SciencCenter in the Houston SchoNursing.
• Setting: Outpclinic of comprehensivcancer centersouthwesternStates
Patien
2 arms nding: by the
st sels, h Grant S nd the Texas ce
ool of
atient
ve r,
n United
• EligspestagschoutphavstatZubsit ifor 3accvide
• PatMea(7.1(11(SDCG
Exercise t
t characteristics
gibility criteria: Engeaking, at least 18ge IV breast canceduled to initiate patient chemotherving a performanctus of 2 or less onbrod scale, being an a straight back 30 min and havingess to a television
eo cassette playerients characteristian age (SD): IG=50) CG=52.25 .43)Mean educati
D): IG=14.4 (3.12) =12.6 (2.5)
treatment for adult
s Interve
glish years, er,
rapy, e
n able to chair g n and a r; ics: 50.0
on
• Intermin exerweecomavai(ArmFitneExerProgconsmin min intenrepeexermin Comseatprog
t cancer patients
ntion(s) Ro
(2Mfage1c(ppe1c(p
rvention: 30 seated rcise 3 x kly using a mercially lable video
mchair ess: Gentle rcise). gram sisted of 5 warm-up, 20 moderate-nsity etitive motion rcise and 5 cool down.
mparator: No ted exercise gram,
InreSbepO(dgEdsc(pgpre
Results primary outcomes
20.5) (p=0.29) Multidimensional atigue inventory: general fatigue exercise group
1.1 (4.2) vs. control 11.9 (4.5) p=0.40);
physical fatigue exercise group
0.1 (4.5) vs. control 10.0 (4.1) p=0.95).
nsufficient data eporting
Statistics between endpoints not provided Overall QOL FACIT-F)
declined for both groups Exercise group declining at slower rate than control group p=0.0254, only
graphical presentation of esults)
Results secondary andother outcome
• No adverse events reported
d es
Critical appraisal ofquality
• High riskbias
• Small sa
size • No ITT
analysis • Overall
adherenc75%
79
f
of
mple
ce
80
Study ID
Hwang 200849
Method
• Sample size: women
• Duration: exeintervention dcycles of chemotherap
• Design: RCT • Sources of fu
none stated • Setting: clinic
setting, Seou• Sample size:
women • Duration: 5 w
Patien
32
ercise during 4
y
2 arms nding:
cal l, Korea 40
weeks
• Eligposwaitwithheaaffeexeunccard
Exercise t
t characteristics
gibility criteria: womst-surgery on outpting list for radioth
h no concurrent malth problems that ect participation inercise program, inccontrolled hypertendiovascular diseas
treatment for adult
s Interve
permcontusuaactiv
men atients
herapy major
could cluding nsion, se,
• Intersupeexerwee(10 m30 mand exercool
t cancer patients
ntion(s) Ro
mitted to tinue any al physical vity
Pbsedsc(pgpreGthgdocc(pmFs“
rvention: ervised rcise 3 x kly for 50 min min warm up,
min stretching aerobic
rcise, 10 min down) Heart
•
•
Results primary outcomes
Physical well-being (FACIT-F subscale): exercise group declining at a slower rate than control, p=0.0252, only
graphical presentation of esults)
Graph suggests hat intervention group had less decline in fatigue over time compared with control group p=0.0078),
measured by FACIT-F subscale Fatigue” Positive effect
for WHOQOL-BREF (p<0.001)
Positive effect, p<0.001 (WHOQOL-BREF subscale
Results secondary andother outcome
• No significaexercise-related adverse events werereported
KCE Report
d es
Critical appraisal ofquality
ant
e
• High risk bias
• No allocaconcealm
• No ITT analysis
• Small samsize
• QOL Sca
t 185
f
of
ation ment
mple
ale not
KCE Report 185
Study ID
Kim 200650
5
Method
• Design: RCT • Sources of fu
supported by from the NatioInstitute of NuResearch andpostdoctoral fellowship awfrom the Korescience and Engineering
Patien
acudisedys
• Pat• Mea
grou• Mea
grou• No
outcbas
2 arms nding: grant
onal ursing d a
ward ea
• Elignewbreaprevall sagerece
• Pat• Mea
(SD• Mea
Exercise t
t characteristics
te or chronic respease, and cognitivfunction. ients characteristian age control up=46.3 (+-9.5) an age exercise up=46.3 (+-7.5) significant differencome measures aseline
gibility criteria: womwly diagnosed withast cancer and novious history of castages of breast ces ≥40 years and eiving cancer treaients characteristian age IG=51.3
D=6.7) an age CG=48.3
treatment for adult
s Interve
piratory ve
ics:
nce on at
rate throuwith encoto wo70%adju
• Com• Patie
wereto peshouexerwereto conorm
men h o ancer, cancer,
atment ics:
• InterAero3 x wmin warmmin 60-7resepeakWeeasse
t cancer patients
ntion(s) Ro
monitored ugh exercise
ouragement ork at 50-
% of age sted max.
mparator: ents in control e shown how erform ulder ROM rcise and e encouraged ontinue with mal activities
•
rvention: obic exercise, weekly for 30 (+ 5 min m up and 5 cool down) at
70% of HR erve or VO2 k at baseline. ekly essment for
•
•
Results primary outcomes
“physical”) Figure
suggests that the control group had a increase in fatigue, that the exercise group had a decrease in fatigue and that there was a significance in difference in the mean fatigue level (measured by Brief Fatigue Inventory) between groups (p<0.05)
No significant group difference in VO2 peak (ml/min)
No significant group difference in resting or maximum heart rate
Results secondary andother outcome
• Secondary outcomes npart of project outcomes
d es
Critical appraisal ofquality
cancer specific
not • High risk
bias • Allocation
concealmnot descr
• High numof drop-o(33 of 74)
• no ITT analysis
81
f
of
n ment ribed
mber uts )
82
Study ID
Mock 200551
Method
Foundation • Setting: Exerc
facility within School of NurMaryland, Ba
• Sample size: women newlydiagnosed wibreast cancer
• Duration: 8 w
• Design: RCT • Sources of fu
study funded competitive F(Fatigue InitiaResearch andEducation) minstitutional awfrom the OncoNursing SocieFoundation toMock.
• Setting: 4 Unteaching hospNational CancInstitute desigCancer Cente4 community
Patien
cise the rsing,
altimore 41
y th r
weeks
(SD• 40.9
che• 31.8
radi• 27.3
comcheradi
2 arms nding: by a
FIRE ative in d ulti-ward ology ety o Dr.
iversity pitals of cer gnated ers and cancer
• EligageIII bsurgrecethercheconprobpartalrepr w
• Pat• Mea
(8.9• Mea
(9.7• The
Che
Exercise t
t characteristics
D=8.8) 9% receiving
emotherapy 8% receiving iotherapy 3% receiving a
mbination of emotherapy and iotherapy
gibility criteria: Woed 18-70 years, Stbreast cancer by dgery, scheduled toeive outpatient radrapy or adjuvant
emotherapy. Excluncurrent major heablems that could aticipation. Patients
eady exercising >4week were excludients characteristian age IG (SD)=59) an age CG (SD)=7) erapy type IG: emotherapy 41.7%
treatment for adult
s Interve
the fto adpartiresp
• Comusuaincluinforbeneexerspecinstrfurthfor e
omen tage 0-definite o diation
uded if alth affect s 45 min ed ics:
51.3
51.6
%,
• Interhomwrittepreswalkat a pace70%rate.keptand coorweewas coorbiwe
• Comusuaenco
t cancer patients
ntion(s) Ro
first 3 weeks djust for icipants HR
ponses mparator: al care uding general rmation of efits of rcise but no cific ructions or her guidance exercise rvention:
me-based with en
scription to k 5-6 x weekly moderate
e at app. 50-% of max heart
. Patients t daily diaries sent these to
rdinators 1 x kly. Patient contacted by
rdinators eekly mparator: al care, ouraged to
•
Results primary outcomes
(beats/min)
No effect for fatigue (measured by Piper Fatigue Scale) at post-intervention
Results secondary andother outcome
• No reportingof overall quality of lifmeasure
• Unclear reporting ofgroup comparisonmeasures (SF-36 “Physical Functioningsubscale)
KCE Report
d es
Critical appraisal ofquality
g
fe
f
n
g”
• Moderateof bias
• possible dilution oftreatmenteffect; 39CG exerc28% of IGnot exerc
• unclear reporting
t 185
f
e risk
f t
9% of cised, G did cise
KCE Report 185
Study ID
Mutrie 200753
5
Method
centers in theEastern US
• Sample size: • Duration: pati
stratified for atherapy form Radiation the(RT) or Chemotherap
• RT pt duratiointervention=6weeks
• CT pt duratiointervention=3months
• Design: RCT • Sources of fu
Cancer ReseUK. CE fundethe UK MedicResearch CoFunders independent fconduct and outcome of thstudy.
• Setting: ThreeNational HeaService Oncoclinics in Scotand communexercise facil
Patien
e
119 ients adjuvant either
erapy
py (CT). n of 6
n of 3-6
Rad• The
CheRad
2 arms nding: arch ed by cal uncil.
from
he
e lth
ology tland ity ities
• EligduristagI-III)
• PatMeaChe
• 15:2RadChe201
Exercise t
t characteristics
diation 58.3% erapy type CG: emotherapy 42.4%diation 57.6%
gibility criteria: woming treatment for ege breast cancer () ients characteristian age=51.6 yearemotherapy= 201, diotherapy=57:201emo+Radiotherap
treatment for adult
s Interve
%,
mainleve
men early (stage
ics: rs.
1, py=129:
• InterEncoattenof mexerweeaddiexerat howeemonensuage maxrate)
• Comusua
t cancer patients
ntion(s) Ro
ntain current l of activity
rvention: ouraged to nd 45 minutes
moderate level rcise 2 x kly and do an tional
rcise session ome each k (women
nitored to ure 50-75% adjusted
ximum heart )
mparator: al care
•
•
•
•
•
Results primary outcomes
Significant effect for FACT-B:
12 weeks effect estimate: 2.5 (CI=1.0-3.9), p=0.0007
6 months effect estimate 1.5 (CI=0.1-2.9), p=0.039
No effect for FAGT-G at any measure point
Non-Significant
Results secondary andother outcome
• No adverseevents reported
• Other secondary outcomes npart of project outcomes
d es
Critical appraisal ofquality
e
not
• Low risk obias
• Allocationconcealmblinding ooutcome assessmeITT-analy
• Number oclasses attended the participannot report
83
f
of
n ment, of
ent, ysis of
by
nts ted
84
Study ID Method
• Sample size: women
• Duration: 12 w
Patien
203
weeks
Exercise t
t characteristics
treatment for adult
s Interve
t cancer patients
ntion(s) RoResults primary outcomes
effect for FACT-F subscale (fatigue) at 12 weeks and 6 months
Results secondary andother outcome
KCE Report
d es
Critical appraisal ofquality
t 185
f
KCE Report 185
Study ID
Schwartz 200755
5
Method
• Design: RCT (aerobic, resisor usual care
• Sources of fuNot stated
• Setting: Two National CancInstitute-desigcancer centermetropolitan a(US)
• Sample Size:women
• Duration:6 mo
Patien
3 arms stance ) nding:
cer gnated rs in area
66
onths
• Pat• Bre
stagche
• Meagrou
• Meaexe
• Meagrou
Exercise t
t characteristics
ient characteristicast cancer patienge I-III beginning emotherapy an age aerobic exup=48 years an age resistance
ercise group=50 yean age usual careup=46 years
treatment for adult
s Interve
cs ts,
xercise
e ears e
• Usuainstrconttheiractiv
• Aerobaseto chaerotheywalkjoggexer30 mdaysdurindura
• Resiinstrexerfour weeTherresisand Partgivediffeexerwerecomsets repe
t cancer patients
ntion(s) Ro
al care: ructed to tinue with r usual vities obic: home-ed, instructed hoose an obic activity y enjoyed (e.g. king or ing) and
rcise for 15-minutes four s pr. Week ng study ation istance: ructed to rcise at home days per k using ra-Band stance band tubing. icipants were n two rent sets of rcises and e asked to plete two of 8-10
etitions and
•
Results primary outcomes
Primary outcomes were not part of project defined outcomes
Results secondary andother outcome
• Aerobic capacity at months : Effect on 12minute walktest for aerobic exercise, mean change all groups=94.(95%CI=812-104.6), p=0.02. Resistance exercise group had slight increase in aerobic capacity. Usual Caregroup had decline in aerobic capacity.
d es
Critical appraisal ofquality
6
2 k-
5 -
• High risk bias
• No descr
of allocatconcealmor blindinoutcome assessme
• Small sam
size • Authors u
ITT princi
85
f
of
iption ion
ment g of
ent
mple
used iples
86
Study ID
Segal 200156
Method
• Design: RCT (self-directedsupervised orcare)
• Sources of fuSupported byNational CancInstitute of Cawith funds froCanadian CaSociety
• Setting: OttawRegional CanCenter, Cana
• Sample size: women
• Duration:26 w
Patien
3 arms , r usual
nding: y the cer anada om the ncer
wa ncer ada
123
weeks
• Elig • Wo
breawithof pther
• Pat• Mea
8.7)• SD
8.7)• Sup
G=5
Exercise t
t characteristics
gibility criteria:
men with stages Iast cancer recruithin 2 weeks of initprescribed adjuvanrapy ient characteristican age ; CG=50.3) exercise G=51.0 ) pervised exercise 51.4 (SD 8.7)
treatment for adult
s Interve
alterexerwithi
I and II ed tiation nt
cs: 3 (SD
(SD
• Intero arm:
exerexerwee
o arm:exerweewalkat prpaceto exhomwee
• Contusua(gen
t cancer patients
ntion(s) Ro
rnate the rcise sets in each week. rvention: : self-directed rcise at home rcising 5 x kly : supervised rcise 3 x pr k (mainly
king exercise rescribed e) + expected xercise at
me 2 other kdays trol arm: al care neral advice)
•
•
•
Results primary outcomes
No effect for FACT-G and FACT-B in patients receiving chemotherapy
No effect for “physical functioning” (SF-36) in institution-based study arm for patients receiving chemotherapy
Positive effect on SF-36 “Physical functioning” (p=0.03) for patient in self-directed arm receiving chemotherapy
Results secondary andother outcome
• Relative VOpeak(ml/kg/in):
• No effect foself-directedinterventionarm compared with control(based datafrom patienreceiving adjuvant therapy)
• No effect fo
supervised interventionarm compared with control(based on data from patients receiving adjuvant therapy)
KCE Report
d es
Critical appraisal ofquality
O2 /m
or d n
l a ts
or
n
l
• Moderateof bias
• Allocationconcealed
• Analysescarried ouan ITT ba
• No blindinoutcome assessme
t 185
f
e risk
n d ut on asis ng of
ent
KCE Report 185
Study ID
Wang 201158
5
Method
• Design: RCT-• Sources of fu
Mark DiamonResearch FunGraduate StuAssociate, Unat Buffalo, theUniversity of York
• Setting: Homeintervention wpatients from Gung MemorHospital and National TaiwUniversity Ho
• Sample size: • Duration: 6 w
Patien
-2 arms nding:
nd nd,
udent niversity e State New
e-based with
Chang-rial
wan ospital
72 weeks
• Elig18 tdiagstagexp
• follosurgwritcritemasexcjoin
• degadvto e
• recophywomaneand(4) exedysbonnauprobconexebrearepotype
• Aveyea
Exercise t
t characteristics
gibility Criteria: woto 72 years, newlygnosed with stagege II breast cance
pecting chemotherowing recovery frogery, and able to te Chinese. Excluseria: (1) obesity (bss index Q30 kg/mluded to avoid bot problems); (2)
generative arthritisverse effects or inaexercise as ommended by theysicians for exampmen with leukopenemia, thrombocytod high fever up to unsafe conditions
ercise; (5) limiting pnea with exertio
ne pain; (7) severeusea; (8) psychiatrblems; (9)
ntraindications to ercise; (10) recurreast cancer; and (1orted history of otes of cancer. erage age; all=50.ars, exercise=48.4
treatment for adult
s Interve
omen y e I or er, rapy om read or sion body m2; ne and
s; (3) ability
eir ple, nia, openia, 102-F;
s to
n; (6) e ric
ent 11) a ther
42 40
• Exerinterweebaseprogmodintenmeahearmaxmax60%modScal0.5 a
• 3 to per wleastper saccu10-msess30 m
t cancer patients
ntion(s) Ro
rcise rvention; 6-ks, home-ed walking gram, low to erate
nsity asured by a rt rate
ximum (HR x) from 40% to % or the
ified Borg le between and 2, 5 sessions week, and at t 30 minutes session or the umulation of minute sions to reach minutes
•
•
•
•
•
•
Results primary outcomes
QOL (FACT-G, Chinese version):
Hierarchical linear model analysis: pattern
of change between the 2 groups was significantly different
at linear growth rate (t70=3.76, p<.001) and quadratic growth rate (t70=2.64, p=.011). (results provided in text and graphs only)
Fatigue (FACIT-F):
Significant differences between the 2 groups were detected only
Results secondary andother outcome
• Not reportewhether there were any adverseevents
d es
Critical appraisal ofquality
d
e
• High risk bias
• High
contaminrate in uscare grou(30.4%),
• Missing lo
from 17.7usual cargroup
• No descr
of randomizprocess oallocationconcealm
87
f
of
ation sual up
ogs 7% in re
iption
zation or n ment
88
Study ID
7.4.2 Prosta
Study ID
Galvao 201046
Method
ate cancer
Method
• Design: RCT-2• Sources of fun
the Cancer Cof Western Au
• Setting: Sir ChGairdner Hos(Perth, WesteAustralia)
• Sample size: 5• Duration: 12 w
Patien
yeayea
Patien
2 arms ding:
Council ustralia arles
spital ern
57 weeks
• IncludoccanexpthanevidactiremsubMedphy
• PatieMea7.3)
• Prev
Exercise t
t characteristics
ars, usual care=52ars
t characteristics
sion criteria: histocumented prostatencer, minimum prioposure to AST no n 2 months, withodence of disease vity, and anticipat
main hypogonadal bsequent 6 monthsdical clearance froysician. ents characteristican age; IG=69.5(S), CG=70.1 (SD 7ious radiation;
treatment for adult
s Interve
2.3
s Interve
orically e or longer
out PSA
ted to for the s. om
cs: SD .3)
• IntervComprogresisaero2 x wweeResiexerchesseatshoutriceleg pexte
t cancer patients
ntion(s) Ro
•
•
•
ntion(s) Ro
vention: mbined gressive stance and obic exercise weekly for 12 ks. istance rcise included st press, ted row, ulder press, ps extension,
press, leg nsion and leg
QSGAdmoM2PcAdm
Results primary outcomes
at the nadir (time 3=8.52, P<.001) and at the end of the
program (time 4=5.78, P<.001).
(results provided in text and graphs only)
Results primary outcomes
QOL (general): SF-36; General health: Adjusted group difference in mean changes over 12 weeks: MD=12.9 (CI; 1.9-23.9), p=0.022 Physical health composite: Adjusted group difference in mean changes
Results secondary andother outcome
Results secondary another outcom
QOL (cancer specific): QLQ-C30; fatigue subsca(p=0.021) No adverse events during testing or exerc
KCE Report
d es
Critical appraisal ofquality
d es
Critical appraisal quality
ale:
cise
• Moderateof bias
• • Low pow• • Cardiopu
ary measnot alignwith projedefined
t 185
f
of
e risk
wer
ulmonsures ed ect
KCE Report 185
Study ID
Windsor 200459
5
Method
• Design: RCT 2• Sources of fun
none stated • Setting: home
intervention, Dundee, Sco
• Sample size: • Duration: 4 we
Patien
IG=• Curre
CG
2 arms nding:
e-based
otland 66 eeks
• EligiboutpradiradiprosExcfrailcomor s
Exercise t
t characteristics
=37.9%, CG=39.3%ent radiation; IG=2=21.4%
bility criteria: men patient waiting listical conformal iotherapy for locastate carcinoma.
clusion criteria: phty due to age and
morbidities e.g. unsevere angina, rec
treatment for adult
s Interve
% 27.6%,
curl,abdocrunResiexerdesigprogto-6-maxto foexeraerocomincluminucardexerwalkat 65maxrate.
• Comp• Usual
on t for
lized
hysical d nstable cent
• Intervhommodintencontwalkmin daysdurin
t cancer patients
ntion(s) Ro
with ominal
nches. istance rcise was gned to
gress from 12--repitition
ximum for two our sets per rcise. The obic ponent
uded 15-20 utes of iovascular
rcise (cycling, king, jogging) 5% to 85% ximum heart . parator: l care
oM9QsQNdd
vention: me-based,
erate-nsity, tinuous king for 30 at least 3 s per week ng
FNdmbra(w
Results primary outcomes
over 12 weeks: MD=5.0(CI; 0.81-9.2), p=0.02 QOL (cancer specific): QLQ-C30; No significant difference for domain “physical”
Fatigue: No significant difference for mean BFI score btwn groups after adiotherapy p=0.18) or at
week 8 follow-up
Results secondary another outcom
Cardio-pulmonfunctioning: No significant group differencin pre-post testresting HR or pto-posttest exercise HR.
d es
Critical appraisal quality
nary
ce t pre-
• High riskbias
• No allocaconcealm
• Low pow
89
of
k of
ation ment wer
90
Study ID
Monga 200752
Method
(duration of radiotherapy
• Design: RCT • Sources of fu
not reported• Setting: Acad
Medical CenUS
• Sample size: with prostatecancer
• Duration: 8 w
Patien
y) myodem
• Patie• Mean• CG=• IG=6
2 arms nding: emic
nter ,
21 men e
eeks
• Eligibwithdiagambcommea
• Patie• Exerc
68 (• Cont
70.6
Exercise t
t characteristics
ocardial infarctionmentia. ents characteristicn age (+- standard69.3 (+-1.3)
68.3 (+-0.9)
bility criteria: patieh first time cancer gnosis, had to be bulatory and able
mplete self-report asures ents characteristiccise group, mean(+-4.2) rol group, mean a6 (+-5.3)
treatment for adult
s Interve
, or
cs: d error)
radioHR 6calcuHR.
• Comppatiediscoperfonormbut arest thingbeca
ents
to
cs: age:
age:
• IntervSupeaeroprogweeweeaeroat tarate HR –rest
• Compstaninclueducradio
t cancer patients
ntion(s) Ro
otherapy at 60-70% of ulated max
parator: ents not ouraged from orming mal activities advised to and take
gs easy if they ame fatigue.
(InsgfaCndfaIG
vention: ervised
obic exercise gram 3 x kly for 8 ks 30 min
obic exercise arget heart
(.65) x (max – rest HR) + HR
parator: dard care
uding cation and otherapy
CbcMmOsde+FgPmfa-4pQ
Results primary outcomes
p=0.197) n time a significant within group increase foratigue scores in CG (p=0.013) but not a significant difference in atigue scores for G (p=0.203)
Cardiac fitness btwn group omparison
METS:(MET=3.5 ml O2·kg−1·min−1) ignificant mean ifference favoring
exercise=2.8 (SD +- 1.8), p=0.006 Fatique btwn
roup comparison PFS significant mean difference avoring exercise=4.3(SD +-2.1),
p<0.001 QOL (FACT-P)
Results secondary another outcom
r
g
Significant withgroup improvement fexercise grouppre-post intervention Cardiac fitness(METS): p<0.0Fatique: p=0.0FACT-P: p=0.0Physical well-being: p=0.002Significant withgroup decline fcontrol groupIncrease in fatique score,
KCE Report
d es
Critical appraisal quality
hin
for p
s 001 02 04
2 hin for
• High riskbias
• Low pow• Possibly
biased towards healthierprostate cancer patients
• no descriptioof allocatconcealm
t 185
of
k of
wer
r
on tion
ment
KCE Report 185
Study ID
Segal 200957
5
Method
• Design: RCT Resistance e(RET), Aerobexercise (AEusual care (U
• Sources of funSupported bfrom the CanProstate CanResearch Fu
• Setting: OttawHospital RegCancer CentOttawa, Can
• Sample size: men
• Duration: 24 w
Patien
3 arms, exercise bic
ET) or UC) nding: y Grant nadian ncer und wa gional tre,
nada 121
weeks
• Eligibdoccanrecewithby t
• Patie• Mean
(SD• Marr• Com
Col• Emp• Canc
Exercise t
t characteristics
bility criteria: histocumented prostatencer, scheduled toeive radiotherapy hout ADT and apptreating oncologisent characteristicsn age; 66.3 years
D=7.0) ied=82.6% pleted University lege=51.2% loyed full-time=23cer stage II=78.5%
treatment for adult
s Interve
orically e o
with or proved t
s:
or
3.9% %
• Interv• 1. arm
exergrouexerweerep oexer70%
• 2. armtrain(AET3 x pbegi60%predVO2weeprog75%24
• 3.arm
t cancer patients
ntion(s) Ro
bcSde+sw(p
vention; m: Resistance rcise training up (RET) rcising 3x pr k (2 x 8-12 of 10 diff rcises at 60-
% of 1RM) m: Aerobic ning group T) exercising pr week nning at 50-
% of determined
peak for k 1-4,
gressing to 70-% for week 5-
m: Usual care
F(dSf1(M7Sf1(M7Sf2t(PN
Results primary outcomes
btwn group omparison
Significant mean ifference favoring
exercise=13.8 (SD+-10.1), p=0.006, ubscale “physical
well-being” p<0.001)
FACT-Fatique unadjusted group
differences): Significant effect for RET vs. UC at 12 weeks midpoint);
M=4.11 (CI=0.87-7.35), p=0 .010 Significant effect for AET vs. UC at 12 weeks midpoint);
M=4.64 (CI=1.47-7.80) P=0.004 Significant effect for RET vs. UC at 24 weeks (post-est ); M=4.78 CI=1.77-7.78)
P=0.002 Not significant for
Results secondary another outcom
g D
l
p=0.004, decliin social well-being; p<0.05
p Objectively measured outcomes Group differen(baseline to potest) Unadjusted VOpeak RET vs. MD=1.5 (CI=03.0) P=0.041 AET vs. UC; MD=1.4 (CI=-02.8) P=0.52 (NAdjusted VO2 peak RET vs. UC ; MD=1.6 (CI=13.1) P=0.037 AET vs. UC ; MD=1.4 (CI=02.8) P=0 .063
d es
Critical appraisal quality
ne
nce ost-
O2 UC; .06-
0.1-NS)
.0-
.08-
• Moderaterisk of bia
• Centralizwith allocationconcealmbefore assignme
91
of
e as zed
n ment
ent.
92
Study ID
Results retrieved
Method
d from a systematic
Patien
review by M.J. Velth
Exercise t
t characteristics
huis, 2010 2
treatment for adult
s Interve
grouwas initiadurin
t cancer patients
ntion(s) Ro
up (UC). UC asked not to
ate exercise ng trial
AwM0FsRw(24FfNFin
Results primary outcomes
AET vs. UC at 24 wks MD=2.65(CI=-0.29-5.58),P=0.08FACT-G significant for RET vs. UC at 12 weeks ; MD 4.76 p=0;017) and at
24 weeks; MD 4.43 (p=0;015) FACT-G no effect for aerobic vs. UCNo effect for FACT-P in any ntervention arm
Results secondary another outcom
8
C
(NS) Adverse event3 adverse eveof these one serious adversevent occurrinthe group performing aerobic exercison day 3 of training protoc(acute myocarinfarction, patierecovered but not complete intervention)
KCE Report
d es
Critical appraisal quality
ts : nts
se g in
se
col rdial ents did
t 185
of
KCE Report 185
7.4.3 Lung
Study ID
Arbane 201127
5
cancer
Method
• Design: RCT, 2• Sources of Fun
St Georges HoTherapies ChaFunding and thFaculty of HeaSocial Care Sc
• Setting: St GeoHealthcare, LoUK
• Sample size: 5patients attendthoractomy for cancer
• Duration: 1-5 dpost-operative further 12 weeoperative with supervised homexercises
Patien
2 arms nding: ospital aritable he lth and
ciences orge
ondon,
53 ding
lung
days and a ks post-
me
• Eligibwith lung thoraassis
• PatieMean47), Imale
Exercise t
t characteristics
bility criteria: PatieNSCLC referred fresection via ope
actomy or visual sted thoractomy ent characteristicsn age CG=62.6y (IG=65.4y (47-82),
es, 25 females
treatment for adult
s Interventio
ents for n
s: (32-, 28
• Intervent(n=22): uplus 2x/dand mob(walking,the spot, bike exerbedside aleg raisesankle weday 1 to dpostoper80% of m+ a 12-wof home
• Compara(n=21): uincludingphysiothetreatmenclearancemobilizatand uppeactivitiesmonthly tcalls proveducation
t cancer patients
on(s) Ro
tion group usual care day strength ility training marching on recumbent
rcises at and seated s with 2-4lb
eights) from day 5 rative, at 60-max heart rate eek program support
ator group usual care, g routine erapy
nts, airway e techniques, tions as able er limb , (1x/day), telephone viding n
QCsdwbE(fIGmd(CCod4
Results primary outcomes
QOL (EORTC-C30): non-significant difference both within groups and between groups EORTC-C30 functional): G: pre to post-op mean difference=2.0 CI=-5.5-9.3)
CG: pre to post-op mean difference=2.7 (-4.7-10.0)
Results secondary another outcomes
Secondary outcomes not part of project outcomes
d Critical appraisal ofquality
(+)moderateof bias randomizatiocodes kept bindependentteam membe
93
f
risk
on by t er
94
7.4.4 Colore
Study ID
Courneya, 200332
ectal cancer
Method
• Design: RCT, 2assigned in a 2
• Sources of fungrant from the National Canceinstitute of Can
• Setting: Cross Institute, EdmoCanada
• Sample size: 1colorectal cancsurvivors
• Duration: 16 w
Patien
2 arms 2:1 ratio ding:
er nada Cancer
onton,
02 cer
weeks
• Eligibcolor3 mosurgeattenundewritteEngliPhysQuescontras demaxifitnes
• Patie• Age
IG=5• CG=• Patie
chemCG=
• PatieIG=2
Exercise t
t characteristics
bility criteria: Surgrectal cancer withionths, recovery froery as indicated b
nding physician, aerstand and providen informed conseish, passed the re
sical Activity Readstionnaire and no raindications to exetermined by a sumal cardio respirass test. ents characteristic(mean, SD);
59.92(10.73) 61.13(9.93)
ents % on motherapy: IG=6367.7%
ents % on radiothe23.0%, CG=16.1%
treatment for adult
s Interve
gery for in past om by bility to de ent in evised diness
xercise ub atory
cs:
.9%,
erapy: %
• Interv(n=62preschomepersoexerc(cardiand flexerctimes 20-3065-75predicmax.)phoneprojecreportlevel oand aquest
• Comp(n=31askeda struexercand wan expresc
t cancer patients
ntion(s) Ro
vention group 2): ription of a
e-based, onalized ise program ovascular exibility ises, 3-5 per week, for
0 minutes at 5% of cted HR ) + weekly e calls from ct director to t participants of exercise
answer any ions.
parator group ): were
d not to begin ctured ise program
were not given ercise ription.
Qbmb15(aoincfiwdcfisfop
DbinbinF(pF(p
Results primary outcomes
QOL (measured by FACT-C): mean change between groups=-
.3(95%CI -7.8-5.1), p=0.679 Exploratory
ancillary analysis of patients with ncreased cardiorespiratory itness compared with patients with decreased cardiorespiratory itness showed a significant effect or FACT-C, p=0.038)
Difference between groups n change from baseline to post-ntervention: FACT-C Scale p=0.679)
FACT-G scale p=0.652)
Results secondary another outcomes
Cardiopulmonay function Mean change iresting HR=-2.(95%CI 3.2 to 8.6) (p=0.361) Remaining outcomes not part of guidelinoutcomes
KCE Report
d Critical appraisal ofquality
ar
in 7 -
ne
moderate risbias ITT analysis Blinding of assessors No allocationconcealmentExercise grodid not perfoappreciably mmoderate/strus exercise tcontrol group
t 185
f
sk of
n t
oup orm more renuothan p
KCE Report 185
Study ID
Houborg 200638
5
Method
• Design: RCT, • Sources of fun
Danish ReseaAgency, DanisCancer SocietDanish HealthInsurance Foundation, DCancer SocietClinical ReseaUnit
• Setting: AarhuUniversity HosDenmark
• Sample size: • Duration: until
Patien
2 arms nding: arch sh ty, h
Danish ty’s arch
us spital,
n=119 l
• Eligib>60yelectcolor
• Excluinflamdissesignifdiseamedi
• • Patie
30 wage 7wom72y (
Exercise t
t characteristics
bility criteria: patiey old when admitteive, abdominal
rectal surgery usion: patients witmmatory bowel diseminated cancer, ficant psychiatric ase or dementia ocal reason
ent characteristicsomen, 30 men, m72y (SD 7) CG: 29en, 30 men, mean(SD 7)
treatment for adult
s Interve
ents ed for
th sease,
or other
s: IG: mean
9 n age
• Interv(n=37mobilstrengupperextremaerobmin/semobilaerob1/3 sttraininextremlower load oone remaxim
t cancer patients
ntion(s) Ro
Tinpbfubebsbcs(p
vention group 7): izations, gth training of r and lower mities and bic training, 45 ession (1/3 ization or
bic training, rength ng upper mity, 1/3 extremity),
of 50-80% of epetition mum.
FP7in1(P3sdbinfapm
Results primary outcomes
Trial outcome ndex (p=0.903) physical well-being (p=0.898) unctional well-being (p=0.987) emotional well-being (p=0.082), social/family well-being (p=0.933), colorectal cancer subscale p=0.839)
Fatigue (VAS): Postoperative day7: more increase n CG 2.3 (95%CI.8-2.9) p=0.0007)
Postoperative day30 and 90: no significant differences between groups n change in atigue score (no p-value mentioned)
Results secondary another outcomes
y
y
d Critical appraisal ofquality
Low risk of b High numberdrop-outs, nodirect measuremenone repetitiomaximum, nmonitoring oactivities besintervention
95
f
bias
r of o
nt of on o
of side
96
Study ID
7.4.5 Haem
Study ID
Baumann 201128
Method
discharge
matological cance
Method
• Design: RCT 2• Sources of fun
the German JoCarreras LeukeFoundation, thStefan MorschFoundation, Förderverein Transplantationum
• Setting: centertransplantation
Patien
ers
Patien
2-arm ding:
osé emia e
nszentr
r for n ,
• Eligibwith schegood
• Excludiseathe lethrombleedsoma
• Patie
Exercise t
t characteristics
t characteristics
bility criteria: patiemalignant diseaseduled for HSCT, >
d German skills usion: severe cardase, orthopedic illnegs, bone metastambopenia, acute dings, acute healtatic complaints ent characteristics
treatment for adult
s Interve
• Comp(n=48positiostretcneck ashouldtighterelaxaexercwrappmassa(45mi
s Interve
ents e, >18y,
diac ness of ases,
th or
s:
• Interv(n=17endur(cycletraininachiev-20%,withouinterruADL-t(durinchem
t cancer patients
ntion(s) Ro
parator group 8): turning and oning in bed, hing, relaxing and ders, ning and ation ises, hot
pings, age n/session)
ntion(s) Ro
vention group 7): aerobic rance training e ergometer, ng intensity ved watt load , 10-20min ut uption) and training
ng otherapy and
Q(COdtiIG6+C5(n
Results primary outcomes
Results primary outcomes
Quality of life EORTC-QLQ-
C30): Overall QOL difference over ime G: 63.7±19.7 vs. 68.6±11.2, +7.7%) CG: 62.5±23.9 vs.56.3±17.6, -9.9%) no p-values
Results secondary another outcomes
Results secondary another outcomes
Fatigue (EORTC-QLQ-C30) Difference ovetime IG: 41.8±25.3 vs. 43.8±22.7, +4.8%, no p-value mentioneCG: 36.1±24.5vs. 52.8±27.1, +46.3%,
KCE Report
d Critical appraisal ofquality
d Critical appraisal ofquality
-
er
ed 5
High risk of b Contaminatiocontrol groupITT analysisreporting of allocation concealment
t 185
f
f
bias
on in p, no , no
t
KCE Report 185
Study ID
5
Method
Germany • Sample size: n• Duration: until
discharge
Patien
n=47 • IG: n
mean• CG:
wom(SD
Exercise t
t characteristics
=17, 11 men, 6 wn age 41.41y (SDn=16, 5 men, 11 en, mean age 42.14.04)
treatment for adult
s Interve
women, 11.75)
.81y
after ediffereon strcoordstretcand s20-30twice conduprofestherapdays transpuntil d
• Comp(n=16standphysioprograconsisindividmobiltreatmand pmethointens20mindays/wconduphysiostart otransp
t cancer patients
ntion(s) Ro
engraftment, ent exercises rength, ination, hing, walking tair climbing,
0min/day), a day,
ucted by ssional pist, start 6 prior to plantation discharge parator group 6): clinic’s ard otherapy am, sting of dualized ization
ment (active passive ods with low sities), n/session, 5 week, ucted by otherapist, one day after plantation
m
PfudtiIG62C52
Results primary outcomes
mentioned)
Physical unctioning difference over ime G: 83.1±16.9 vs. 65.9±16.5, -20.7%, p=0.005 CG: 79.6±19.2 vs.59.6±22.9, -25.1%, p=0.002
Results secondary another outcomes
p=0.046
d Critical appraisal ofquality
97
f
98
Study ID
Coleman 200331
Jarden 200939
Method
• Design: RCT 2• Sources of fun
University of Arkansas for MSciences MedEndowment Research FunOncology NurFoundation, thKnudsen ChaFoundation
• Setting: ArkanSample size:
• Duration: durachemotherapy6 months)
• Design: RCT, armed
• Sources of funthe Lundbeck Foundation, thNordic Foundthe Danish CaSociety, the Copenhagen Hospital Corpand the Danis
Patien
2-arm nding:
Medical dical
nd, the rsing he Earl ritable
nsas n=24 ation of y (+/-
• Eligibpatiechemperiptranstreatmmyelrisk f
• Patieage 574 yemen,
two-
nding:
he Novo ation, ancer
poration sh
• Eligibsche
• Exclurecenpulmabnopsycmotoneurobonyanem
Exercise t
t characteristics
bility characteristicents receiving highmotherapy and ranpheral blood stem splantation for the ment of multiple oma, >40y, not atfor pathologic fracent characteristics55 years, age ranears, 10 women, 1, all white
bility criteria: 18-6duled for HDSCTusion: prior HSCTnt cardiovascular onary disease,
ormal electrocardiohiatric disorder an
or, musculoskeletaological dysfunctio
y metastasis, infecmia, neutropenia,
treatment for adult
s Interve
until ddischa
cs: h-dose ndem cell
t high cture s: mean ge 42-14
• Interv(n=14basedprogracombresistaaerob3x weminut
• Comp(n=10and encouremai
5y,
T, or
ogram, nd al or on, ction,
• Interv(n=21plus mintervconsiswarm(statio15-30max hdays/wdynam
t cancer patients
ntion(s) Ro
day before arge
vention group 4): Home-d exercise am, ination of ance and
bic exercise, eekly for 20 es
parator group 0): usual care
uragement to n active
Fntiam
vention group ): usual care
multimodal ention, sting of 4min -up onary cycling, 0min,<75% of heart rate, 5 week), mic and
Qfu(CDpgIG7C
Results primary outcomes
Fatigue (POMS): no reduction over ime (no changes and p-values mentioned)
QOL-Physical unctioning EORTC-QLQ-
C30): Difference pre-post between groups G:82.9±16.3 vs 75.3±17.4 CG: 83.8±13.4 vs
Results secondary another outcomes
Adverse eventa broken centrvenous cathetestick
Fatigue (EORTC-QLQ-C30): Difference pre-post between groups IG:33.9±28.2 v50.3±24.6 CG: 34.9±28.4vs 58.8±26.0
KCE Report
d Critical appraisal ofquality
ts: ral er
Low sample size, study underpowereUnclear reporting (stusplit results opatients on othalidomide therapy thusonly 10 patieare reported exercise versnot exercise)No reportingcompletion ror adherenceexercise
-
-
vs
4
High risk of bControl grouwas free to increase physical activSmall samplsize
t 185
f
ed
udy of or off
s ents
on sus ) of ate e to
bias p
vity e
KCE Report 185
Study ID
5
Method
Nursing Socie• Setting: Unive
Hospital of Copenhagen, Denmark
• Sample size: • Duration: 4-6
Patien
ety ersity
n=42 week
throm• Patie• IG: n
(SD • CG:
(SD
Exercise t
t characteristics
mbocytopenia ents characteristic=21, mean age 413.3) n=21, mean age 311.1)
treatment for adult
s Interve
cs: 0.9y
37.4y
stretcexerc20mindays/wresista(15-203daysprogrerelaxa2dayspsych
• Comp(n=21(rangeresistamassa
t cancer patients
ntion(s) Ro
hing ises (15-
n, 5 week), ance training 0min, s/week), essive ation (20min, s/week) and ho-education parator group ): usual care e of motion, ance and age)
6(D3gIG7C6(D6gIG8C7(
QDpgIG8C6(
Results primary outcomes
63.5±22.6 p=0.089)
Difference pre-3months between groups G: 82.9±16.3 vs 77.1±18.1 CG: 83.8±13.4 vs 67.7±23.1 p=0.325)
Difference pre-6months between groups G: 82.9±16.3 vs 87.1±13.2 CG: 83.8±13.4 vs 74.4±23.1 p=0.131)
QOL-FACT-g: Difference pre-post between groups G:87.0±10.9 vs 81.6±14.5 CG: 77.8±14.7 vs 69.0±11.5 p=0.298)
Results secondary another outcomes
(p=0.405) Difference pre-3months between groupIG:33.9±28.2 v44.4±25.0 CG: 34.9±28.4vs 57.3±26.0 (p=0.302) Difference pre-6months between groupIG:33.9±28.2 v29.6±21.3 CG: 34.9±28.4vs 49.6±34.1 (p=0.097) Fatigue (FACTAn) Difference pre-post between groups IG:39.6±6.7 vs33.9±9.7 CG: 37.5±8.9 v27.8±9.0 (p=0.218)
d Critical appraisal ofquality
-
ps vs
4
-
ps vs
4
T-
-
s
vs
99
f
100
Study ID Method Patien
Exercise t
t characteristics
treatment for adult
s Interve
t cancer patients
ntion(s) Ro
D3gIG8C7(6(D6gIG9C7(
QDpgIG1Cv(
Results primary outcomes
Difference pre-3months between groups G:87.0±10.9 vs 85.6±9.9 CG: 77.8±14.7 vs 71.3±13.0 p=0.241)
67.7±23.1 p=0.241)
Difference pre-6months between groups G:87.0±10.9 vs 90.1±11.9 CG: 77.8±14.7 vs 78.1±18.0 p=0.620)
QOL-FACT-An: Difference pre-post between groups G:149.2±18.0 vs 36.5±26.1
CG: 136.4±24.6 vs 115.8±21.6 p=0.225)
Results secondary another outcomes
Difference pre-3months between groupIG:39.6±6.7 vs37.1±8.9 CG: 37.5±8.9 v31.2±11.9 (p=0.312) Difference pre-6months between groupIG:39.6±6.7 vs40.1±10.6 CG: 37.5±8.9 v33.2±13.0 (p=0.325) Cardiopulmonay function (VO2peak) Difference pre-post IG: 1.97±0.53 v2.03±0.59 (mean % change 0.01) CG: 2.03±0.58vs 1.45±0.46 (mean %
KCE Report
d Critical appraisal ofquality
-
ps s
vs
-
ps s
vs
ar
-
vs
8
t 185
f
KCE Report 185
Study ID
Courneya 200934
5
Method
• Design: RCT, • Sources of Fu
Lance ArmstroFoundation, thCanada ReseChair programHealth Studenships, Senior Scholar AwardClinical InvestAward from thAlberta HeritaFoundation fo
Patien
2 arms unding: ong he earch m, nt –Health d, and tigator he age or
• EligibspeahistoNHL,chemtreatm
• Patieage: Canc(42%(39.3lympstatu
Exercise t
t characteristics
bility criteria: Englaking, ≥18 years, rically confirmed H, receiving
motherapy or no ment
ent characteristics53.2 (range 18-80
cer type: NHL indo%), NHL aggressiv3%), Hodgkins homa (18%) Treas: Chemotherapy
treatment for adult
s Interve
ish
HL or
s: Mean 0) olent ve
atment y
• Interv(n=60exercfor 12intenspeak first wincreaeach (week15-204, incmin p45min
t cancer patients
ntion(s) Ro
D3gIG1Cv(D6gIG1Cv(
vention group 0): aerobic ise 3xweekly
2 weeks, sity at 60% of power output
week, ased by 5% week to 75% k 4), duration 0 min week 1-reased by 5 r week to 40-n (week 9).
Cfu(DpIG+0C-00Ud
Results primary outcomes
Difference pre-3months between groups G:149.2±18.0 vs 45.6±19.9
CG: 136.4±24.6 vs 121.7±25.2 p=0.167)
Difference pre-6months between groups G:149.2±18.0 vs 53.8±25.1
CG: 136.4±24.6 vs 131.7±34.6 p=0.395)
Cardiopulmonary unction (VO2peakl/min))
Difference pre-post G: mean change +0.40 (95%CI 0.34-0.47) CG: mean change0.03 (95%CI -
0.09-0.03) Unadjusted group difference in
Results secondary another outcomes
change -27.68p<0.0001
k
e
Fatigue (FACTAn) Difference pre-post IG: mean change +4.5 (95%CI 1.9-7.1CG: mean change -0.1 (95%CI -2.7-2.Unadjusted group differencin mean chang
d Critical appraisal ofquality
)
T-
-
1)
.4)
ce ge
moderate risbias allocation sequence generated independentand concealein opaque envelopes frthe study coordinator wassigned participants t
101
f
sk of
tly ed
om
who
to
102
Study ID Method
Medical Resegrant from NaCancer instituCanada, by Canadian CanSociety and thNCIC/CCS SociobehavioCancer ReseaNetwork
• Setting: CrossCancer instituEdmonton, AlCanada
• Sample size: lymphoma pat
• Duration: 12 w
Patien
arch, ational ute of
ncer he
ural arch
s ute, berta,
122 tients weeks
(44.3treatmtreatm
Exercise t
t characteristics
3%) but stratified fment status Off ment (55.7%)
treatment for adult
s Interve
for Additisessiotraininventila(weeksessiopeak trainin
• Comp(n=62and aincreaaboveduring
t cancer patients
ntion(s) Ro
onally one on of interval ng above ator threshold k 7) and one on of VO2 interval ng (week9) parator group 2): usual care asked not to ase exercise e baseline g trial
m+0(Adm+0(
QDpIG+4C+6Udm+1Adm+1
Results primary outcomes
mean change +0.43 (95%CI 0.34-0.52) p<.001)
Adjusted group difference in mean change +0.43 (95%CI 0.34-0.52) p<.001)
QOL (FACT-An) Difference pre-post G: mean change +10.6 (95%CI 4.9-16.3) CG: mean change+1.1 (95%CI -4.5-6.7) Unadjusted group difference in mean change +9.5 (95%CI 1.5-
7.5) (p=0.021) Adjusted group difference in mean change +7.2 (95%CI 0.4-
4.1)(p=0.039)
Results secondary another outcomes
e
+4.6 (95%CI 1.0-8.3) (p=0.013) Adjusted groupdifference in mean change +4.0 (95%CI 0.9-7.0)(p=0.012)Treatment status (on or ochemo) did notmoderate effecfor any objectively measured outcomes: Adverse evenNo serious adverse event but 3 adverse event (back, hiand knee pain)related to exercise. Patients with knee pain withdrew. The two other patients continued with
KCE Report
d Critical appraisal ofquality
p
ff t ct
ts
ip )
groups
t 185
f
KCE Report 185
Study ID
Dimeo 199735
5
Method
• Design: RCT, • Sources of fun
the Nenad KeFoundation Preventive MeFreisburg in Breisgau, Ger
• Setting: FreibuUniversity MeCentre
• Sample size: • Duration: indiv
duration depeon hospitaliza(11-18 days)
Patien
2arms nding:
eul
edicine,
rmany urg dical
70 vidual
ending ation
• Eligibconfiperfo60y, impapulmfunctmetaextretransperip
• Patiemean10), m(+-11
Exercise t
t characteristics
bility criteria: maligrmed by biopsy, E
ormance score 0-2no evidence of
airment of cardiac,onary, renal and tion; absence of bastases in the loweemities; and splantation of CD 3pheral blood stem ents characteristicn age IG 39 yearsmean age CG 40 1)
treatment for adult
s Interve
gnancy ECOG 2, 18-
, hepatic
bony er
34+ cells.
cs: s (+-years
• Interv(n=33exercergominterv15 daat mincardia
• Comp(n=37
t cancer patients
ntion(s) Ro
vention group 3): aerobic ises on bed
meter, als of 1 min x
aily, intensity n 50% of ac reserve parator group 7): no exercise
CfuraMraIGCpMraIGCp
%mraIGCp%mraIG
Results primary outcomes
Cardiopulmonary unction (heart ate)
Maximal heart ate at admissionG: 170±18 CG: 168±16 p=0.58 Maximal heart ate at dischargeG: 166±21 CG: 168±19 p=0.84
% of estimated maximal heart ate at admissionG: 94±7 CG: 94±8 p=0.89 % of estimated maximal heart ate at admissionG: 92±10
Results secondary another outcomes
modified exercise program
Adverse eventless severity ofcomplications IG: Diarrhea: p=0.04 Pain: p=0.01 One severe adverse event exercise groupdeemed to be highly unlikely related to exercise (patiedied of hepatichemorrhage)
d Critical appraisal ofquality
ts f in
in p
ent c
high risk of b multiple comparisonsincreased risspurious find randomizationot well described no descriptioallocation concealment
103
f
bias
s, sk of dings
on
on of
t
104
Study ID
Chang 200830
Method
• Design: RCT, • Sources of fun
none stated • Setting: medic
centre in centTaiwan
• Sample size: 2patients with A
• Duration: 3 we
Patien
2 arms nding:
cal ral
22 AML eeks
• Eligibof agand aprescsatisfcondECOwillin
• Patiemean(SD=(SD=
Exercise t
t characteristics
bility criteria: > 18 ge diagnosed withaware of their diagcribed chemotherafactory functional ition as determine
OG-PS (rating of 0-g to sign consent
ents characteristicn age IG=49.4 yea=15.3), CG=53.3 y=13.6)
treatment for adult
s Interve
years AML gnosis, apy, in
ed by -3.), t form cs: ars years
• Interv(n=11walkinhallwaper wweeks
• Comp(n=11invasicare
t cancer patients
ntion(s) Ro
Cp
vention group ): 12 min
ng in hospital ay, five days eek for 3 s parator group ): non-ive routine
FAindbA(90A(90A(90
WindbA(90A(91A(9
Results primary outcomes
CG: 93±9 p=0.69
Fatigue Average fatigue ntensity: difference between groups At day 7: -3.64 95%CI -6.65 to -
0.62) p=0.02 At day 14: -3.73 95%CI -6.65 to -
0.81) p=0.010 At day 21: -2.55 95%CI -5.62 to -
0.53) p=0.100
Worst fatigue ntensity: difference between groups At day 7: -4.73 95%CI -8.73 to -
0.72) p=0.02 At day 14: -4.27 95%CI -7.53 to -.01) p=0.01
At day 21: -3.36 95%CI -6.74 to
Results secondary another outcomes
Secondary outcomes not part of project outcomes No adverse events
KCE Report
d Critical appraisal ofquality
high risk of ballocation concealmentdescribed small samplesize lacks patientsimilarity at baseline
t 185
f
bias
t not
e
t
KCE Report 185
Study ID
5
Method Patien
Exercise t
t characteristics
treatment for adult
s Interve
t cancer patients
ntion(s) Ro
0FindbA(90A(90A(90
Results primary outcomes
0.01) p=0.05 Fatigue nterference difference between groups At day 7: -2.58 95%CI -5.06 to -
0.09) p=0.04 At day 14: -2.83 95%CI -5.56 to -
0.11) p=0.04 At day 21: -3.32 95%CI -6.18 to -
0.46) p=0.02
Results secondary another outcomes
d Critical appraisal ofquality
105
f
106
7.4.6 Mixed
Study ID
Rummans 200641
d cancers
Method
• Design: RCT, tarms
• Sources of funthe Linse BockFoundation, SaMarys HospitaSponsorship B
• Setting: Mayo Cancer Center
• Sample size: n• Duration: 4 we
Patien
two-
ding: k aint l
Board Clinic r n=103 eks
• EligibdiagncancsurviplannweekExcluon FostatumoreCoopGroudisorongosubsradiaof dis
• Patien=4911.4959.4y
Exercise t
t characteristics
bility criteria: newlnosed with advancer, estimated 5-yeval rate of 0-50% ned to receive at lks of radiation theusion: scored 20 oolstein mini mentas examination, 3
e on the Eastern perative Oncologyup, active thought rder or suicidality, oing alcohol or tance abuse, prev
ation therapy, recusease ent characteristics9, mean age 59.7y9), CG n=54, meay (SD 10.62)
treatment for adult
s Interve
y ced ear who east 2 rapy. or less al or
y
vious urrence
s: IG: y (SD an age
• Interv(n=49sessiocompweeksenrollpsychpsychfacilitanursetherapor soc20minexerceducainstru20minexerc
• Comp(n=54
t cancer patients
ntion(s) Ro
vention group 9): 8x90min-ons, leted within 4 s after ment, led by
hiatrist or hologist co ated by
e, physical pist, chaplain cial worker, n conditioning ises,
ational ction and n relaxation ises.
parator group 4): usual care
QUAAoObIGCpOwIGCpOwIGCpOwIGCpNd
Results primary outcomes
QOL (Spitzer QOLUniscale + Linear Analogue Scales oAssessment (LASAof QOL) Overall QOL at baseline G: 70.0±21.89 CG: 73.0±20.80 p=0.4829 Overall QOL at week 4 G: 72.8±20.62 CG: 64.1±22.53 p=0.0469 Overall QOL at week 8 G: 71.9±19.41 CG: 68.4±23.48 p=0.4229 Overall QOL at week 27 G: 72.1±19.49 CG: 72.1±18.97 p=0.9922 No significant difference in overa
Results secondary aother outcom
L
of A)
all
Secondary outcomes noof project outcomes
KCE Report
and mes
Critical appraisaquality
ot part High risk bias Small samsize Heterogeof study populatio
t 185
al of
of
mple
eneity
on
KCE Report 185
Study ID
Adamsen 200926
5
Method
• Design: RCT 2• Sources of fun
The LundbeckFoundation, TNovo NordiskEgmont FounThe Danish CSociety, The SAndersen Foundation, TAase and EjnaDanielsen Foundation, TBeckett FoundThe Wedell-Wedellsborg Foundation, THede Nielsen Foundation, TGangsted Foundation, Copenhagen University Hos
• Setting: Two University Hosin CopenhageDenmark
Patien
2 arms nding: k The , The dation,
Cancer Svend
The ar
The dation,
The Family
The
spital
spitals en,
• Eligibof caleastchemdiseatreatmperfoand 1
• Patiemen,47 ye21dif59 diregim
Exercise t
t characteristics
bility criteria: diagnancer, having rece
one cycle of motherapy for advaase or as adjuvanment, having a Wormance status of 18-65 years ents characteristic, 196 women, meaears (range 20-65fferent cancer diagfferent chemothe
mes
treatment for adult
s Interve
nosis eived at
anced t
WHO 0 or 1,
cs: 73 an age
5), gnosis, rapy
• Interv(n=11basedhigh aintensintervsupertrainespeciaphysiohigh itraininminutfor 6 wactivitequivatotal ohours
• Comp(n=11convemedicalloweincreaactivitprograsix we
t cancer patients
ntion(s) Ro
Qgd(nm
vention group 8): Group
d multimodal and low sity exercise ention rvised by ed nurse alist and otherapist, ntensity ng for 90 es 3 x weekly weeks, ties alent to a of 43 MET s per week parator group 7):
entional cal care + ed freely to ase physical ty + exercise am after the eek
QQGsd6IG6C6M27
Pfud6IG8C8M25
Results primary outcomes
QOL in interventiogroup, a significandecrease in QOL no p-value
mentioned)
QOL (EORTC QLQ-C30) Global health status/QOL: difference baseline6weeks G: 63.8±21.1 vs 67.2±20.3 CG: 60.2±22.4 vs 63.3±22.4 Mean difference: 2.2 (95%CI -2.7-7.1), p=0.4
Physical unctioning: difference baseline6weeks G: 84.7±14.5 vs 89.0±12.4 CG: 84.0±15.7 vs 86.4±14.5 Mean difference: 2.4 (95%CI -0.4-5.1), p=0.09
Results secondary aother outcom
on nt
e-
e-
Fatigue (EORQLQ-C30) Difference baseline-6weIG: 39.7±25.834.6±24.3 CG: 43.0±2341.0±22.7 Mean differe6.6 (95%CI -to -0.9), p=0. Adverse eveOne patient wbrain tumor experienced grade 3 seizupost cardiovascultraining (recovered bsubsequentlyexcluded fromtrial)
and mes
Critical appraisaquality
RTC-
eeks 8 vs
3.9 vs
nce: --12.3 .02
nts with
ure
ar
but y m
Low risk bias Randomion using CITMAS AllocationconcealeOutcomemeasureskeyed ananalyzedindependresearch assistant Analysescarried ouon an ITTbasis
107
al of
of
zati
n ed e s
nd by
dent
s ut T
108
Study ID
Mustian 200940
Method
• Sample size: 2patients with c(mixed)
• Duration: 6 we
• Design: RCT 2• Sources of fun
the National CInstitute
• Setting: UniveRochester JamWilmot CanceCenter
• Sample size: (breast and prcancer patient
• Duration: 4 we
Patien
269 cancer
eeks
2-arms nding: Cancer
ersity of mes P. er
n=38 rostate ts) eeks
• Eligibwith with begintherametadiseacontrschetreatmlifesty
• Patien=19CG:
Exercise t
t characteristics
bility criteria: wombreast cancer andprostate cancer nning standard radapy, no distant astases, no recurrease, no raindications, at leduled radiation ments, sedentary yle
ent characteristics9, 6 men, 13 women=19, 5 men, 14 w
treatment for adult
s Interve
asses
men d men
diation
ent
east 30
s: IG: en, women
• Interv(n=19therapindividhomeprogrewalkinheart a weeweekstherapresistaprogra(modeintensprogreresistaexercweek
t cancer patients
ntion(s) Ro
ssment CfuinD6IG1C1M00
vention group 9): radiation py+ dually tailored
e-based, essive ng (60-70% of rate, 7 days
ek for 4 s) and peutic ance band am erately se essive ance ise, 7 days a for 4 weeks,
FDpIG10(C20(
Din3IG10
Results primary outcomes
Cardiopulmonary unction (VO2peakn l/min) Difference baselin6weeks G: 1.82±0.4 vs .96±0.5
CG: 1.90±0.5 vs .88±0.5
Mean difference: 0.16 (95%CI 0.1-0.2), p<0.0001
Fatigue (BFI) Difference baselinpost-intervention G:1.85±1.87 vs .60±1.36 (-
0.25±1.24) Cohen’s d=-0.15)
CG: 2.62±2.14 vs 2.44±2.08 (-0.18±1.16) Cohen’s d=-0.08)
Difference post-ntervention-3months G:1.60±1.36 vs .16±0.98 (-
0.66±1.52)
Results secondary aother outcom
k
e-
e-
)
)
Secondary outcomes noof project outcomes
KCE Report
and mes
Critical appraisaquality
ot part Low risk bias Patients blinded, rof experimebias, participanexpectaneffect or nonspecitreatmeneffects
t 185
al of
of
not risk
enter
nt ncy
fic t
KCE Report 185
Study ID
5
Method Patien
Exercise t
t characteristics
treatment for adult
s Interve
focusebody)
• Compconvemedic(radia
t cancer patients
ntion(s) Ro
ed on upper ) parator group: entional cal care ation therapy)
(C2(0(
FDpIG4((C31(
Din3IG4((C4((
Results primary outcomes
Cohen’s d=-0.58)CG: 2.44±2.08 vs 2.73± 2.60 0.12±1.95) Cohen’s d=0.04)
Fatigue (FACIT-F)Difference baselinpost-intervention G:38.68±11.66 vs41.79±8.99 3.11±8.69) Cohen’s d=0.29)
CG: 36.89±11.73 v35.84±12.08 (-
.05±4.84) Cohen’s d=-0.09)
Difference post-ntervention-3months G:41.79±8.99 vs 43.17±7.74 3.89±7.77) Cohen’s d=0.45)
CG: 35.84±12.08 v40.35±12.24 3.88±6.97) Cohen’s d=0.29)
Results secondary aother outcom
)
) e-
s
vs
)
vs
and mes
Critical appraisaquality
109
al of
110
Study ID Method Patien
Exercise t
t characteristics
treatment for adult
s Interve
t cancer patients
ntion(s) Ro
CfuDpIGv(4(C112(
Din3IGv((C11((
QDp
Results primary outcomes
Cardiopulmonary unction (6MWT) Difference baselinpost-intervention G:1894.37±296.7vs 1937.95±261.943.58±227.84) Cohen’s d=0.16)
CG: 478.21±401.02 v425.28±438.27 (-
28.44±303.75) Cohen’s d=-0.13)
Difference post-ntervention-3months G:1937.95±261.9vs 2020.59± 386.3133.53±396.79) Cohen’s d=0.37)
CG: 425.28±438.27 v600.33±468.86 78.73±484.12) Cohen’s d=0.28)
QOL (FACIT-F) Difference baselinpost-intervention
Results secondary aother outcom
e-
8 9
vs -
)
9 36
vs
e-
KCE Report
and mes
Critical appraisaquality
t 185
al of
KCE Report 185
Study ID
Griffith 200937
5
Method
• Design: RCT 2• Sources of fun
The National Institutes of HNational CentResearch resoNIH RoadmapMedical Rese
• Setting: univeteaching hospcommunity cacenter in Balti
Patien
2-arms nding:
Health, ter for ources, p for arch rsity
pital and ancer more
• Eligibdiagncancto recradiaexcluindivthan
• Patien=6810.8)60.6y
Exercise t
t characteristics
bility criteria: >21ynosis of stage I to er who were scheceive chemothera
ation therapy or bousion: comorbiditieiduals exercising 120min per week
ent characteristics8, mean age 59.8y), CG: n=58, meany (SD 10.8)
treatment for adult
s Interve
y, II
eduled apy, oth, es, more
k s: IG: y (SD n age
• Interv(n=68interv70% oheart 20-30followslowe(cool times biweecall by
t cancer patients
ntion(s) Ro
IG1(6(Cv0(Din3IG11CCv(8(
vention group 8): walking ention, 50-of maximum rate, brisk
0 min walk wed by 5 min er walking down), 5 per week +
ekly telephone y study nurse
CfuDIGCp
Results primary outcomes
G:124.19±25.12 v30.19±20.13 6.00±18.31) Cohen’s d=0.26)
CG: 117.59±29.65vs 116.92±30.58 (0.67±11.51) Cohen’s d=-0.02)
Difference post-ntervention-3months G:130.19±20.13 v32.96± 6.41(8.76±16.51)
Cohen’s d=0.41) CG: 116.92±30.58vs 126.13±31.81 8.55±11.28) Cohen’s d=0.28)
Cardiopulmonary unction (VO2peakDifference pre-posG: -2.9% CG: +5.6% p=0.26
Results secondary aother outcom
vs
5 -
)
vs
)(
8
k) st
Cardiopulmofunction (VO2peak) Difference prpost (dose-response analysis) Prostate grou+8% Nonprostate group:->9%
and mes
Critical appraisaquality
onary
re-
up:
High risk bias Adherencproblemssmall samsize, limitpower forsubset analysis, of 2 methodos for
111
al of
of
ce s, mple ted r
use
logie
112
Study ID
Brown 200629
Method
• Sample size: • Duration: ?
• Design: RCT 2• Sources of fun
the Linse BocFoundation anSaint Mary’s HSponsorship B
• Setting: DivisiRadiation OncMayo Clinic, Rochester
• Sample size: • Duration: 4we
Patien
n=126
2-arms nding:
ck nd the Hospital Board on of cology
n=115 eeks
• Eligibdiagnmontat leasurvimorerecom2 weless tor mosubsthougplans
• Patien=49
Exercise t
t characteristics
bility criteria: cancnosis within the paths, expected survast 6 months, 5-yeval probability of n
e than 50%, treatmmmendation for aeks, exclusion: Mthan 20, ECOG score, active alcohotance abuse, activght disorder, suicis ent characteristics9, CG: n=54
treatment for adult
s Interve
• Comp(n=58phonestudy patienencoumaintcurrenactivit
cer ast 12 vival of ear no ment t least MSE core 3
ol or ve dal
s: IG:
• Interv(n=49sessioweeksrangeexercand loextremresistwith estretcexercfunctioextremto incendurrelaxaexercindividhome
• Comp(n=54medic
t cancer patients
ntion(s) Ro
parator group 8): biweekly e calls by nurse +
nts were uraged to ain their nt level of ty vention group 9): 8x90-min ons over 4 s, seated
e of motion ises of upper
ower mities, ive exercises
elastic band, hing ises, onal lower mity exercises rease rance, ation ises and a dualized
e program parator group 4): standard cal care (not
FDgPinPaSpLS
Dgofa(
Dg
Results primary outcomes
Fatigue Difference betweegroups at baselinePOMS fatigue-nertia: p=0.3934POMS vigor-activity: p=0.2495SDS Fatigue: p=0.9887 LASA: p=0.7950 STAI: p=0.9302
Difference betweegroups at week 4:overall higher atigue QOL-scorep=0.047) in IG
Difference betweegroups at week 8
Results secondary aother outcom
p=0.008
en e:
en
es
en
Secondary outcomes noof project outcomes
KCE Report
and mes
Critical appraisaquality
cardiorestory fitnesassessm
ot part High risk bias Complianto exercisinstructiounknownamount oexercisesknown in control gr
t 185
al of
spirass ent
of
nce se
ons ,
of s not
roup
KCE Report 185
Study ID
Dodd 201036
5
Method
• Design: RCT • Sources of fun
the National CInstitute, the Cand TranslatioScience InstituClinical ReseaCenter
• Setting: 6 outpsettings in SaFrancisco Bay
• Sample size: • Duration: 1y
Patien
3-arms nding: Cancer Clinical onal ute, arch
patient n y Area n=119
• Eligib>18ybreascancchemPerfo60 orconcboneuncodiabeinten3, lytorthoof madisorwithinAIDSleuke
• Patien=448.2); 52.0yn=36
Exercise t
t characteristics
bility criteria: womy, confirmed diagnst, colorectal or over, beginning first
motherapy, Karnoformance Status scr greater, exclusiourrent radiation th
e marrow transplaontrolled hypertensetes mellitus, painsity score greateric bone lesion,
opedic limitations, ajor depression, srders, chemotheran past year, diagn
S-related malignanemia ent characteristics4, mean age 49.4y
CG: n=39, mean y (SD 10.8); Post-6, mean age 50.4y
treatment for adult
s Interve
furthe
men, nosis of varian t fsky core of on: herapy, ntation, sion, n r than
history sleep apy nosis of ncy,
s: IG: y (SD age
-IG: y (SD
• Interv(n=37prescweeklfrom etraineof indcardioobic etimes heart 80% V30mincontinexerc
• Later-groupsimilaintervcompcance
• Comp(n=37(no ex
t cancer patients
ntion(s) Ro
er described) ndtrfa(inSp
vention group 7): exercise ription with ly phone calls exercise
ers, consisting ividualized ovascular/aerexercises, 3-5 per week, rate at 60-
VO2peak, 20-n of nuous ises -intervention p (n=32): ar exercise ention after letion of
er treatment parator group 7): usual care xercise
FCp
CpNm
Results primary outcomes
no significant differences, but rend towards bettatigue-score in CGPOMS Fatigue-nertia p=0.065 anSDS Fatigue p=0.098)
Fatigue (PFS) Change over timep=0.084
Change over time per group No p-value mentioned
Results secondary aother outcom
ter G
d
Adverse eveHip pain, scia(n=16), arm discomfort (nknee discom(n=10), anklediscomfort (nfoot discomfo(n=8), asymptomatiischemic chaelectrocardio(n=10), asymptomatibigeminy (n=premature ventricular complexes (n
and mes
Critical appraisaquality
nts atica
n=4), fort
e n=3), ort
ic anges ogram
ic =6),
n=9)
Moderaterisk of biaOnly 3 assessmin 1 year period to capture effect
113
al of
e as
ents
114
Study ID
Courneya 200833
Method
• Design: RCT, • Funding: fund
drug supply pby Amgen, CaInc.
• Setting: CrossCancer InstituEdmonton, Ca
• Sample size: to-moderatelyanemic cancepatients
• Duration: 12 w
Patien
9.0)
2 arms ding and rovided anada,
s ute, anada 55 mild-
y er
weeks
• EligibconficancleverEasteOncostatudefinsurvispeaage, thera
• Patieage=(81.8chemnot snon-c
Exercise t
t characteristics
bility criteria: histormed nonmyoloider diagnosis, an H
r of 80-110 g/l, an ern Cooperative ology group perfors of 0-2, completeitive surgery, expval ≥3 months, En
aking and ≥18 yeadarbepoetin alfa
apy ent characteristics=56 (25-77), Fema8%), Current motherapy=51 (92stratified for chemochemo
treatment for adult
s Interve
prescweeklby res
orically
Hb
rmance ed ected nglish
ars of
s: mean ale 45
.7%), o vs.
• Interv(n=26ergomsessiofor 12100%peak
• Comp(n=29askedinitiateexercduringperiod
t cancer patients
ntion(s) Ro
ription) + ly phone calls search nurse vention group 6):3 x cycle metry ons pr week 2 weeks at 60-
% of baseline power output
parator group 9):usual care, d not to e a structured ise program g intervention d
QMbp+2C9Ud(9pAd(9p
FMbp+1C4Ud
Results primary outcomes
QOL ( FACT-An)Mean change baseline-postintervention IG+13.4 (95%CI 2.5-24.2) CG: +20.3 (95%C9.2-31.4) Unadjusted group difference: -6.9 95%CI -22.1-8.3)
p=0.363 Adjusted group difference: -3.2 95%CI -16.7-10.4
p=0.637
Fatigue (FACT-AnMean change baseline-postintervention IG+7.8 (95%CI 2.8-
2.8) CG: +9.1 (95%CI 4.4-13.8) Unadjusted group difference: -1.3
Results secondary aother outcom
G: -
I
,
4),
n)
G:
Cardiopulmofunction (VO2peak) VO2peak (ml/kg/min) Unadjusted gdifference: +(95%CI -1.2-p=0.001 Adjusted grodifference: +(95%CI 1.1-5p=0.003 VO2peak (l/mUnadjusted gdifference: +(95%CI 0.080.34), p=0.00Adjusted grodifference: +(95%CI 0.080.37), p=0.00
KCE Report
and mes
Critical appraisaquality
onary
group 3.0 -4.7),
oup 3.0 5.0),
min) group 0.21 -01
oup 0.22 -04
moderaterisk of biaITT analyAppropriaallocationconcealm
t 185
al of
e as ysis ate n ment
KCE Report 185
Study ID
Schwartz 200942
5
Method
• Design: RCT • Funding: Natio
Institutes of Hgrant
• Setting: 3 majcancer centrecommunity meoncology prac
• Sample size: women
• Duration: 12m
Patien
3 arms onal
Health
jor s and edical ctices 101
months
• Eligibwith neopspeaambuexercchemradiobeginwith aantiepsyccardimovepulm6 mostudyhyperheumankymeta
• Patien=34n=34n=33
Exercise t
t characteristics
bility criteria: womhistologically conf
plasia, >18y, able ak and read Englisulatory, cised<120min per
motherapy and otherapy naïve, nning chemotheraa steroid or as an
emetic, exclusion: hiatric illness, ovascular disease
ement-limiting arthonary diseases, s
onths prior to starty, Paget’s disease
erparathyroidism, matoid arthritis, losing spondylitis
abolic bone diseasent characteristics4, mean age 48y; 4, mean age 47y; 3, mean age 48y
treatment for adult
s Interve
men firmed to
sh,
r week,
apy
e, hritis, steroids t of e,
, other ses s: AG: RG: CG:
• Intervaerobgroup4days30minintensbearinactivittelephup
• Intervresistagroupspecifwith thon weequip3 setsrepetisets orepetion surepetimaximtelephup
t cancer patients
ntion(s) Ro
(9pAd(9p
vention bic exercise p (AG)(n=34): s/week, 20-n, low sities, weight ng aerobic ties + hone follow-
vention ance exercise
p (RG)(n=34): fic exercises heraband or eight ment, at least
s of 12 tions or 2
of 18-20 tions (based bjects 1-tion
mum)+ hone follow-
CfuCA16(m1R16(m1C1619DgA6
Results primary outcomes
95%CI -8.0-5.4), p=0.694 Adjusted group difference: +2.1 95%CI -2.8-7.1),
p=0.388
Cardiopulmonary unction (12MWT) Change over timeAG: baseline
017.3 (SD 210), a6 months 1219.2 SD 178), at 12
months 1201 (SD 83)
RG: baseline 021.7 (SD 186), a
6 months 1174.7 SD 191), at 12
months 1144 (SD 85)
CG: baseline 035.4 (SD 200), a
6 months 911.1 (S94), at 12 months
983 (SD 193) Difference betweegroups AG:+16%, mean 661±9ft at 6 and
Results secondary aother outcom
at
at
at SD s
en
Adherence rain AG 94% (7at 12months)RG 74% andat 12 months
and mes
Critical appraisaquality
ate: 79% ), in
d 65% s
High risk bias Problemswith adherencrate in RG
115
al of
of
s
ce G
116
Study ID
Method Patien
Exercise t
t characteristics
treatment for adult
s Interve
• Comp(n=33teleph
t cancer patients
ntion(s) Ro
parator group 3): only hone call
1R41Cain1dto
Results primary outcomes
2months RG:+11%, mean 401±28ft at 6 and
2months (p<0.05CG: 12% decreaseat 6 months, ncrease at 2months but 5%
decline compared o baseline
Results secondary aother outcom
5) e
KCE Report
and mes
Critical appraisaquality
t 185
al of
KCE Report 185
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