A Systematic Review of Exercise Systematic Reviews in the Cancer Literature (2005‐2017)

• Published in: PM & R Vol. 9; no. 9S2; pp. S347 - S384
• Main Authors: Stout, Nicole L., Baima, Jennifer, Swisher, Anne K., Winters‐Stone, Kerri M., Welsh, Judith
• Format: Journal Article
• Language: English
• Published: United States 01.09.2017
• Subjects: Continuity of Patient Care; Disease-Free Survival; Exercise - physiology; Exercise Therapy - methods; Female; Humans; Male; Neoplasms - mortality; Neoplasms - pathology; Neoplasms - rehabilitation; Physical Fitness - physiology; Quality of Life; Review Literature as Topic; Risk Assessment; Survival Analysis; Survivors - psychology
• ISSN: 1934-1482; 1934-1563
• DOI: 10.1016/j.pmrj.2017.07.074

Background Evidence supports the benefits of exercise for patients with cancer; however, specific guidance for clinical decision making regarding exercise timing, frequency, duration, and intensity is lacking. Efforts are needed to optimize clinical recommendations for exercise in the cancer population. Objectives To aggregate information regarding the benefit of exercise through a systematic review of existing systematic reviews in the cancer exercise literature. Data Sources PubMed, CINAHL Plus, Scopus, Web of Science, and EMBASE. Study Eligibility Criteria Systematic reviews and meta‐analyses of the impact of movement‐based exercise on the adult cancer population. Methods Two author teams reviewed 302 s for inclusion with 93 selected for full‐text review. A total of 53 studies were analyzed. A Measurement Tool to Assess Systematic Reviews (AMSTAR) was used as a quality measure of the reviews. Information was extracted using the PICO format (ie, participants, intervention, comparison, outcomes). Descriptive findings are reported. Results Mean AMSTAR score = 7.66/11 (±2.04) suggests moderate quality of the systematic reviews. Exercise is beneficial before, during, and after cancer treatment, across all cancer types, and for a variety of cancer‐related impairments. Moderate‐to‐vigorous exercise is the best level of exercise intensity to improve physical function and mitigate cancer‐related impairments. Therapeutic exercises are beneficial to manage treatment side effects, may enhance tolerance to cancer treatments, and improve functional outcomes. Supervised exercise yielded superior benefits versus unsupervised. Serious adverse events were not common. Limitations Movement‐based exercise intervention outcomes are reported. No analysis of pooled effects was calculated across reviews due to significant heterogeneity within the systematic reviews. Findings do not consider exercise in advanced cancers or pediatric populations. Conclusions Exercise promotes significant improvements in clinical, functional, and in some populations, survival outcomes and can be recommended regardless of the type of cancer. Although generally safe, patients should be screened and appropriate precautions taken. Efforts to strengthen uniformity in clinical trial reporting, develop clinical practice guidelines, and integrate exercise and rehabilitation services into the cancer delivery system are needed.