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The effects of physical exercise in the palliative care phase for people with advanced cancer: a systematic review with meta-analysis

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Abstract

Purpose

The purpose of this systematic review with meta-analysis was to evaluate the safety, feasibility and effectiveness of exercise in the palliative care phase for people with advanced cancer.

Methods

Electronic databases were searched for exercise randomised controlled trials involving individuals with incurable cancer that were published prior to April 14, 2021. Meta-analyses were performed to evaluate the effects of exercise on health outcomes. Subgroup effects for exercise mode, supervision, intervention duration and cancer diagnosis were assessed.

Results

Twenty-two trials involving interventions ranging between 2 weeks and 6 months were included. Interventions comprised of aerobic (n = 3), resistance (n = 4), mixed-mode (n = 14) and other exercise (n = 1) modalities. Cancer types consisted of lung (n = 6), breast (n = 3), prostate (n = 2), multiple myeloma (n = 1) and mixed cancer types (n = 10). Meta-analysis of 20 RCTs involving 1840 participants showed no difference in the risk of a grade 2–4 adverse event between exercise and usual care (n = 110 adverse events (exercise: n = 66 events; usual care: n = 44 events), RD =  − 0.01 (91% CI =  − 0.01, 0.02); p = 0.24). Overall median recruitment, retention and adherence rates were 56%, 80% and 69%, respectively. Meta-analysis of health outcomes showed effects in favour of exercise for quality of life, fatigue, aerobic fitness and lower-body strength (SMD range = 0.27–0.48, all p < 0.05).

Conclusions

Participants who engaged in exercise experienced an increase in quality of life, fitness and strength and a decrease in fatigue.

Implications for Cancer Survivors

Physical activity programs were found to be safe and feasible for people with advanced cancer in the palliative care phase.

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Availability of data and material

Provided in the supplementary file.

Code availability

Not required due to this work being a review and meta-analysis.

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Acknowledgements

The authors would like to acknowledge Dearbhla Mulcahy’s contribution to the title and abstract screening and the first draft of this manuscript.

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Authors and Affiliations

  1. Faculty of HealthCanberra Specialist Medical CentreACT, University of Canberra, Level C Office 3, Bruce, 2617, Australia

    Kellie Toohey & Anne-Marie Rushby

  2. Exercise and Survivorship (PACES) Research Group, University of Canberra, ActivityBruce ACT, Cancer, Australia

    Kellie Toohey

  3. Palliative Care, Canberra Hospital, ACT Health Services, Canberra ACT, Australia

    Michael Chapman

  4. ANU Medical School, Australian National University, Canberra, Australia

    Michael Chapman

  5. University of South Australia, Adelaide, SA, Australia

    Anne-Marie Rushby

  6. Australian Institute of Health and Welfare, Canberra, Australia

    Anne-Marie Rushby

  7. Palliative Care, Lismore Base Hospital, Lismore, NSW, Australia

    Kat Urban

  8. Palliative Care, Prince of Wales Hospital, Randwick, NSW, Australia

    Gemma Ingham

  9. Greenslopes Private Hospital, Brisbane, QLD, Australia

    Benjamin Singh

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  1. Kellie Toohey
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  2. Michael Chapman
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  3. Anne-Marie Rushby
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  4. Kat Urban
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  6. Benjamin Singh
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Contributions

Concept/design: K. Toohey, M. Chapman, K. Urban, G. Inghram; data analysis: K. Toohey and B. Singh; data interpretation: all listed authors; draft: K. Toohey and A. Rushby; critical revision and approval: all listed authors.

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Correspondence to Kellie Toohey.

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Key findings:

Exercise was feasible in terms of recruitment and retention; however, adherence (69%) did not meet the pre-specified criteria of > 75%.

Exercise was safe: there was no difference in adverse event risk between exercise and usual care. Only 3% of adverse events were exercise related, which were low severity (musculoskeletal pain/soreness: n = 4 events, grade 1). No grade 2 or higher exercise-related events were reported.

Adverse event risk was similar irrespective of exercise mode, intervention supervision, intervention duration and cancer type.

Exercise was effective for improving various health-related outcomes. Small to moderate effects (all p < 0.05) were observed in favour of exercise for quality of life, fatigue, aerobic fitness and lower-body strength.

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Toohey, K., Chapman, M., Rushby, AM. et al. The effects of physical exercise in the palliative care phase for people with advanced cancer: a systematic review with meta-analysis. J Cancer Surviv 17, 399–415 (2023). https://doi.org/10.1007/s11764-021-01153-0

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