Supportive Care in Cancer

, Volume 14, Issue 7, pp 699–712 | Cite as

A meta-analysis of exercise interventions among people treated for cancer

  • Vicki S. Conn
  • Adam R. Hafdahl
  • Davina C. Porock
  • Roxanne McDaniel
  • Paul J. Nielsen
Review Article

Abstract

Goal

This review applied meta-analytic procedures to integrate primary research findings that tested exercise interventions among people treated for cancer.

Methods

Extensive literature searching strategies located published and unpublished intervention studies that tested exercise interventions with at least five participants (k=30). Primary study results were coded. Meta-analytic procedures were conducted.

Main results

The overall weighted mean effect size (ES) for two-group comparisons was 0.52 (higher mean for treatment than control) for physical function, 0.35 for symptoms other than fatigue, and 0.27 for body composition. More modest positive ESs were documented for mood (0.19), quality of life (0.14), fatigue (0.11), and exercise behavior (0.04). ESs were larger among single-group pre–post design studies. ESs among control group participants were typically negative and not (statistically) significantly different from 0.

Conclusions

Exercise interventions resulted in small positive effects on health and well-being outcomes among existing studies. Future research should examine intervention-specific characteristics that result in optimal results, such as dose.

Keywords

Exercise Cancer Meta-analysis 

Notes

Acknowledgements

Financial support provided by a grant from the NIH NINR (RO1NR07870) to Vicki Conn, principal investigator.

Refrences

  1. 1.
    Aziz NM (2002) Cancer survivorship research: challenge and opportunity. J Nutr 132(11 Suppl):3494S–3503SPubMedGoogle Scholar
  2. 2.
    Berglund G, Bolund C, Gustafsson UL, Sjoden PO (1994) One-year follow-up of the ’Starting Again’ group rehabilitation programme for cancer patients. Eur J Cancer 30A(12):1744–1751CrossRefPubMedGoogle Scholar
  3. 3.
    *Burnham TR, Wilcox A (2002) Effects of exercise on physiological and psychological variables in cancer survivors. Med Sci Sports Exerc 34(12):1863–1867CrossRefPubMedGoogle Scholar
  4. 4.
    Chlebowski RT, Aiello E, McTiernan A (2002) Weight loss in breast cancer patient management. J Clin Oncol 20(4):1128–1143PubMedCrossRefGoogle Scholar
  5. 5.
    Conn V, Rantz M (2003) Research methods: managing primary study quality in meta-analyses. Res Nurs Health 26:322–333CrossRefPubMedGoogle Scholar
  6. 6.
    Conn V, Rantz M, Maas M, Wipke-Tevis D (2001) Designing effective nursing interventions. Res Nurs Health 24(5):433–442CrossRefPubMedGoogle Scholar
  7. 7.
    Conn V, Isamaralai S, Rath S, Jantarakupt P, Wadhawan R, Dash Y (2003) Beyond MEDLINE for literature searches. J Nurs Scholarsh 35:177–182CrossRefPubMedGoogle Scholar
  8. 8.
    Conn V, Valentine J, Cooper H, Rantz M (2003) Grey literature in meta-analyses. Nurs Res 52:256–261CrossRefPubMedGoogle Scholar
  9. 9.
    Cook DJ, Guyatt GH, Ryan G (1993) Should unpublished data be included in meta-analyses? JAMA 269:749–753CrossRefGoogle Scholar
  10. 10.
    Courneya KS, Friedenreich CM (1999) Physical exercise and quality of life following cancer diagnosis: a literature review. Ann Behav Med 21(2):171–179PubMedCrossRefGoogle Scholar
  11. 11.
    Courneya KS, Friedenreich CM (2001) Framework PEACE: an organizational model for examining physical exercise across the cancer experience. Ann Behav Med 23(4):263–272CrossRefPubMedGoogle Scholar
  12. 12.
    *Courneya KS, Friedenreich C, Quinney HA, Fields ALA, Jones LW, Fairey AS (2003) A randomized trial of exercise and quality of life in colorectal cancer survivors. Eur J Cancer Care 12(4):347–357CrossRefGoogle Scholar
  13. 13.
    *Courneya KS, Friedenreich CM, Sela RA, Quinney HA, Rhodes RE, Handman M (2003) The group psychotherapy and home-based physical exercise (group–hope) trial in cancer survivors: physical fitness and quality of life outcomes. Psychooncology 12(4):357–374CrossRefPubMedGoogle Scholar
  14. 14.
    *Courneya KS, Mackey JR, Bell GJ, Jones LW, Field CJ, Fairey AS (2003) Randomized controlled trial of exercise training in postmenopausal breast cancer survivors: cardiopulmonary and quality of life outcomes. J Clin Oncol 21(9):1660–1668PubMedCrossRefGoogle Scholar
  15. 15.
    *Craddock RB, Adams PF, Usui WM, Mitchell L (1999) An intervention to increase use and effectiveness of self-care measures for breast cancer chemotherapy patients. Cancer Nurs 22(4):312–319CrossRefPubMedGoogle Scholar
  16. 16.
    Cunningham BA, Morris G, Cheney CL, Buergel N, Aker SN, Lenssen P (1986) Effects of resistive exercise on skeletal muscle in marrow transplant recipients receiving total parenteral nutrition. JPEN J Parenter Enteral Nutr 10(6):558–563PubMedCrossRefGoogle Scholar
  17. 17.
    Decker WA, Turner-McGlade J, Fehir KM (1989) Psychosocial aspects and the physiological effects of a cardiopulmonary exercise program in patients undergoing bone marrow transplantation (BMT) for acute leukemia (AL). Transplant Proc 21(1 Pt3):3068–3069PubMedGoogle Scholar
  18. 18.
    Devine E (2003) Meta-analysis of the effect of psychoeducational interventions on pain in adults with cancer. Oncol Nurs Forum 30:75–89PubMedCrossRefGoogle Scholar
  19. 19.
    *Dimeo F, Bertz H, Finke J, Fetscher S, Mertelsmann R, Keul J (1996) An aerobic exercise program for patients with haematological malignancies after bone marrow transplantation. Bone Marrow Transplant 18(6):1157–1160PubMedGoogle Scholar
  20. 20.
    *Dimeo F, Tilmann MH, Bertz H, Kanz L, Mertelsmann R, Keul J (1997) Aerobic exercise in the rehabilitation of cancer patients after high dose chemotherapy and autologous peripheral stem cell transplantation. Cancer 79(9):1717–1722CrossRefPubMedGoogle Scholar
  21. 21.
    *Dimeo F, Fetscher S, Lange W, Mertelsmann R, Keul J (1997) Effects of aerobic exercise on the physical performance and incidence of treatment-related complications after high-dose chemotherapy. Blood 90(9):3390–3390PubMedGoogle Scholar
  22. 22.
    *Dimeo F, Rumberger BG, Keul J (1998) Aerobic exercise as therapy for cancer fatigue. Med Sci Sports Exerc 30(4):475–478PubMedGoogle Scholar
  23. 23.
    *Dimeo FC, Stieglitz RD, Novelli-Fischer U, Fetscher S, Keul J (1999) Effects of physical activity on the fatigue and psychologic status of cancer patients during chemotherapy. Cancer 85(10):2273–2277CrossRefPubMedGoogle Scholar
  24. 24.
    *Durak EP, Lilly PC (1998) The application of an exercise and wellness program for cancer patients: a preliminary outcomes report. J Strength Cond Res 12(1):3–6CrossRefGoogle Scholar
  25. 25.
    *Durak E, Lilly PC (1999) Preliminary results of exercise in breast cancer: a two-year follow-up survey. J Rehabil Outcomes Meas 3(4):53–60Google Scholar
  26. 26.
    *Durak EP, Lilly PC, Hackworth JL (1999) Physical and psychosocial responses to exercise in cancer patients: a two year follow-up survey with prostrate, leukemia, and general carcinoma. J Exerc Physiol Online 2(1)Google Scholar
  27. 27.
    Fairey AS, Courneya KS, Field CJ, Mackey JR (2002) Physical exercise and immune system function in cancer survivors: a comprehensive review and future directions. Cancer 94(2):539–551CrossRefPubMedGoogle Scholar
  28. 28.
    Friedenreich CM, Courneya KS (1996) Exercise as rehabilitation for cancer patients. Clin J Sport Med 6(4):237–244PubMedCrossRefGoogle Scholar
  29. 29.
    Galvao D, Newton R (2005) Review of exercise intervention studies in cancer patients. J Clin Oncol 23(4):899–909CrossRefPubMedGoogle Scholar
  30. 30.
    Gleser LJ, Olkin I (1994) Stochastically dependent effect sizes. In: Cooper H, Hedges L (eds) The handbook of research synthesis. Russell Sage Foundation, New York, pp 339–355Google Scholar
  31. 31.
    *Goodwin P, Esplen MJ, Butler K, Winocur J, Pritchard K, Brazel S, Gao A, Miller J (1998) Multidisciplinary weight management in locoregional breast cancer: results of a phase II study. Breast Cancer Res Treat 48(1):53–64CrossRefPubMedGoogle Scholar
  32. 32.
    *Hayes S, Davies PS, Parker T, Bashford J (2003) Total energy expenditure and body composition changes following peripheral blood stem cell transplantation and participation in an exercise programme. Bone Marrow Transplant 31(5):331–338CrossRefPubMedGoogle Scholar
  33. 33.
    Hedges L (1994) Fixed effects models. In: Cooper H, Hedges L (eds) The handbook of research synthesis. Russell Sage Foundation, New York, pp 285–299Google Scholar
  34. 34.
    Hedges L, Olkin I (1985) Statistical methods for meta-analysis. Academic, OrlandoGoogle Scholar
  35. 35.
    Hedges L, Vevea J (1998) Fixed- and random-effects models in meta-analysis. Psychol Methods 3:486–504CrossRefGoogle Scholar
  36. 36.
    *Holley S, Borger D (2001) Energy for living with cancer: preliminary findings of a cancer rehabilitation group intervention study. Oncol Nurs Forum 28(9):1393–1396PubMedGoogle Scholar
  37. 37.
    Holtzman J, Schmitz K, Babes G, Kane R, Duval S, Wilt T, MacDonald R, Rutks I (2004) Effectiveness of behavioral interventions to modify physical activity behaviors in general populations and cancer patients and survivors (evidence report/technology assessment no. 102 no. AHRQ publication no. 04-E027-02). Agency for Healthcare Research and Quality, RockvilleGoogle Scholar
  38. 38.
    Irwin ML, Ainsworth BE (2004) Physical activity interventions following cancer diagnosis: methodologic challenges to delivery and assessment. Cancer Invest 22:30–50CrossRefPubMedGoogle Scholar
  39. 39.
    Kalaian HA, Raudenbush SW (1996) A multivariate mixed linear model for meta-analysis. Psychol Methods 1:227–235CrossRefGoogle Scholar
  40. 40.
    Kolden GG, Strauman TJ, Ward A, Kuta J, Woods TE, Schneider KL, Heerey E, Sanborn L, Burt C, Millbrandt L, Kalin NH, Stewart JA, Mullen B (2002) A pilot study of group exercise training (GET) for women with primary breast cancer: feasibility and health benefits. Psychooncology 11(5):447–456PubMedCrossRefGoogle Scholar
  41. 41.
    Kuhn K, Boesen E, Ross L, Johansen C (2005) Evaluation and outcome of behavioural changes in the rehabilitation of cancer patients: a review. Eur J Cancer 41(2):216–224CrossRefPubMedGoogle Scholar
  42. 42.
    Lubbe AS, Krischke NR, Dimeo F, Forkel S, Petermann F (2001) Health-related quality of life and pulmonary function in lung cancer patients undergoing medical rehabilitation treatment. Wien Med Wochenschr 151(1–2):29–34PubMedGoogle Scholar
  43. 43.
    Luebbert K, Dahme B, Hasenbring M (2001) The effectiveness of relaxation training in reducing treatment-related symptoms and improving emotional adjustment in acute non-surgical cancer treatment: a meta-analytical review. Psychooncology 10(6):490–502PubMedCrossRefGoogle Scholar
  44. 44.
    MacVicar MG, Winningham ML, Nickel JL (1989) Effects of aerobic interval training on cancer patients’ functional capacity. Nurs Res 38(6):348–351PubMedCrossRefGoogle Scholar
  45. 45.
    McKenzie DC, Kalda AL (2003) Effect of upper extremity exercise on secondary lymphedema in breast cancer patients: a pilot study. J Clin Oncol 21(3):463–466PubMedCrossRefGoogle Scholar
  46. 46.
    Mock V (2004) Evidence-based treatment for cancer-related fatigue. J Natl Cancer Inst Monogr 32:112–118CrossRefPubMedGoogle Scholar
  47. 47.
    *Mock V, Burke MB, Sheehan P, Creaton EM, Winningham ML, McKenney-Tedder S, Schwager LP, Liebman M (1994) A nursing rehabilitation program for women with breast cancer receiving adjuvant chemotherapy. Oncol Nurs Forum 21(5):899–907PubMedGoogle Scholar
  48. 48.
    Morris SB (2000) Distribution of the standardized mean change effect size for meta-analysis on repeated measures. Br J Math Stat Psychol 53:17–29PubMedCrossRefGoogle Scholar
  49. 49.
    Morris SB, DeShon RP (2002) Combining effect size estimates in meta-analysis with repeated measures and independent-groups designs. Psychol Methods 2:105–125CrossRefGoogle Scholar
  50. 50.
    *Nieman DC, Cook VD, Henson DA, Suttles J, Rejeski WJ, Ribisl PM, Fagoaga OR, Nehlsen-Cannarella SL (1995) Moderate exercise training and natural killer cell cytotoxic activity in breast cancer patients. Int J Sports Med 16(5):334–337PubMedCrossRefGoogle Scholar
  51. 51.
    Nony P, Cucherat M, Haugh M, Boissell J (1995) Critical reading of the meta-analysis of clinical trials. Therapie 50:339–351PubMedGoogle Scholar
  52. 52.
    Oldervoll LM, Kaasa S, Hjermstad MJ, Lund JA, Loge JH (2004) Physical exercise results in the improved subjective well-being of a few or is effective rehabilitation for all cancer patients? Eur J Cancer 40:951–962CrossRefPubMedGoogle Scholar
  53. 53.
    *Peters C, Lotzerich H, Niemeier B, Schule K, Uhlenbruck G (1994) Influence of a moderate exercise training on natural killer cytotoxicity and personality traits in cancer patients. Anticancer Res 14(3A):1033–1036PubMedGoogle Scholar
  54. 54.
    *Pinto BM, Clark MM, Maruyama NC, Feder SI (2003) Psychological and fitness changes associated with exercise participation among women with breast cancer. Psychooncology 12(2):118–126PubMedCrossRefGoogle Scholar
  55. 55.
    Porock D, Kristjanson L, Tinnelly K, Duke T, Blight J (2000) An exercise intervention for advanced cancer patients experiencing fatigue: a pilot study. J Palliat Care 16(3):30–36PubMedGoogle Scholar
  56. 56.
    Raudenbush SW (1994) Random effects models. In: Cooper H, Hedges L (eds) The handbook of research synthesis. Russell Sage Foundation, New York, pp 301–321Google Scholar
  57. 57.
    Rock CL, Demark-Wahnefried W (2002) Can lifestyle modification increase survival in women diagnosed with breast cancer? J Nutr 132:3504S–3507SPubMedGoogle Scholar
  58. 58.
    Schwartz AL, Thompson JA, Masood N (2002) Interferon-induced fatigue in patients with melanoma: a pilot study of exercise and methylphenidate. Oncol Nurs Forum 29(7):E85–E90PubMedCrossRefGoogle Scholar
  59. 59.
    *Segal R, Evans W, Johnson D, Smith J, Colletta S, Gayton J, Woodard S, Wells G, Reid R (2001) Structured exercise improves physical functioning in women with stages I and II breast cancer: results of a randomized controlled trial. J Clin Oncol 19(3):657–665PubMedGoogle Scholar
  60. 60.
    *Segal RJ, Reid RD, Courneya KS, Malone SC, Parliament MB, Scott CG, Venner PM, Quinney HA, Jones LW, D’Angelo ME, Wells GA (2003) Resistance exercise in men receiving androgen deprivation therapy for prostate cancer. J Clin Oncol 21(9):1653–1659PubMedCrossRefGoogle Scholar
  61. 61.
    Segar ML, Katch VL, Roth RS, Garcia AW, Portner TI, Glickman SG, Haslanger S, Wilkins EG (1998) The effect of aerobic exercise on self-esteem and depressive and anxiety symptoms among breast cancer survivors. Oncol Nurs Forum 25(1):107–113PubMedGoogle Scholar
  62. 62.
    Servaes P, Verhagen C, Bleijenberg G (2002) Fatigue in cancer patients during and after treatment: prevalence, correlates and interventions. Eur J Cancer 38(1):27–43CrossRefPubMedGoogle Scholar
  63. 63.
    Shadish W, Haddock C (1994) Combining estimates of effect size. In: Cooper H, Hedges L (eds) The handbook of research synthesis. Russell Sage Foundation, New York, pp 261–282Google Scholar
  64. 64.
    Stone P (2002) The measurement, causes and effective management of cancer-related fatigue. Int J Palliat Nurs 8(3):120–128PubMedGoogle Scholar
  65. 65.
    Stricker CT, Drake D, Hoyer KA, Mock V (2004) Evidence-based practice for fatigue management in adults with cancer: exercise as an intervention. Oncol Nurs Forum 31:963–974PubMedCrossRefGoogle Scholar
  66. 66.
    Vevea JL, Hedges LV (1995) A general linear model for estimating effect size in the presence of publication bias. Psychometrika 60:419–435CrossRefGoogle Scholar
  67. 67.
    Watson T, Mock V (2004) Exercise as an intervention for cancer-related fatigue. Phys Ther 84:736–743PubMedGoogle Scholar
  68. 68.
    Winningham ML, MacVicar MG (1988) The effect of aerobic exercise on patient reports of nausea. Oncol Nurs Forum 15(4):447–450PubMedGoogle Scholar
  69. 69.
    Zinna EM, Yarasheski KE (2003) Exercise treatment to counteract protein wasting of chronic diseases. Curr Opin Clin Nutr Metab Care 6(1):87–93CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Vicki S. Conn
    • 1
  • Adam R. Hafdahl
    • 2
  • Davina C. Porock
    • 3
  • Roxanne McDaniel
    • 4
  • Paul J. Nielsen
    • 5
  1. 1.S317 School of NursingUniversity of Missouri–ColumbiaColumbiaUSA
  2. 2.28 McAlester Hall, Department of Psychological SciencesUniversity of Missouri–ColumbiaColumbiaUSA
  3. 3.Queens Medical Centre, Nottingham Education CenterUniversity of NottinghamNottinghamUK
  4. 4.S410 School of NursingUniversity of Missouri–ColumbiaColumbiaUSA
  5. 5.Biochemistry DepartmentUniversity of Missouri–ColumbiaColumbiaUSA

Personalised recommendations