Exercise Interventions for Cancer Survivors: A Meta-Analysis of Quality of Life Outcomes
- 2.2k Downloads
Exercise improves quality of life (QOL) in cancer survivors, although characteristics of efficacious exercise interventions for this population have not been identified.
The present meta-analysis examines the efficacy of exercise interventions in improving QOL in cancer survivors, as well as features that may moderate such effects.
Studies were identified and coded, and QOL effect sizes were calculated and analyzed for trends.
Overall, exercise interventions increased QOL, but this tendency depended to some extent on exercise and patient features. Although several features were associated with effect sizes, models revealed that interventions were particularly successful if they targeted more intense aerobic exercise and addressed women. These tendencies emerged over longer periods of time and were more prominent in studies with higher methodological quality.
Appropriately designed exercise interventions enhance QOL for cancer survivors and this pattern is especially evident for women. Limitations are discussed.
KeywordsCancer Oncology Exercise Behavioral interventions Quality of life Meta-analysis Exercise interventions Cancer survivors
This research was supported by University of Connecticut Research Foundation Grant 433527 to Blair T. Johnson and Linda B. Pescatello and facilitated by NIH grants F31MH080626 to Rebecca A. Ferrer and R01-MH58563 to Blair T. Johnson. We thank Michelle R. Warren for her feedback on prior versions of this manuscript.
Conflict of Interest Statement
The authors have no conflict of interest to disclose.
- 7.American College of Sports Medicine. In ACSM’s Guidelines for Exercise Testing and Prescription, 9 th ed. Thomspon WR, Gordon NF, Pescatello LS (Eds.) Baltimore, MD: Lippincott Williams & Wilkins.Google Scholar
- 8.Doyle C, Kushi LH, Byers, T, Nutrition, Physical Activity, and Cancer Survivorship Committee. Nutrition and physical activity during and after cancer treatment: An American Cancer Society guide for informed choices. CA Cancer J Clin. 2006; 56: 323–353.Google Scholar
- 14.Blanchard CM, Baker F, Denniston MM. Do adults change their lifestyle behaviors after cancer diagnosis? Am J Health Beh. 2003; 27: 246–256.Google Scholar
- 26.Cramp DF. Exercise for the management of cancer-related fatigue in adults (Review). The Cochrane Library. 2008;4,1–37.Google Scholar
- 28.Dimeo F, Fetscher S, Lange W, Mertelsmann R, Keul J. Effects of aerobic exercise on the physical performance and incidence of treatment-related complications after high dose chemotherapy. Blood. 1997; 9: 3390–3394.Google Scholar
- 33.Lipsey MW, Wilson DB. Practical meta-analysis. Thousand Oaks, CA: Sage, 2001.Google Scholar
- 36.Borst JM. An exercise program for cancer patients: Physical and emotional well-being as indicators of quality of life. Unpublished Doctoral Dissertation, Michigan State University, 2005.Google Scholar
- 59.Durak EP, Lilly PC. The application of an exercise and wellness program for cancer patients: A preliminary outcomes report. J Strength Cond Res. 1998; 12: 3–6.Google Scholar
- 60.Earle C, Reid B, Johnson D. Exercise may ameliate the effects of adjuvant breast cancer treatment on physical fitness and quality of life. Clin Invest Med. 1996; 19: 417.Google Scholar
- 62.Galvao DA, Taaffe DR, Spry N, Joseph D, Newton RU. Combined resistance and aerobic exercise program reverses muscle loss in men undergoing androgen suppression therapy for prostate cancer without bone metastases: A randomized controlled trial. J Clin Oncol. 2010; 28: 340–347.PubMedCrossRefGoogle Scholar
- 63.Hall J. Psychological interventions for exercise and dietary behavior change with breast cancer survivors. Unpublished doctoral dissertation, University of Houston, 1998.Google Scholar
- 64.Hawkes Al, Gollschewski S, Lynch BM, Chambers S. A telephone-delivered lifestyle intervention for colorectal cancer survivors ‘CanChange’: A pilot study. Psycho-Oncol. 2009; 18: 449–455.Google Scholar
- 69.Hughs DC. Physical activity and stress in Hispanic breast cancer survivors. Unpublished doctoral dissertation, University of Houston, 2004.Google Scholar
- 71.Ives J. A comparison between a combined exercise and recreation therapy intervention and an exercise only intervention in post-treated breast cancer patients. Unpublished master’s thesis, University of North Carolina, 2009.Google Scholar
- 72.Jarden M, Baadsgaard MT, Hovgaard DJ, Boesen E, Adamsen L. A randomized trail on the effect of a multimodal intervention on physical capacity, functional percormance, and quality of life in adult patients undergoing allogeneic SCT. Bone Marrow Transplant. 2009; 43: 725–737.PubMedCrossRefGoogle Scholar
- 74.Kramer MM. The effects of exercise on psychological well-being in women recovering from breast cancer. Unpublished doctoral dissertation, Arizona State University, 1996.Google Scholar
- 77.Lucas J. The effect of a combined exercise and recreation therapy program on quality of life in post-treated female breast cancer patients. Unpublished master’s thesis, University of North Carolina at Chapel Hill, 2009.Google Scholar
- 81.McNeely ML. Exercise rehabilitation for breast and head and neck cancer survivors. Unpublished doctoral dissertation, University of Alberta, 2007.Google Scholar
- 85.Mustian KM, Peppone L, Darling TV, Palesh O, Heckler CE, Morrow GR. A 4-week home-based aerobic and resistance exercise program during radiation therapy: A pilot randomized clinical trial. J Support Oncol. 2009;9:158–167.Google Scholar
- 89.Schulz KH. Implementierung und evaluation eines ambulanten bewegungs-therapeutischen rehabilitations-angebotes fur brustkrebspatientinnen. Psychother Psychosom, Med Psychol. 1998; 48: 398–407.Google Scholar
- 92.Segal R, Reid B, Johnson D. Progressive resistance exercise training in men with advanced prostate cancer. Clinl Invest Med. 1997; 20: S58 [abstract].Google Scholar
- 94.Speck, RM, Gross, CR, Hormes, JM, et al. Changes in the body image and relationship scale following a one-year strength training trial for breast cancer survivors with or at risk for lymphedema. [Published online ahead of print September 22 2009]. Breast Cancer Res Treat. 2009. http://www.springerlink.com/content/1428112433361g45/. Accessed April 22, 2010.
- 95.Tang M-F, Liou T-H, Lin C-C. Improving sleep quality for cancer patients: Benefits of a home-based exercise intervention. [Published online ahead of print October 16 2009]. Support Cancer Care. 2009. http://www.springerlink.com/content/061wq41587x60560/. Accessed April 22, 2010.
- 98.Todd J, Scally A, Dodwell D, Horgan K, Topping A. A randomized controlled trial of two programmes of shoulder exercise following axillary node dissection for invasive breast cancer.Physiother. 2008; 94: 265–273.Google Scholar
- 100.Vallance JK, Courneya KS, Plotnikoff RC, Dinu I, Mackey JR. Maintenance of physical activity in breast cancer survivors after a randomized trial. Medi Sci Sports Exerc. 2007; 40: 173–180Google Scholar
- 101.Vito NL. The effects of a yoga intervention on physical and psychological functioning for breast cancer survivors. Unpublished doctoral dissertation, California School of Professional Psychology.Google Scholar
- 106.Yang Y. The effects of a Taiji Quan exercise intervention on balance, mobility, and quality of life of people treated for cancer. Unpublished master’s thesis, Lakehead University.Google Scholar
- 108.Moseley AM, Herber RD, Sherrington C, Maher CC. Evidence for physiotherapy practice: A survey of the Physiotherapy Evidence Database (PEDro). Australian Journal of Physiotherapy. 2002;49:43–49.Google Scholar
- 111.Hedges LV, Olkin I. Statistical methods for meta-analysis. Appl Psychol Meas. 1985; 11: 104–106.Google Scholar
- 112.Becker BJ. Synthesizing standardized mean-change measures. Br J Math Stat Psychol. 1988; 41: 257–278.Google Scholar
- 114.Johnson BT, Eagly AH. Quantitative synthesis of social psychological research. In Handbook of research methods in social and personality psychology. Reis HT Judd CM (eds.). New York: Cambridge, 2002: 496–528Google Scholar
- 116.Duval S, Tweedlie. Trim and Fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 2000; 56: 455–463.Google Scholar
- 118.Egger M, Davey G, Schneider M, Minder C. Bias in meta-analysis detected by a simple graphical test. Bristish Medical Journal 1997; 315: 629–634.Google Scholar
- 121.Johnson BT, Scott-Sheldon LAJ, Carey MP. Meta-synthesis of health behavior change meta-analyses. [Published online ahead of print February 12 2010]. American Journal of Public Health. 2010. http://ajph.aphapublications.org/cgi/content/abstract/AJPH.2008.155200v2. Accessed May 4, 2010.
- 130.Mancini D, LeJemetel T, Aaronson K. Peak VO2: A simple yet enduring standard. Circulation. 2008;101:1080.Google Scholar
- 132.Schag CA, Ganz PA, Heinrich RL. Cancer rehabilitation evaluation system—short form (CARES-SF). A cancer specific rehabilitation and quality of life instrument. Cancer. 1991;68:1406–1413.Google Scholar
- 136.List MA, D’Antonio LL, Cella DF, et al. The performance status scale for head and neck cancer patients and the Functional Essessment of Cancer Therapy—Head and Neck Scale. A study of utility and validity. Cancer. 1996;77:2294–2301.Google Scholar
- 138.Webster ZK, Odom L, Peterman A, Lent L, Cella D. The functional assessment of chronic illness therapy (FACTIT) measurement system: Validation of version 4 of the core questionnaire. Qual Life Res. 1999;8:604.Google Scholar
- 139.Frank-Stromborg M, Olsen S. Instruments for clinical healthcare research, 2nd Ed. Boston: Jones and Bartlett.Google Scholar
- 140.Ware JE, Kosinski M, Gandek B. SF-36 Health Survey: Manual and interpretation guide. 2000. Lincoln RI: Quality Metric Incorporated.Google Scholar
- 141.de Jeu JH, Pedersen SS, Balk RT, van Domburg RT, Vantrimpont PJMJ, Erdman RAM. Development of the Rotterdam Quality of Life Questionnaire for heart transplant recipients. Neth Heart J. 2003;11:289–293.Google Scholar