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A systematic review of the safety and efficacy of aerobic exercise during cytotoxic chemotherapy treatment

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Abstract

Purpose

Aerobic exercise improves prognosis and quality of life (QoL) following completion of chemotherapy. However, the safety and efficacy of aerobic exercise during chemotherapy is less certain. A systematic review was performed of randomised trials of adult patients undergoing chemotherapy, comparing an exercise intervention with standard care.

Method

From 253 abstracts screened, 33 unique trials were appraised in accordance with PRISMA guidance, including 3257 patients. Interventions included walking, jogging or cycling, and 23 were of moderate intensity (50–80% maximum heart rate).

Results

Aerobic exercise improved, or at least maintained fitness during chemotherapy. Moderately intense exercise, up to 70–80% of maximum heart rate, was safe. Any reported adverse effects of exercise were mild and self-limiting, but reporting was inconsistent. Adherence was good (median 72%). Exercise improved QoL and physical functioning, with earlier return to work. Two out of four studies reported improved chemotherapy completion rates. Four out of six studies reported reduced chemotherapy toxicity. There was no evidence that exercise reduced myelosuppression or improved response rate or survival.

Conclusions

Exercise during chemotherapy is safe and should be encouraged because of beneficial effects on QoL and physical functioning. More research is required to determine the impact on chemotherapy completion rates and prognosis.

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Acknowledgments and declarations of contribution

JC and CYH performed the search and data extraction. AP wrote the first draft of the text. All authors contributed to review of the extracted data and drafting the final version of the manuscript.

We would like to acknowledge Celia Diez De Los Rios De La Serna for Spanish translation and Michael Ahn for Korean translation. Also, Mr. Stephen Kerr Royal College of Surgeons Edinburgh for performing the searches.

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Authors and Affiliations

  1. Department of Medical Oncology, University Hospital Southampton NHS Foundation Trust, MP 307, Tremona Road, Southampton, SO16 6YD, UK

    J. Cave, A. Paschalis & E. Copson

  2. Department of Acute Internal Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK

    C. Y. Huang

  3. Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK

    M. West

  4. Department of Critical Care Research, University Hospital Southampton NHS Foundation Trust, Southampton, UK

    S. Jack & M. P. W. Grocott

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  1. J. Cave
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  2. A. Paschalis
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  3. C. Y. Huang
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  4. M. West
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  5. E. Copson
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Corresponding author

Correspondence to J. Cave.

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Conflict of interest

JC has received payment to her institution as research funding from Boehringer Ingelheim. MW has received payment to his institution as grant funding from National Institute of Health Research. MG has received payment to his institution for board membership from Sphere Medical Ltd., for consultancy from Duke University Medical Centre, and as unrestricted grants from Sphere Medical Ltd. and Pharmacosmos Ltd. MG has received honoraria and lecture payments from Edwards Lifesciences.

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Cave, J., Paschalis, A., Huang, C.Y. et al. A systematic review of the safety and efficacy of aerobic exercise during cytotoxic chemotherapy treatment. Support Care Cancer 26, 3337–3351 (2018). https://doi.org/10.1007/s00520-018-4295-x

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  • DOI: https://doi.org/10.1007/s00520-018-4295-x

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