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Can Exercise Counteract Cancer Cachexia? A Systematic Literature Review and Meta-Analysis.

ABSTRACT: BACKGROUND:Cancer-cachexia is associated with chronic inflammation, impaired muscle metabolism and body mass loss, all of which are classical targets of physical exercise. OBJECTIVES:This systematic review and meta-analysis aimed to determine the effects of exercise on body and muscle mass in cachectic cancer hosts. DATA SOURCES:PubMed/Medline, EMBASE, CINHAL, ISI Web of Science, and Cochrane Library were searched until July 2019. STUDY SELECTION:Trials had to be randomized controlled trials or controlled trials including cancer patients or animal models with cachexia-inducing tumors. Only sole exercise interventions over at least 7 days performed in a controlled environment were included. DATA EXTRACTION:Risk of bias was assessed and a random-effects model was used to pool effect sizes by standardized mean differences (SMD). RESULTS:All eligible 20 studies were performed in rodents. Studies prescribed aerobic (n = 15), strength (n = 3) or combined training (n = 2). No statistical differences were observed for body mass and muscle weight of the gastrocnemius, soleus, and tibialis muscles between the exercise and control conditions (SMD = ?0.05, 95%CI-0.64-0.55, P = 0.87). Exercise duration prior to tumor inoculation was a statistical moderator for changes in body mass under tumor presence (P = 0.04). LIMITATIONS:No human trials were identified. A large study heterogeneity was present, probably due to different exercise modalities and outcome reporting. CONCLUSION:Exercise does not seem to affect cancer-cachexia in rodents. However, the linear regression revealed that exercise duration prior to tumor inoculation led to reduced cachexia-severity, possibly strengthening the rationale for the use of exercise in cancer patients at cachexia risk.

SUBMITTER: Niels T

PROVIDER: S-EPMC7503012 | biostudies-literature | 2020 Jan-Dec

REPOSITORIES: biostudies-literature

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Can Exercise Counteract Cancer Cachexia? A Systematic Literature Review and Meta-Analysis.

Niels Timo T Tomanek Annika A Freitag Nils N Schumann Moritz M

Integrative cancer therapies 20200101

<h4>Background</h4>Cancer-cachexia is associated with chronic inflammation, impaired muscle metabolism and body mass loss, all of which are classical targets of physical exercise.<h4>Objectives</h4>This systematic review and meta-analysis aimed to determine the effects of exercise on body and muscle mass in cachectic cancer hosts.<h4>Data sources</h4>PubMed/Medline, EMBASE, CINHAL, ISI Web of Science, and Cochrane Library were searched until July 2019.<h4>Study selection</h4>Trials had to be ran ...[more]

PMID: 32954861

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Project description:ObjectiveThe purpose of this study was to determine the impact of prehabilitation exercise intervention with respect to (1) acceptability, feasibility, and safety; and (2) physical function, measured by 6-minute-walk test (6MWT).Data sourcesPRISMA guidelines were used to systematically search PubMed, Embase, and CINAHL databases evaluating prehabilitation exercise interventions.Study selectionThe inclusion criteria were studies investigating patients who underwent surgery for their cancer and underwent prehabilitation exercise.Data extraction and synthesisGuidelines were applied by independent extraction by multiple observers. Data were pooled using a random-effects model.Main outcome(s) and measure(s)Acceptability, feasibility, and safety rates were calculated. 6MWT (maximum distance a person can walk at their own pace on a hard, flat surface, measured in meters, with longer distance indicative of better performance status) was compared using two arms using the DerSimonian and Laird method.ResultsObjective 1. Across 21 studies included in this review, 1564 patients were enrolled, 1371 (87.7%) accepted the trial; of 1371, 1230 (89.7% feasibility) completed the intervention. There was no grade 3+ toxicities. Objective 2. Meta-analysis of five studies demonstrated a statistically significant decrease in 6MWT distance postoperatively in the control group (mean difference = +27.9 m; 95% confidence interval (CI): 9.3; 46.6) and a significant improvement postoperatively in the prehabilitation group (mean difference = -24.1 m; 95% CI: -45.7; -2.6). Meta-analysis demonstrated improvements in 6MWT distance 4-8 weeks postoperatively in the prehabilitation group compared to the control group (mean difference = -58.0 m, 95% CI: -92.8; -23.3).Conclusions and relevancePrehabilitation exercise for cancer patients undergoing surgery was found to be safe, acceptable, and feasible with a statistically significant improvement in the 6MWT, indicating that prehabilitation can improve postoperative functional capacity.

Project description:Purpose: To compare peak oxygen uptake (VO2peak) between the asynchronous arm crank ergometry (ACE), and synchronous wheelchair ergometry (WERG), wheelchair treadmill (WTR), and upper-body poling (UBP) mode. Methods: PubMed, Scopus, CINAHL, and SPORTDiscus™ were systematically searched, and identified studies screened based on title, abstract, and thereafter full-text. Studies comparing VO2peak between ≥2 of the modes were included. A meta-analysis was performed by pooling the differences in VO2peak between upper-body exercise modes. The quality of the included studies was assessed and the level of evidence (LoE) established for each mode comparison. Meta-regression analyses investigated the effect of total body mass and participant-related characteristics (% of able-bodied participants, % of participants with tetraplegia and % of participants who are wheelchair athletes) on differences in VO2peak between modes. Results: Of the 19 studies included in this review, 14 studies investigated the difference in absolute and body-mass normalized VO2peak between ACE and WERG, and 5 studies examined the differences between ACE and WTR. No significant difference in absolute or body-mass normalized VO2peak was found between ACE and WERG (overall effect ±95% CI: 0.01 ± 0.06 L·min-1 and 0.06 ± 1.2 ml·kg-1·min-1, both p > 0.75; LoE: strong). No significant difference in absolute or body-mass normalized VO2peak was found between ACE and WTR (overall effect ±95% CI: -0.10 ± 0.18 L·min-1 and -1.8 ± 2.5 ml·kg-1·min-1, both p > 0.14; LoE: moderate). Absolute and/or body-mass normalized VO2peak did not differ between WERG and WTR in one study with 13 participants (LoE: limited) and between ACE and UBP in one study with 18 participants (LoE: moderate). In the meta-regression analyses, there was no significant effect of the investigated factors on differences in VO2peak. Conclusions: The differences between the asynchronous ACE and synchronous WERG propulsion, including possible differences in trunk involvement, do not seem to influence VO2peak. Therefore, ACE and WERG can be used interchangeably to test VO2peak. Possible differences in VO2peak in all other mode comparisons remain unclear due to the wide CIs and limited to moderate LoE.

Project description: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 abstracts 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.

Project description:PurposeResistance exercise improves an array of treatment-related adverse effects in men with prostate cancer; however, the minimal dosage required is unknown. We systematically reviewed the resistance training effects in prostate cancer patients to determine the minimal dosage regarding the exercise components (type, duration, volume, and intensity) on body composition, physical function, muscle strength, cardiorespiratory fitness, body mass index, and prostate-specific antigen.MethodsUsing PRISMA guidelines, MEDLINE, CINAHL, EMBASE, SPORTDiscus, and Web of Science databases were searched. Eligible randomized controlled trials examined prostate cancer patients undertaking resistance-based exercise programs during or after treatment. Meta-analysis was undertaken when more than three studies were included. Associations between mean differences and exercise components were tested by univariate and multivariate meta-regression analysis.ResultsTwenty-three articles describing 21 trials and involving 1748 prostate cancer patients were included. Exercise improved fat mass (-1% in body fat and -0.6 kg in fat mass), lean mass (~0.5 kg in lean and appendicular lean mass), functional capacity (i.e., chair rise, 400-m test, 6-m fast walk, and stair climb tests), and fitness outcomes (i.e., V?O2peak and muscle strength) (P = 0.040-<0.001) with no change in body mass index or prostate-specific antigen (P = 0.440-0.735). Meta-regression indicated no association between exercise type, resistance training duration, weekly volume and intensity, and primary outcomes (P = 0.075-0.965). There was a significant association between exercise intensity and chest press muscle strength (favoring moderate intensity, P = 0.012), but not in other secondary outcomes.ConclusionIn untrained older men with prostate cancer initiating an exercise program, lower volume at moderate to high intensity is as effective as higher volume resistance training for enhancing body composition, functional capacity, and muscle strength in the short term. A low exercise dosage may help reduce barriers to exercise and enhance adherence.

Dataset Information

Can Exercise Counteract Cancer Cachexia? A Systematic Literature Review and Meta-Analysis.

Publications

Can Exercise Counteract Cancer Cachexia? A Systematic Literature Review and Meta-Analysis.

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