Review of exercise intervention studies in cancer patients.

PURPOSE To present an overview of exercise interventions in cancer patients during and after treatment and evaluate dose-training response considering type, frequency, volume, and intensity of training along with expected physiological outcomes. METHODS The review is divided into studies that incorporated cardiovascular training, combination of cardiovascular, resistance, and flexibility training, and resistance training alone during and after cancer management. Criteria for inclusion were based on studies sourced from electronic and nonelectronic databases and that incorporated preintervention and postintervention assessment with statistical analysis of data. RESULTS Twenty-six published studies were summarized. The majority of the studies demonstrate physiological and psychological benefits. However, most of these studies suffer limitations because they are not randomized controlled trials and/or use small sample sizes. Predominantly, studies have been conducted with breast cancer patients using cardiovascular training rather than resistance exercise as the exercise modality. Recent evidence supports use of resistance exercise or "anabolic exercise" during cancer management as an exercise mode to counteract side effects of the disease and treatment. CONCLUSION Evidence underlines the preliminary positive physiological and psychological benefits from exercise when undertaken during or after traditional cancer treatment. As such, other cancer groups, in addition to those with breast cancer, should also be included in clinical trials to address more specifically dose-response training for this population. Contemporary resistance training designs that provide strong anabolic effects for muscle and bone may have an impact on counteracting some of the side effects of cancer management assisting patients to improve physical function and quality of life.

[1]  D. Trump Osteoporosis in men with prostate carcinoma receiving androgen-deprivation therapy: Recommendations for diagnosis and therapies. Diamond TH, Higano CS, Smith MR, Guise TA, Singer FR, Department of Medicine, University of New South Wales, St. George Hospital Campus, Sydney, Australia.: Cancer 2004;10 , 2004 .

[2]  C. Higano,et al.  “Osteoporosis in Men with Prostate Carcinoma Receiving Androgen-Deprivation Therapy: Recommendations for Diagnosis and Therapies,” , 2004 .

[3]  D. Galvão,et al.  High- and low-volume resistance training similarly enhances functional performance in older adults , 2004 .

[4]  M. Michaelson,et al.  Contribution of Androgen Deprivation Therapy to Elevated Osteoclast Activity in Men with Metastatic Prostate Cancer , 2004, Clinical Cancer Research.

[5]  Matthew R. Smith Changes in fat and lean body mass during androgen-deprivation therapy for prostate cancer. , 2004, Urology.

[6]  William J Kraemer,et al.  Fundamentals of resistance training: progression and exercise prescription. , 2004, Medicine and science in sports and exercise.

[7]  C. Friedenreich,et al.  A randomized trial of exercise and quality of life in colorectal cancer survivors. , 2003, European journal of cancer care.

[8]  E. Thiel,et al.  Effects of endurance training on the physical performance of patients with hematological malignancies during chemotherapy , 2003, Supportive Care in Cancer.

[9]  M. Ro̸rth,et al.  Feasibility, physical capacity, and health benefits of a multidimensional exercise program for cancer patients undergoing chemotherapy , 2003, Supportive Care in Cancer.

[10]  K. Yarasheski,et al.  Effects of Exercise Training Added to Ongoing Hormone Replacement Therapy on Bone Mineral Density in Frail Elderly Women , 2003, Journal of the American Geriatrics Society.

[11]  Fernando Costa,et al.  Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease: a statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Ph , 2003, Circulation.

[12]  J. Eastham,et al.  Randomized controlled trial of zoledronic acid to prevent bone loss in men receiving androgen deprivation therapy for nonmetastatic prostate cancer. , 2003, The Journal of urology.

[13]  K. Courneya,et al.  Resistance exercise in men receiving androgen deprivation therapy for prostate cancer. , 2003, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[14]  D. Lowenthal,et al.  Strength training and hemodynamic responses to exercise. , 2003, The American journal of geriatric cardiology.

[15]  N. Kalin,et al.  A pilot study of group exercise training (GET) for women with primary breast cancer: feasibility and health benefits , 2002, Psycho-oncology.

[16]  Matthew R. Smith Osteoporosis during androgen deprivation therapy for prostate cancer. , 2002, Urology.

[17]  R. Newton,et al.  Mixed-methods resistance training increases power and strength of young and older men. , 2002, Medicine and science in sports and exercise.

[18]  S. Cerutti,et al.  Changes in bone mineral density, lean body mass and fat content as measured by dual energy x-ray absorptiometry in patients with prostate cancer without apparent bone metastases given androgen deprivation therapy. , 2002, The Journal of urology.

[19]  D. Lowenthal,et al.  Resistance Exercise and Physical Performance in Adults Aged 60 to 83 , 2002, Journal of the American Geriatrics Society.

[20]  Jacques Ferlay,et al.  Estimating the world cancer burden: Globocan 2000 , 2001, International journal of cancer.

[21]  G. Hunter,et al.  High-resistance versus variable-resistance training in older adults. , 2001, Medicine and science in sports and exercise.

[22]  P. Kantoff,et al.  Pamidronate to prevent bone loss during androgen-deprivation therapy for prostate cancer. , 2001, The New England journal of medicine.

[23]  F. Dimeo,et al.  Effects of exercise on cancer‐related fatigue , 2001, Cancer.

[24]  H. Daniell,et al.  Osteoporosis due to androgen deprivation therapy in men with prostate cancer. , 2001, Urology.

[25]  R. Parker,et al.  Bone loss in men with prostate cancer treated with gonadotropin-releasing hormone agonists. , 2001, The Journal of clinical endocrinology and metabolism.

[26]  K J Stewart,et al.  Fatigue and quality of life outcomes of exercise during cancer treatment. , 2001, Cancer practice.

[27]  M. Mori,et al.  Exercise reduces daily fatigue in women with breast cancer receiving chemotherapy. , 2001, Medicine and science in sports and exercise.

[28]  V. Mock Evaluating a Model of Fatigue in Children with Cancer , 2001, Journal of pediatric oncology nursing : official journal of the Association of Pediatric Oncology Nurses.

[29]  S. Colletta,et al.  Structured exercise improves physical functioning in women with stages I and II breast cancer: results of a randomized controlled trial. , 2001, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[30]  L. Kristjanson,et al.  An Exercise Intervention for Advanced Cancer Patients Experiencing Fatigue: A Pilot Study , 2000, Journal of palliative care.

[31]  D. Yoon,et al.  Exercise therapy effect on natural killer cell cytotoxic activity in stomach cancer patients after curative surgery. , 2000, Archives of physical medicine and rehabilitation.

[32]  Steven Blair,et al.  Low Cardiorespiratory Fitness and Physical Inactivity as Predictors of Mortality in Men with Type 2 Diabetes , 2000, Annals of Internal Medicine.

[33]  D. Bruner,et al.  Prostate cancer elder alert. Living with treatment choices and outcomes. , 2000, Journal of gerontological nursing.

[34]  J. Kampert,et al.  Relationship between low cardiorespiratory fitness and mortality in normal-weight, overweight, and obese men. , 1999, JAMA.

[35]  R. Marcus,et al.  Once‐Weekly Resistance Exercise Improves Muscle Strength and Neuromuscular Performance in Older Adults , 1999, Journal of the American Geriatrics Society.

[36]  John T. Wei,et al.  Androgen deprivation therapy for prostate cancer results in significant loss of bone density. , 1999, Urology.

[37]  A. Schwartz Fatigue mediates the effects of exercise on quality of life , 1999, Quality of Life Research.

[38]  K. Häkkinen,et al.  Effects of heavy-resistance training on hormonal response patterns in younger vs. older men. , 1999, Journal of applied physiology.

[39]  F. Dimeo,et al.  Effects of physical activity on the fatigue and psychologic status of cancer patients during chemotherapy , 1999, Cancer.

[40]  T. Diamond,et al.  The effect of combined androgen blockade on bone turnover and bone mineral densities in men treated for prostate carcinoma , 1998, Cancer.

[41]  M. R. Visser,et al.  Fatigue and radiotherapy: (A) experience in patients undergoing treatment. , 1998, British Journal of Cancer.

[42]  M. R. Visser,et al.  Fatigue and radiotherapy: (B) experience in patients 9 months following treatment. , 1998, British Journal of Cancer.

[43]  Carol Ewing Garber,et al.  ACSM Position Stand: The Recommended Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory and Muscular Fitness, and Flexibility in Healthy Adults , 1998 .

[44]  Peter R. Cavanagh,et al.  Exercise and physical activity for older adults , 1998 .

[45]  W J Kraemer,et al.  Changes in agonist-antagonist EMG, muscle CSA, and force during strength training in middle-aged and older people. , 1998, Journal of applied physiology.

[46]  F. Dimeo,et al.  Aerobic exercise as therapy for cancer fatigue. , 1998, Medicine and science in sports and exercise.

[47]  D. Irvine,et al.  Fatigue in women with breast cancer receiving radiation therapy. , 1998, Cancer nursing.

[48]  Roland Mertelsmann,et al.  Aerobic exercise in the rehabilitation of cancer patients after high dose chemotherapy and autologous peripheral stem cell transplantation. , 1998 .

[49]  E. Durak,et al.  The Application of an Exercise and Wellness Program for Cancer Patients: A Preliminary Outcomes Report , 1998 .

[50]  F. Dimeo,et al.  Correlation between physical performance and fatigue in cancer patients. , 1997, Annals of oncology : official journal of the European Society for Medical Oncology.

[51]  J Keul,et al.  Effects of aerobic exercise on the physical performance and incidence of treatment-related complications after high-dose chemotherapy. , 1997, Blood.

[52]  I. Gage,et al.  Effects of exercise on fatigue, physical functioning, and emotional distress during radiation therapy for breast cancer. , 1997, Oncology nursing forum.

[53]  G. Uhlenbruck,et al.  Exercise, cancer and the immune response of monocytes. , 1997, Anticancer research.

[54]  L. Kanz,et al.  Aerobic exercise in the rehabilitation of cancer patients after high dose chemotherapy and autologous peripheral stem cell transplantation , 1997, Cancer.

[55]  A. Hicks,et al.  A longitudinal trial of weight training in the elderly: continued improvements in year 2. , 1996, The journals of gerontology. Series A, Biological sciences and medical sciences.

[56]  W J Kraemer,et al.  Neuromuscular adaptations during bilateral versus unilateral strength training in middle-aged and elderly men and women. , 1996, Acta physiologica Scandinavica.

[57]  R. Marcus,et al.  Comparative effects of high- and low-intensity resistance training on thigh muscle strength, fiber area, and tissue composition in elderly women. , 1996, Clinical physiology.

[58]  R. Prince,et al.  Exercise effects on bone mass in postmenopausal women are site‐specific and load‐dependent , 1996, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[59]  R. Marcus,et al.  Effects of a one‐year high‐intensity versus low‐intensity resistance training program on bone mineral density in older women , 1995, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[60]  P. Williams,et al.  Physical activity and public health. , 1995, JAMA.

[61]  W. Rejeski,et al.  Moderate Exercise Training and Natural Killer Cell Cytotoxic Activity in Breast Cancer Patients , 1995, International journal of sports medicine.

[62]  G. Oster,et al.  Health-related quality of life in patients with advanced prostate cancer: A multinational perspective , 1995, Quality of Life Research.

[63]  K. Patrick,et al.  Physical Activity and Public Health: A Recommendation From the Centers for Disease Control and Prevention and the American College of Sports Medicine , 1995 .

[64]  M. Fiatarone,et al.  Effects of High-Intensity Strength Training on Multiple Risk Factors for Osteoporotic Fractures: A Randomized Controlled Trial , 1994 .

[65]  R L Hintz,et al.  Effect of recombinant human growth hormone on the muscle strength response to resistance exercise in elderly men. , 1994, The Journal of clinical endocrinology and metabolism.

[66]  D. Irvine,et al.  The prevalence and correlates of fatigue in patients receiving treatment with chemotherapy and radiotherapy; A comparison with the fatigue experienced by healthy individuals , 1994, Cancer nursing.

[67]  S B Roberts,et al.  Exercise training and nutritional supplementation for physical frailty in very elderly people. , 1994, The New England journal of medicine.

[68]  G. Uhlenbruck,et al.  Influence of a moderate exercise training on natural killer cytotoxicity and personality traits in cancer patients. , 1994, Anticancer research.

[69]  B. Garssen,et al.  Fatigue in cancer patients. , 1993, British Journal of Cancer.

[70]  G. Barber,et al.  Cardiac rehabilitation after cancer therapy in children and young adults. , 1993, The American journal of cardiology.

[71]  N. Vogelzang,et al.  Quality of life and psychosocial status in stage D prostate cancer , 1992, Quality of Life Research.

[72]  R. Wiswell,et al.  Muscle hypertrophy response to resistance training in older women. , 1992, Journal of applied physiology.

[73]  L. Lipsitz,et al.  High-intensity strength training in nonagenarians. Effects on skeletal muscle. , 1990, JAMA.

[74]  M. Macvicar,et al.  Effects of Aerobic Interval Training on Cancer Patients' Functional Capacity , 1989, Nursing research.

[75]  M. Macvicar,et al.  Effect of aerobic exercise on body weight and composition in patients with breast cancer on adjuvant chemotherapy. , 1989, Oncology nursing forum.

[76]  D G Sale,et al.  Neural adaptation to resistance training. , 1988, Medicine and science in sports and exercise.

[77]  Winningham Ml,et al.  The effect of aerobic exercise on patient reports of nausea. , 1988 .

[78]  W. Frontera,et al.  Strength conditioning in older men: skeletal muscle hypertrophy and improved function. , 1988, Journal of applied physiology.

[79]  C. Cheney,et al.  Effects of resistive exercise on skeletal muscle in marrow transplant recipients receiving total parenteral nutrition. , 1986, JPEN. Journal of parenteral and enteral nutrition.

[80]  F. West,et al.  Influence of progressive resistance exercises on knee function following femoral fractures. , 1950, The Journal of bone and joint surgery. American volume.

[81]  A. L. Watkins,et al.  Technics of progressive resistance exercise. , 1948, Archives of physical medicine and rehabilitation.

[82]  D. Galvão,et al.  Multiple sets are superior to single sets for enhancing muscle function in older adults , 2004 .

[83]  S. Gordon,et al.  Physiological changes with periodized resistance training in women tennis players. , 2003, Medicine and science in sports and exercise.

[84]  F. Dimeo Radiotherapy-related fatigue and exercise for cancer patients: a review of the literature and suggestions for future research. , 2002, Frontiers of radiation therapy and oncology.

[85]  A. Schwartz Daily fatigue patterns and effect of exercise in women with breast cancer. , 2000, Cancer practice.

[86]  R. Stege Potential side‐effects of endocrine treatment of long duration in prostate cancer , 2000, The Prostate. Supplement.

[87]  F. Schröder,et al.  Endocrine treatment: Expected duration stage by stage , 2000, The Prostate. Supplement.

[88]  P. Hedlund,et al.  Side effects of endocrine treatment and their mechanisms: Castration, antiandrogens, and estrogens , 2000, The Prostate. Supplement.

[89]  D. Ferguson,et al.  Progressive osteoporosis during androgen deprivation therapy for prostate cancer. , 2000, The Journal of urology.

[90]  H. Kemper,et al.  The Effect of Exercise Training Programs on Bone Mass: A Meta-analysis of Published Controlled Trials in Pre- and Postmenopausal Women , 1999, Osteoporosis International.

[91]  E. Durak,et al.  Physical and psychosocial responses to exercise in cancer patients: A two year follow-up survey with prostate, leukemia, and general carcinoma , 1999 .

[92]  A. Jemal,et al.  Global cancer statistics , 2011, CA: a cancer journal for clinicians.

[93]  V. Katch,et al.  The effect of aerobic exercise on self-esteem and depressive and anxiety symptoms among breast cancer survivors. , 1998, Oncology nursing forum.

[94]  N. Vogelzang,et al.  Quality of life and psychosocial status in stage D prostate cancer. Zoladex Prostate Cancer Study Group. , 1992, Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation.

[95]  M. Macvicar,et al.  The effect of aerobic exercise on patient reports of nausea. , 1988, Oncology nursing forum.

[96]  D. Sale Influence of exercise and training on motor units activation. , 1987 .

[97]  A. McComas,et al.  Effect of strength training upon motoneuron excitability in man. , 1983, Medicine and science in sports and exercise.

[98]  V. Polezhaev Effect of a , 1974 .