Exercise interventions before and during active cancer treatment. A systematic review

Abstract

Background: Poorer initial physical health in cancer patients is associated with a higher risk of treatment-related complications and poorer health outcomes. Physical functioning is amenable to interventions, such as exercise focusing on maintaining or building strength and endurance. This systematic review focuses on the effect of prehabilitation in patients undergoing or due to undergo cancer treatment on the course of treatment, quality of life, physical functioning and fatigue.

Materials and methods: A systematic Medline and Embase search for randomised controlled trials addressing the effect of exercise interventions prior to or during active cancer treatment with radiotherapy, chemotherapy or surgery.

Results: The search yielded 21,663 publications of which 33 publications from 28 studies were included in this review. Exercise interventions had the most consistent effect on functional tests (positive effect reported in 69%), followed by the ability to perform daily activities (positive effect in 53%), fatigue (41%) and overall quality of life (38%). Three studies also reported a positive effect on other outcomes such as chemotherapy completion, treatment-related complications and duration of hospitalisation. For improving physical functioning, endurance training appears to be most beneficial, while for maintaining overall quality of life, combined endurance-resistance exercise appeared superior to endurance or resistance exercise only.

Conclusion: Although prehabilitative exercise interventions increase results on endurance tests, no benefit for quality of life, fatigue or daily functioning was ascertained. It is questionable whether these findings justify the investments that prehabilitation interventions require from both health care providers as well as patients.