Evidence summary (Updated 2022)
Systematic review of exercise programmes during chemotherapy helped prevent decline in cardiorespiratory and muscular fitness – with a small improvement(1). Increase in muscular strength was noted in systematic reviews in patients performing aerobic and/or resistance exercise during chemotherapy or radiotherapy(2). Significant improvement in physical function in further meta-analysis(3). In breast cancer a meta-analyses demonstrated moderate improvement in cardiorespiratory fitness and small increase in muscular strength(4). Systematic reviews of aerobic and resistance exercise therapy for patients receiving androgen deprivation therapy and radiotherapy showed increase in muscular fitness and small improvement in cardiorespiratory fitness(5,6).
In a recent review of the evidence 14 reviews were shown to have a definite positive effect on physical function in cancer patients(7–20).
Five of 14 studies reported an improvement seen during the treatment stage(9,16–18,20). Six reported on interventions during and post treatment(7,8,11,12,14,15). One did not specify the treatment stage of the interventions(13).
While 6 reported on multiple cancer types, including patients with advanced disease(10,12,14–17), several reported on a single cancer only; improved physical function with the physical activity intervention group was seen in breast(7,8,11,13), gastrointestinal(18,19), prostate(9,20), and lung cancer patients.
When considering the intervention type, studies considered multiple or combination physical activity/exercise interventions(9–11,20). Combined aerobic and anaerobic activities were evaluated(7,14,15,18,19). Other interventions shown to be effective included Pilates(8), HIIT(17), anaerobic/ resistance(12,13), aerobic(16), mind-body activities such as Tai Chi, Yoga, Qigong, and dance.
Interventions of any frequency, intensity and duration were included in several the studies. Improvements in physical function was seen in moderate(16) and moderate-vigorous(14) intensity interventions.
Quality of evidence
Grade B – Moderate quality.
Strength of recommendation
2 – Weak recommendation.
Studies are heterogenous with regards to the design and there is a mixture of studies looking at radiotherapy and chemotherapy. Further robust RCTs are needed however there is good preliminary evidence, with some promising evidence present for breast cancer to improve physical function with physical activity. Overall patients will expect an improvement in their physical function – with more evidence present for improvement in muscular strength. There is a mixture of aerobic and resistance training in studies and it is likely both are of benefit however a dose response has not been indicated.
Meta-analyses demonstrates improvement in cardiorespiratory fitness and muscular fitness after aerobic and resistance training. Systematic review demonstrated low to moderate evidence that exercise increased walking endurance. Systematic reviews demonstrated small and moderate sized improvements in cardiorespiratory fitness following aerobic training, for 3 months after lung resection, and for colorectal cancer respectively.[3, 6] Meta-analysis in breast cancer has shown an increase in muscular strength.. Two further reviews found a positive effect on improved physical function with physical activity interventions after cancer treatment.(10,19)
Quality of evidence
Grade B – Moderate quality.
Strength of recommendation
2 – Weak evidence.
Patients that include PA post their treatment for cancer can expect based on evidence that they will gain an improvement in physical function – primarily in cardiorespiratory function, but also in muscular fitness. A number of studies have been done with some looking at aerobic activity and some resistance training. Evidence has primarily shown an improvement in cardiorespiratory fitness. Evidence demonstrates an improvement in muscular fitness. Studies are heterogenous in design. The benefits are likely to outweigh any risks for patients undertaking physical activity.
- Moll CC. The effect of training during treatment with chemotherapy on muscle strength and endurance capacity: A systematic review. Acta Oncol. 55(5):539–46.
- Stene GB. Effect of physical exercise on muscle mass and strength in cancer patients during treatment–a systematic review. Crit Rev Oncol Hematol. 88(3):573–93.
- Buffart LM. Effects and moderators of exercise on quality of life and physical function in patients with cancer: An individual patient data meta-analysis of 34 RCTs. Cancer Treat Rev. 52:91–104.
- Furmaniak AC, Menig M, Markes MH. Exercise for women receiving adjuvant therapy for breast cancer. Cochrane Database Syst Rev. 9:5001.
- Baumann FT, Zopf EM, Bloch W. Clinical exercise interventions in prostate cancer patients–a systematic review of randomized controlled trials. Support Care Cancer. 20(2):221–33.
- Gardner JR, Livingston PM, Fraser SF. Effects of exercise on treatment-related adverse effects for patients with prostate cancer receiving androgen-deprivation therapy: a systematic review. J Clin Oncol. 32(4):335–46.
- Boing L, Vieira M de CS, Moratelli J, Bergmann A, Guimarães AC de A. Effects of exercise on physical outcomes of breast cancer survivors receiving hormone therapy – A systematic review and meta-analysis. Maturitas [Internet]. 2020 Nov 1 [cited 2022 Oct 10];141:71–81. Available from: https://pubmed.ncbi.nlm.nih.gov/33036706/
- Pinto-Carral A, Molina AJ, de Pedro Á, Ayán C. Pilates for women with breast cancer: A systematic review and meta-analysis. Complement Ther Med [Internet]. 2018 Dec 1 [cited 2022 Oct 10];41:130–40. Available from: https://pubmed.ncbi.nlm.nih.gov/30477829/
- Schumacher O, Luo H, Taaffe DR, Galvão DA, Tang C, Chee R, et al. Effects of Exercise During Radiation Therapy on Physical Function and Treatment-Related Side Effects in Men With Prostate Cancer: A Systematic Review and Meta-Analysis. Int J Radiat Oncol Biol Phys [Internet]. 2021 Nov 1 [cited 2022 Oct 11];111(3):716–31. Available from: https://pubmed.ncbi.nlm.nih.gov/34246737/
- Brayall P, Donlon E, Doyle L, Leiby R, Violette K. Physical Therapy-Based Interventions Improve Balance, Function, Symptoms, and Quality of Life in Patients with Chemotherapy-Induced Peripheral Neuropathy: A Systematic Review. Rehabil Oncol [Internet]. 2018 Jul 1 [cited 2022 Oct 13];36(3):161–6. Available from: https://journals.lww.com/rehabonc/Fulltext/2018/07000/Physical_Therapy_Based_Interventions_Improve.5.aspx
- Gebruers N, Camberlin M, Theunissen F, Tjalma W, Verbelen H, Van Soom T, et al. The effect of training interventions on physical performance, quality of life, and fatigue in patients receiving breast cancer treatment: a systematic review. Support Care Cancer [Internet]. 2019 Jan 1 [cited 2022 Oct 13];27(1):109–22. Available from: https://pubmed.ncbi.nlm.nih.gov/30302542/
- Lee J. The effects of resistance training on muscular strength and hypertrophy in elderly cancer patients: A systematic review and meta-analysis. J Sport Heal Sci [Internet]. 2022 Mar 1 [cited 2022 Sep 1];11(2):194–201. Available from: https://pubmed.ncbi.nlm.nih.gov/33592324/
- Montaño-Rojas LS, Romero-Pérez EM, Medina-Pérez C, Reguera-García M, de Paz JA. Resistance Training in Breast Cancer Survivors: A Systematic Review of Exercise Programs. Int J Environ Res Public Health [Internet]. 2020 Sep 2 [cited 2022 Oct 10];17(18):1–17. Available from: https://pubmed.ncbi.nlm.nih.gov/32906761/
- Sweegers MG, Altenburg TM, Chinapaw MJ, Kalter J, Verdonck-De Leeuw IM, Courneya KS, et al. Which exercise prescriptions improve quality of life and physical function in patients with cancer during and following treatment? A systematic review and meta-analysis of randomised controlled trials. Br J Sports Med [Internet]. 2018 Apr 1 [cited 2022 Oct 13];52(8):505–13. Available from: https://pubmed.ncbi.nlm.nih.gov/28954800/
- Yang J, Choi M, Choi JA, Kang M, Jo AJ, Chung SH, et al. Supervised Physical Rehabilitation in the Treatment of Patients with Advanced Cancer: a Systematic Review and Meta-analysis. J Korean Med Sci [Internet]. 2020 Jul 27 [cited 2022 Oct 13];35(29). Available from: https://pubmed.ncbi.nlm.nih.gov/32715671/
- Cave J, Paschalis A, Huang CY, West M, Copson E, Jack S, et al. A systematic review of the safety and efficacy of aerobic exercise during cytotoxic chemotherapy treatment. Support Care Cancer [Internet]. 2018 Oct 1 [cited 2022 Oct 10];26(10):3337–51. Available from: https://pubmed.ncbi.nlm.nih.gov/29936624/
- Lavín-Pérez AM, Collado-Mateo D, Mayo X, Humphreys L, Liguori G, James Copeland R, et al. High-intensity exercise to improve cardiorespiratory fitness in cancer patients and survivors: A systematic review and meta-analysis. Scand J Med Sci Sports [Internet]. 2021 Feb 1 [cited 2022 Oct 10];31(2):265–94. Available from: https://pubmed.ncbi.nlm.nih.gov/33098219/
- McGettigan M, Cardwell CR, Cantwell MM, Tully MA. Physical activity interventions for disease-related physical and mental health during and following treatment in people with non-advanced colorectal cancer. Cochrane database Syst Rev [Internet]. 2020 May 3 [cited 2022 Oct 10];5(5). Available from: https://pubmed.ncbi.nlm.nih.gov/32361988/
- Mbous YP, Patel J, Kelly KM. A systematic review and meta-analysis of physical activity interventions among colorectal cancer survivors. Transl Behav Med [Internet]. 2020 Oct 1 [cited 2022 Oct 10];10(5):1134–43. Available from: https://pubmed.ncbi.nlm.nih.gov/33044539/
- Zdravkovic A, Hasenöhrl T, Palma S, Crevenna R. Effects of resistance exercise in prostate cancer patients : A systematic review update as of March 2020. Wien Klin Wochenschr [Internet]. 2020 Aug 1 [cited 2022 Oct 11];132(15–16):452–63. Available from: https://pubmed.ncbi.nlm.nih.gov/32681360/