Advertisement

Exercise intervention in people with cancer undergoing neoadjuvant cancer treatment and surgery: A systematic review

  • L. Loughney
    Correspondence
    Corresponding author. Anaesthesia and Critical Care Research Area, NIHR Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, CE93, MP24, Tremona Road, Southampton, SO16 6YD, UK.
    Affiliations
    Anaesthesia and Critical Care Research Area, NIHR Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, CE93, MP24, Tremona Road, Southampton, SO16 6YD, UK

    Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, CE93, MP24, Tremona Road, Southampton, SO16 6YD, UK
    Search for articles by this author
  • M.A. West
    Affiliations
    Anaesthesia and Critical Care Research Area, NIHR Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, CE93, MP24, Tremona Road, Southampton, SO16 6YD, UK

    Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, CE93, MP24, Tremona Road, Southampton, SO16 6YD, UK

    Academic Unit of Cancer Sciences, Faculty of Medicine, University of Southampton, South Academic Block, Tremona Road, Southampton, SO16 6YD, UK
    Search for articles by this author
  • G.J. Kemp
    Affiliations
    Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, CE93, MP24, Tremona Road, Southampton, SO16 6YD, UK

    Department of Musculoskeletal Biology and MRC – Arthritis Research UK Centre for Integrated Research into Musculoskeletal Ageing (CIMA), Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
    Search for articles by this author
  • M.P.W. Grocott
    Affiliations
    Anaesthesia and Critical Care Research Area, NIHR Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, CE93, MP24, Tremona Road, Southampton, SO16 6YD, UK

    Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, CE93, MP24, Tremona Road, Southampton, SO16 6YD, UK
    Search for articles by this author
  • S. Jack
    Affiliations
    Anaesthesia and Critical Care Research Area, NIHR Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, CE93, MP24, Tremona Road, Southampton, SO16 6YD, UK

    Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, CE93, MP24, Tremona Road, Southampton, SO16 6YD, UK
    Search for articles by this author
Published:October 15, 2015DOI:https://doi.org/10.1016/j.ejso.2015.09.027

      Abstract

      Background

      Neoadjuvant cancer treatment decreases physical fitness. Low levels of physical fitness are associated with poor surgical outcome. Exercise training can stimulate skeletal muscle adaptations, such as increased mitochondrial content and improved oxygen uptake capacity that may contribute to improving physical fitness. This systematic review evaluates the evidence in support of exercise training in people with cancer undergoing the “dual hit” of neoadjuvant cancer treatment and surgery.

      Methods

      We conducted a systematic database search of Embase Ovid, Ovid Medline without Revisions, SPORTDiscus, Web of Science, Cochrane Central Register of Controlled Trials Library and ClinicalTrials.gov to identify trials addressing the effect of exercise training in people scheduled for neoadjuvant cancer treatment and surgery. Data extraction and analysis were based on a pre-defined plan.

      Results

      The database search yielded 6489 candidate abstracts. Ninety-four references included the required terms. Four studies were eligible for inclusion (breast cancer, locally advanced rectal cancer). All studies reported that exercise training was safe and feasible and that adherence rates were acceptable (66–96%). In-hospital exercise training improves physical fitness however the impact on HRQoL and other clinical important outcomes was uncertain.

      Conclusion

      This is the first systematic review of the effects of exercise training in people scheduled for “dual-hit” treatment. This evidence synthesis indicates that this approach is safe and feasible but that there are insufficient controlled trials in this area to draw reliable conclusions about the efficacy of such an intervention, the optimal characteristics of the intervention, or the impact on clinical or patient reported outcomes.

      Keywords

      To read this article in full you will need to make a payment

      References

        • Brown S.C.
        • Abraham J.S.
        • Walsh S.
        • Sykes P.A.
        Risk factors and operative mortality in surgery for colorectal cancer.
        Ann R Coll Surg Engl. 1991; 73: 269-272
        • Gilliam L.
        • Clair D.
        Chemotherapy-induced weakness and fatigue in skeletal muscle: the role of oxidative stress.
        Antioxid Redox Signal. 2011; 15: 2543-2663
        • West M.A.
        • Loughney L.
        • Lythgoe D.
        • et al.
        The effect of neoadjuvant chemoradiotherapy on whole-body physical fitness and skeletal muscle mitochondrial oxidative phosphorylation in vivo in locally advanced rectal cancer patients – an observational pilot study.
        PLoS One. 2014; 9: e111526
        • Moros M.T.
        • Ruidiaz M.
        • Caballero A.
        • Serrano E.
        • Martínez V.
        • Tres A.
        Effects of an exercise training program on the quality of life of women with breast cancer on chemotherapy.
        Rev Med Chil. 2010; 138: 715-722
        • Jack S.
        • West M.
        • Raw D.
        • et al.
        The effect of neoadjuvant chemotherapy on physical fitness and survival in patients undergoing oesophagogastric cancer surgery.
        Eur J Surg Oncol. 2014; 40: 1313-1320
        • West M.A.
        • Loughney L.
        • Barben C.P.
        • et al.
        The effects of neoadjuvant chemoradiotherapy on physical fitness and morbidity in rectal cancer surgery patients.
        Eur J Surg Oncol. 2014; 40: 1421-1428
        • Holloszy J.O.
        • Coyle E.F.
        Adaptations of skeletal muscle to endurance exercise and their metabolic consequences.
        J Appl Physiol. 1984; 56: 831-838
        • Holmes M.D.
        • Giovannucci E.L.
        • Feskanich D.
        • Kroenke C.H.
        • Colditz G.A.
        Physical activity and survival after breast cancer diagnosis.
        JAMA. 2005; 293
        • Meyerhardt J.A.
        • Giovannucci E.L.
        • Holmes M.D.
        • et al.
        Physical activity and survival after colorectal cancer diagnosis.
        J Clin Oncol. 2006; 24: 3527-3534
        • Jones L.W.
        • Alfano C.M.
        Exercise-oncology research: past, present, and future.
        Acta Oncol. 2013; 52: 195-215
        • Betof A.S.
        • Lascola C.D.
        • Weitzel D.
        • et al.
        Modulation of murine breast tumor vascularity, hypoxia and chemotherapeutic response by exercise.
        JNCI J Natl Cancer Inst. 2015; 107
        • Granger C.L.
        • MacDonald C.F.
        • Berney S.
        • Chao C.
        • Denehy L.
        Exercise intervention to improve exercise capacity and health related quality of life for patients with non-small cell lung cancer: a systematic review.
        Lung Cancer. 2011; 72: 139-153
        • Crandall K.
        • Maguire R.
        • Campbell A.
        • Kearney N.
        Exercise intervention for patients surgically treated for Non-Small Cell Lung Cancer (NSCLC): a systematic review.
        Surg Oncol. 2014; 23: 17-30
        • Singh F.
        • Newton R.U.
        • Galvao D.A.
        • Spry N.
        • Baker M.K.
        A systematic review of pre-surgical exercise intervention studies with cancer patients.
        Surg Oncol. 2013; 22: 92-104
        • Buffart L.M.
        • Galvao D.A.
        • Brug J.
        • Chinapaw M.J.
        • Newton R.U.
        Evidence-based physical activity guidelines for cancer survivors: current guidelines, knowledge gaps and future research directions.
        Cancer Treat Rev. 2014; 40: 327-340
        • West M.
        • Jack S.
        • Grocott M.P.
        Perioperative cardiopulmonary exercise testing in the elderly.
        Best Pract Res Clin Anaesthesiol. 2011; 25: 427-437
        • Downs S.H.
        • Black N.
        The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions.
        J Epidemiol Community Health. 1998; 52: 377-384
        • O'Doherty A.F.
        • West M.
        • Jack S.
        • Grocott M.P.
        Preoperative aerobic exercise training in elective intra-cavity surgery: a systematic review.
        Br J Anaesth. 2013; 110: 679-689
        • Hornsby W.E.
        • Douglas P.S.
        • West M.J.
        • et al.
        Safety and efficacy of aerobic training in operable breast cancer patients receiving neoadjuvant chemotherapy: a phase II randomized trial.
        Acta Oncol. 2014; 53: 65-74
        • Jones L.W.
        • Douglas P.S.
        • West M.
        • et al.
        Modulation of circulating angiogenic factors and tumor biology by aerobic training in breast cancer patients receiving neoadjuvant chemotherapy.
        Cancer Prev Res. 2013; 6: 925-937
        • Rao R.
        • Cruz V.
        • Peng Y.
        • et al.
        Bootcamp during neoadjuvant chemotherapy for breast cancer: a randomized pilot trial.
        Breast Cancer. 2012; 6: 39-46
        • West M.A.
        • Loughney L.
        • Lythgoe D.
        • et al.
        Effect of prehabilitation on objectively measured physical fitness after neoadjuvant treatment in preoperative rectal cancer patients: a blinded interventional pilot study.
        Br J Anaesth. 2014; 114: 244-251
        • MacVicar M.G.
        • Winningham M.L.
        • Nickel J.L.
        Effects of aerobic interval training on cancer patients' functional capacity.
        Nurs Res. 1989; 38: 348-351
        • Older P.
        • Smith R.
        • Courtney P.
        • Hone R.
        Preoperative evaluation of cardiac failure and ischemia in elderly patients by cardiopulmonary exercise testing.
        Chest. 1993; 104: 701-704
        • Snowden C.P.
        • Prentis J.
        • Jacques B.
        • Anderson H.
        • Manas D.
        • Jones D.T.M.
        Cardiorespiratory fitness predicts mortality and hospital length of stay after major elective surgery in older people.
        Ann Surg. 2013; 257: 999-1004
        • Nugent A.M.
        • Riley M.
        • Megarry J.
        • O'Reilly M.J.G.
        • MacMahon J.
        • Lowry R.
        Cardiopulmonary exercise testing in the pre-operative assessment of patients for repair of abdominal aortic aneurysm.
        Ir J Med Sci. 1998; 167
        • Barakat H.M.
        • Shahin Y.
        • Barnes R.
        • et al.
        Supervised exercise program improves aerobic fitness in patients awaiting abdominal aortic aneurysm repair.
        Ann Vasc Surg. 2014; 28: 74-79
        • Bobbio A.
        • Chetta A.
        • AL
        • et al.
        Preoperative pulmonary rehabilitation in patients undergoing lung resection for non-small cell lung cancer.
        Eur J Cardiothorac Surg. 2008; 33: 95-98
        • Thomas R.J.
        • Holm M.
        • AL-Adhami A.
        Physical activity after cancer: an evidence review of the international literature.
        BJMP. 2014; 7: a708
        • Adamsen L.
        • Quist M.
        • Andersen C.
        • et al.
        Effect of a multimodal high intensity exercise intervention in cancer patients undergoing chemotherapy: randomised controlled trial.
        BMJ. 2009; 339: b3410
        • Courneya K.S.
        • Booth C.M.
        • Gill S.
        • et al.
        The colon health and life-long exercise change trial: a randomized trial of the national Cancer Institute of Canada clinical trials group.
        Curr Oncol. 2008; 15
        • Costantini M.
        • Mencaglia E.
        • Giulio P.D.
        • Cortesi Roila F.
        • Ballatori E.
        Cancer patients as experts in defining quality of life domains. A multicentre survey by the Italian group for the evaluation of outcomes in oncology (IGEO).
        Qual Life Res. 2000; 9: 151-159
        • Burke S.M.
        • Brunet J.
        • Sabiston C.M.
        • Jack S.
        • Grocott M.P.
        • West M.A.
        Patients' perceptions of quality of life during active treatment for locally advanced rectal cancer: the importance of preoperative exercise.
        Support Care Cancer. 2013; 21: 3345-3353
        • Pollak M.N.
        • Chapman J.W.
        • Shepherd L.
        • et al.
        Insulin resistance, estimated by serum C-peptide level, is associated with reduced event-free survival for postmenopausal women in NCIC CTG MA.14 adjuvant breast cancer trial.
        J Clin Oncol. 2006; 24
        • Irwin M.L.
        • Varma K.
        • Alvarez-Reeves M.
        • et al.
        Randomized controlled trial of aerobic exercise on insulin and insulin-like growth factors in breast cancer survivors: the Yale Exercise and Survivorship study.
        Cancer Epidemiol Biomarkers Prev. 2009; 18: 306-313
        • Fairey A.S.
        • Courneya K.S.
        • Field C.J.
        • Bell G.J.
        • Jones L.W.
        • Mackey J.R.
        Effects of exercise training on fasting insulin, insulin resistance, insulin-like growth factors, and insulin-like growth factor binding proteins in postmenopausal breast cancer survivors: a randomized controlled trial 1.
        Cancer Epidemiol Biomarkers Prev. 2003; 12: 721-727