Exercise programs for patients with cancer improve
Blikk på forskning i Fysioterapeuten 4/2013
Blikk på forskning utarbeides i samarbeid med Journal of Physiotherapy (Australia), som trykker forskningspresentasjonene under betegnelsen Critically appraised Papers, CAPs.
Summary of: Fong DYT, et al (2012) Physical activity for cancer survivors: meta-analysis of randomized controlled trials.BMJ344:e70 doi: 10.1136/bmj.e70. [Prepared by Nicholas Taylor, CAP Co-ordinator.]
Objective: To review the evidence about whether physical activity exercise programs improve health indicators in adult patients after they have completed their main treatment related to cancer.
Data sources: PubMed, CINAHL and Google Scholar were searched up to September, 2011. This search was supplemented by searching the Cochrane Library for systematic reviews and examining the reference lists of all selected studies.
Study selection: Randomised controlled trials involving adult patients who had completed their main treatment for cancer but who might still be receiving hormonal therapy. The effect of an exercise
program was assessed on physical functions, physiological parameters, psychosocial outcomes, and quality of life compared with sedentary or no-exercise control groups.
Data extraction: Two reviewers independently extracted data and discrepancies were resolved by consensus. Risk of bias in selected studies was assessed using a checklist developed by the Scottish Inter-Collegiate Guidelines Network.
Data synthesis: Of 1505 studies initially identified by the search and 387 studies identified from additional sources, 34 studies were included for review and meta-analysis. Most studies focused on patients with breast cancer (65%) and investigated aerobic exercise programs (86%), while a smaller number investigated resistance training interventions (14%). The median duration of the exercise programs was 13 weeks. Based on quantitative pooling of available data there were statistically significant improvement in insulin-like growth factor-I, muscle strength, fatigue, depression, and quality of life in favour of exercise for patients with breast cancer. Based on quantitative pooling of data from studies of different types of cancer, there were improvements in favour of exercise in body mass index, body weight, peak oxygen consumption, distance walked in 6 minutes, handgrip strength and quality of life. For example, there was a weighted mean difference of 29 m (95% CI 4 to 55) for the 6 minute walk distance in favour of exercise. Significant differences were not found on the remaining outcomes, including lean mass and flexibility.
Conclusion: Exercise programs for patients who have completed their treatment for cancer result in positive effects in a range of health indicators including physical functioning and quality of life.
With advances in detection, diagnosis, and treatment, cancer is now recognized as a chronic disease (McCorkle et al 2011). The need for exercise has been identified as an unmet need in cancer survivors (Thorsen et al 2011). Fong et al reviewed the effects of exercise on cancer survivors after completion of treatment. Survivors who participated in exercise had significant improvements across a variety of domains. Improvements were seen in commonly used clinical outcome measures such as 6 minute walk test, handgrip strength, and SF36. Although 65% of the meta-analyses reviewed focused on breast cancer, Fong et al provide evidence that physical activity is beneficial across a variety of tumor streams after completion of treatment. However, cancer patients can also benefit from physical activity during treatment for their cancer (Knols et al 2005). Patients often have greater access to allied health services such as physiotherapy during active treatment compared to post treatment. Additionally, there is not always a clear point in time when treatment is completed. Ideally physiotherapists should establish an appropriate exercise program whilst the patient is undergoing active treatment, with a plan in place for ongoing exercise post treatment. Fong et al found that incorporating resistance training significantly improved outcomes, most likely due to the increased intensity of exercises. Although further research is required into the intensity of exercise, the meta-analysis suggests that moderate intensity exercise is recommended for cancer survivors. It is currently not standard practice for cancer survivors to be prescribed exercises post treatment, despite evidence by Fong et al that exercise improves physical function and quality of life. Exercise for cancer survivors should be the norm, rather than the exception. Further research on type and intensity of exercise across a variety of tumour streams will assist clinicians in appropriate exercise prescription.
Ambulatory Oncology Rehabilitation Program, Health Independence Program, Eastern Health, Melbourne, Australia
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