Targeting Exercise Interventions to Patients With Cancer in Need: An Individual Patient Data Meta-Analysis

104 Background: Fatigue is a common and disabling complaint in patients with cancer and can be reduced by exercise. To further personalize exercise prescriptions, moderators of exercise effects on fatigue should be investigated. However, most randomized controlled trials (RCTs) are not adequately powered to identify heterogeneity in responses to exercise. Therefore, we conducted a meta-analysis using individual patient data (IPD) of exercise RCTs to investigate the effect and moderators of exercise on cancer-related fatigue. Methods: Within the Predicting OptimaL cAncer RehabIlitation and Supportive care (POLARIS) consortium, principal investigators of 34 exercise RCTs worldwide have shared their IPD, including in total 4366 cancer patients. A 1-step IPD meta-analysis, using a linear mixed-effect model with a random intercept on study was undertaken to investigate effect on fatigue. The result, a between-group difference in standardized z-scores, corresponds to a Cohen’s d effect size. An interaction term was included in the model to assess potential moderators including demographic (sex, age, marital status, education), clinical (body mass index, distant metastasis), intervention-related (timing, delivery mode, duration) and exercise-related (type, frequency, intensity, duration) characteristics. Results: Exercise significantly reduced fatigue (β = -0.17, 95% CI -0.22;-0.12). The effect was not moderated by demographic, clinical or exercise-related characteristics. Supervised exercise had significantly larger effects on fatigue than unsupervised exercise (βdifference= -0.18, 95%CI -0.28;-0.08). Compared to the control group, supervised exercise significantly improved fatigue (β = -0.23, 95%CI = -0.29;-0.17), while unsupervised exercise did not (β = -0.04, 95%CI = -0.13;0.04). Conclusions: Exercise significantly reduces cancer-related fatigue across subgroups formed on the basis of demographic and clinical characteristics. The effect of exercise is significantly larger when performed under supervision. Hence, exercise, and preferably supervised exercise, represents a viable intervention for the prevention and treatment of fatigue among patients with cancer.

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Effects and moderators of psychosocial interventions on quality of life, and emotional and social function in patients with cancer: An individual patient data meta-analysis of 22 RCTs

Psycho-Oncology ◽

10.1002/pon.4648 ◽

2018 ◽

Vol 27 (4) ◽

pp. 1150-1161 ◽

Cited By ~ 26

Author(s):

J. Kalter ◽

I.M. Verdonck-de Leeuw ◽

M.G. Sweegers ◽

N.K. Aaronson ◽

P.B. Jacobsen ◽

...

Keyword(s):

Quality Of Life ◽

Individual Patient Data ◽

Meta Analysis ◽

Psychosocial Interventions ◽

Social Function ◽

Patient Data ◽

Patients With Cancer

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Erythropoietin or Darbepoetin for patients with cancer - meta-analysis based on individual patient data

Cochrane Database of Systematic Reviews ◽

10.1002/14651858.cd007303.pub2 ◽

2009 ◽

Cited By ~ 44

Author(s):

Julia Bohlius ◽

Kurt Schmidlin ◽

Corinne Brillant ◽

Guido Schwarzer ◽

Sven Trelle ◽

...

Keyword(s):

Individual Patient Data ◽

Meta Analysis ◽

Patient Data ◽

Patients With Cancer

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Effects and moderators of exercise on muscle strength, muscle function and aerobic fitness in patients with cancer: a meta-analysis of individual patient data

British Journal of Sports Medicine ◽

10.1136/bjsports-2018-099191 ◽

2018 ◽

Vol 53 (13) ◽

pp. 812-812 ◽

Cited By ~ 15

Author(s):

Maike G Sweegers ◽

Teatske M Altenburg ◽

Johannes Brug ◽

Anne M May ◽

Jonna K van Vulpen ◽

...

Keyword(s):

Muscle Strength ◽

Aerobic Fitness ◽

Muscle Function ◽

Individual Patient Data ◽

Meta Analysis ◽

Lower Body ◽

Exercise Interventions ◽

Patients With Cancer ◽

Body Muscle ◽

Session Duration

ObjectiveTo optimally target exercise interventions for patients with cancer, it is important to identify which patients benefit from which interventions.DesignWe conducted an individual patient data meta-analysis to investigate demographic, clinical, intervention-related and exercise-related moderators of exercise intervention effects on physical fitness in patients with cancer.Data sourcesWe identified relevant studies via systematic searches in electronic databases (PubMed, Embase, PsycINFO and CINAHL).Eligibility criteriaWe analysed data from 28 randomised controlled trials investigating the effects of exercise on upper body muscle strength (UBMS) and lower body muscle strength (LBMS), lower body muscle function (LBMF) and aerobic fitness in adult patients with cancer.ResultsExercise significantly improved UBMS (β=0.20, 95% Confidence Interval (CI) 0.14 to 0.26), LBMS (β=0.29, 95% CI 0.23 to 0.35), LBMF (β=0.16, 95% CI 0.08 to 0.24) and aerobic fitness (β=0.28, 95% CI 0.23 to 0.34), with larger effects for supervised interventions. Exercise effects on UBMS were larger during treatment, when supervised interventions included ≥3 sessions per week, when resistance exercises were included and when session duration was >60 min. Exercise effects on LBMS were larger for patients who were living alone, for supervised interventions including resistance exercise and when session duration was >60 min. Exercise effects on aerobic fitness were larger for younger patients and when supervised interventions included aerobic exercise.ConclusionExercise interventions during and following cancer treatment had small effects on UBMS, LBMS, LBMF and aerobic fitness. Demographic, intervention-related and exercise-related characteristics including age, marital status, intervention timing, delivery mode and frequency and type and time of exercise sessions moderated the exercise effect on UBMS, LBMS and aerobic fitness.

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