title: Exercise behavior, functional capacity, and survival in adults with malignant recurrent glioma.
abstract: OBJECTIVE
  Identifying strong markers of prognosis are critical to optimize treatment and survival outcomes in patients with malignant recurrent glioma. We investigated the prognostic significance of exercise behavior and functional capacity in this population.
  
  
  METHODS
  Using a prospective design, 243 patients with WHO grades 3 to 4 recurrent malignant glioma and Karnofsky performance status (KPS) ≥ 70 completed a self-administered questionnaire that assessed exercise behavior and performed a 6-minute walk test (6MWT) to assess functional capacity. Cox proportional models were used to estimate the risk of all-cause mortality according to 6MWT distance (6MWD; < 390 meters, 390-489 meters, > 489 meters) and exercise behavior (metabolic equivalent [MET] -h/wk) adjusted for KPS and other important clinical factors.
  
  
  RESULTS
  Median follow-up was 27.43 months. During this period, 149 deaths were recorded (61% of the total sample). Exercise behavior was an independent predictor of survival (P = .0081). Median survival was 13.03 months for patients reporting < 9 MET-h/wk relative to 21.84 months for those reporting ≥ 9 MET-h/wk. Exercise behavior added incremental prognostic value beyond that provided by KPS, age, sex, grade, and number of prior progressions (P < .001). Compared with patients reporting < 9 MET-h/wk, the adjusted hazard ratio for mortality was 0.64 (95% CI, 0.46 to 0.91) for patients reporting ≥ 9 MET-h/wk. Functional capacity was not an independent predictor of prognosis.
  
  
  CONCLUSIONS
  Exercise behavior is a strong independent predictor of survival that provides incremental prognostic value to KPS as well as traditional markers of prognosis in malignant recurrent glioma.
authors.affiliation: Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Ruden
authors.forename: David A
authors.initials: DA
authors.lastname: Reardon
authors.forename: April D
authors.initials: AD
authors.lastname: Coan
authors.forename: James E
authors.initials: JE
authors.lastname: Herndon
authors.forename: Whitney E
authors.initials: WE
authors.lastname: Hornsby
authors.forename: Miranda
authors.initials: M
authors.lastname: West
authors.forename: Diane R
authors.initials: DR
authors.lastname: Fels
authors.forename: Annick
authors.initials: A
authors.lastname: Desjardins
authors.forename: James J
authors.initials: JJ
authors.lastname: Vredenburgh
authors.forename: Emily
authors.initials: E
authors.lastname: Waner
authors.forename: Allan H
authors.initials: AH
authors.lastname: Friedman
authors.forename: Henry S
authors.initials: HS
authors.lastname: Friedman
authors.forename: Katherine B
authors.initials: KB
authors.lastname: Peters
authors.forename: Lee W
authors.initials: LW
authors.lastname: Jones
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000401:mortality* / Q000473:pathology / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D015444:Exercise; D005080:Exercise Test; D005260:Female; D005910:Glioma / Q000401:mortality* / Q000473:pathology / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D015438:Health Behavior; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009657:North Carolina; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires; D016019:Survival Analysis; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D016138:Walking