title: 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.
abstract: This individual patient data meta-analysis aimed to evaluate the effects of exercise on quality of life (QoL) and physical function (PF) in patients with cancer, and to identify moderator effects of demographic (age, sex, marital status, education), clinical (body mass index, cancer type, presence of metastasis), intervention-related (intervention timing, delivery mode and duration, and type of control group), and exercise-related (exercise frequency, intensity, type, time) characteristics. Relevant published and unpublished studies were identified in September 2012 via PubMed, EMBASE, PsycINFO, and CINAHL, reference checking and personal communications. Principle investigators of all 69 eligible trials were requested to share IPD from their study. IPD from 34 randomised controlled trials (n=4519 patients) that evaluated the effects of exercise compared to a usual care, wait-list or attention control group on QoL and PF in adult patients with cancer were retrieved and pooled. Linear mixed-effect models were used to evaluate the effects of the exercise on post-intervention outcome values (z-score) adjusting for baseline values. Moderator effects were studies by testing interactions. Exercise significantly improved QoL (β=0.15, 95%CI=0.10;0.20) and PF (β=0.18, 95%CI=0.13;0.23). The effects were not moderated by demographic, clinical or exercise characteristics. Effects on QoL (βdifference_in_effect=0.13, 95%CI=0.03;0.22) and PF (βdifference_in_effect=0.10, 95%CI=0.01;0.20) were significantly larger for supervised than unsupervised interventions. In conclusion, exercise, and particularly supervised exercise, effectively improves QoL and PF in patients with cancer with different demographic and clinical characteristics during and following treatment. Although effect sizes are small, there is consistent empirical evidence to support implementation of exercise as part of cancer care.
authors.affiliation: Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands; Department of Medical Oncology, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: l.buffart@vumc.nl.
authors.forename: Laurien M
authors.initials: LM
authors.lastname: Buffart
authors.affiliation: Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: j.kalter@vumc.nl.
authors.forename: Joeri
authors.initials: J
authors.lastname: Kalter
authors.affiliation: Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: m.sweegers@vumc.nl.
authors.forename: Maike G
authors.initials: MG
authors.lastname: Sweegers
authors.affiliation: Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Canada. Electronic address: kerry.courneya@ualberta.ca.
authors.forename: Kerry S
authors.initials: KS
authors.lastname: Courneya
authors.affiliation: Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia. Electronic address: r.newton@ecu.edu.au.
authors.forename: Robert U
authors.initials: RU
authors.lastname: Newton
authors.affiliation: Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands. Electronic address: n.aaronson@nki.nl.
authors.forename: Neil K
authors.initials: NK
authors.lastname: Aaronson
authors.affiliation: Division of Population Science, Moffitt Cancer Center and Research Institute, Tampa, FL, USA. Electronic address: Paul.Jacobsen@moffitt.org.
authors.forename: Paul B
authors.initials: PB
authors.lastname: Jacobsen
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: a.m.may@umcutrecht.nl.
authors.forename: Anne M
authors.initials: AM
authors.lastname: May
authors.affiliation: Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia. Electronic address: d.galvao@ecu.edu.au.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Galvão
authors.affiliation: Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: m.chinapaw@vumc.nl.
authors.forename: Mai J
authors.initials: MJ
authors.lastname: Chinapaw
authors.affiliation: Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany. Electronic address: k.steindorf@dkfz-heidelberg.de.
authors.forename: Karen
authors.initials: K
authors.lastname: Steindorf
authors.affiliation: Yale School of Public Health, New Haven, USA. Electronic address: melinda.irwin@yale.edu.
authors.forename: Melinda L
authors.initials: ML
authors.lastname: Irwin
authors.affiliation: Department of Physiotherapy, Netherlands Cancer Institute, Amsterdam, The Netherlands. Electronic address: m.stuiver@nki.nl.
authors.forename: Martijn M
authors.initials: MM
authors.lastname: Stuiver
authors.affiliation: School of Public Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD, Australia. Electronic address: sc.hayes@qut.edu.au.
authors.forename: Sandi
authors.initials: S
authors.lastname: Hayes
authors.affiliation: School of Nursing, University of Maryland, Baltimore, USA. Electronic address: Griffith@son.umaryland.edu.
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Griffith
authors.affiliation: European University, Madrid, Spain. Electronic address: alejandro.lucia@uem.es.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Lucia
authors.affiliation: Department of Epidemiology, Maastricht University, The Netherlands. Electronic address: ilse.mesters@maastrichtuniversity.nl.
authors.forename: Ilse
authors.initials: I
authors.lastname: Mesters
authors.affiliation: University Medical Centre Groningen, University of Groningen, Center for Rehabilitation, Groningen, The Netherlands. Electronic address: e.van.weert@rev.umcg.nl.
authors.forename: Ellen
authors.initials: E
authors.lastname: van Weert
authors.affiliation: Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: hans.knoop@amc.uva.nl.
authors.forename: Hans
authors.initials: H
authors.lastname: Knoop
authors.affiliation: Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. Electronic address: m.m.goedendorp@med.umcg.nl.
authors.forename: Martine M
authors.initials: MM
authors.lastname: Goedendorp
authors.affiliation: Physical Activity for Health Research Center, University of Edinburgh, Edinburgh, UK. Electronic address: nanette.mutrie@ed.ac.uk.
authors.forename: Nanette
authors.initials: N
authors.lastname: Mutrie
authors.affiliation: Primary Care Clinical Sciences, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK. Electronic address: a.daley@bham.ac.uk.
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Daley
authors.affiliation: Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK. Electronic address: alex.mcconnachie@glasgow.ac.uk.
authors.forename: Alex
authors.initials: A
authors.lastname: McConnachie
authors.affiliation: Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Heidelberg University, Mannheim, Germany; Faculty of Health, University of Antwerp, Belgium. Electronic address: martin.bohus@zi-mannheim.de.
authors.forename: Martin
authors.initials: M
authors.lastname: Bohus
authors.affiliation: National Advisory Unit on Late Effects after Cancer, Department of Oncology, Oslo University Hospital, Oslo, Norway. Electronic address: LKA@ous-hf.no.
authors.forename: Lene
authors.initials: L
authors.lastname: Thorsen
authors.affiliation: Athleticum - Competence Center for Sports- and Exercise Medicine and Institute for Medical Psychology, University Medical Center Hamburg-Eppendorf, Germany. Electronic address: khschulz@uke.uni-hamburg.de.
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Schulz
authors.affiliation: Freemasons Foundation Centre of Men's Health, School of Medicine, University of Adelaide, SA, Australia. Electronic address: camille.short@adelaide.edu.au.
authors.forename: Camille E
authors.initials: CE
authors.lastname: Short
authors.affiliation: School of Medicine & Public Health, the University of Newcastle, Callaghan, NSW, Australia. Electronic address: erica.james@newcastle.edu.au.
authors.forename: Erica L
authors.initials: EL
authors.lastname: James
authors.affiliation: Priority Research Centre for Physical Activity and Nutrition, the University of Newcastle, Callaghan, NSW, Australia. Electronic address: ron.plotnikoff@newcastle.edu.au.
authors.forename: Ron C
authors.initials: RC
authors.lastname: Plotnikoff
authors.affiliation: Lane Fox Respiratory Research Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK. Electronic address: Gill.Arbane@gstt.nhs.uk.
authors.forename: Gill
authors.initials: G
authors.lastname: Arbane
authors.affiliation: Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany. Electronic address: m.schmidt@dkfz.de.
authors.forename: Martina E
authors.initials: ME
authors.lastname: Schmidt
authors.affiliation: Department of Medical Oncology, National Center for Tumor Diseases (NCT) and Heidelberg University Hospital, Heidelberg, Germany; Department of Radiation Oncology, National Center for Tumor Diseases (NCT) and Heidelberg University Hospital, Heidelberg, Germany. Electronic address: karin_potthoff@gmx.de.
authors.forename: Karin
authors.initials: K
authors.lastname: Potthoff
authors.affiliation: Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. Electronic address: m.v.beurden@nki.nlm.
authors.forename: Marc
authors.initials: M
authors.lastname: van Beurden
authors.affiliation: Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. Electronic address: h.oldenburg@nki.nl.
authors.forename: Hester S
authors.initials: HS
authors.lastname: Oldenburg
authors.affiliation: Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. Electronic address: g.sonke@nki.nl.
authors.forename: Gabe S
authors.initials: GS
authors.lastname: Sonke
authors.affiliation: Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands; University of Twente, Enschede, The Netherlands. Electronic address: w.v.harten@nki.nl.
authors.forename: Wim H
authors.initials: WH
authors.lastname: van Harten
authors.affiliation: Department of Respiratory Medicine, Kings College London, London, UK. Electronic address: rachelgarrod1@gmail.com.
authors.forename: Rachel
authors.initials: R
authors.lastname: Garrod
authors.affiliation: Penn State Health, College of Medicine, and Cancer Institute, Hershey, PA, USA. Electronic address: kschmitz@phs.psu.edu.
authors.forename: Kathryn H
authors.initials: KH
authors.lastname: Schmitz
authors.affiliation: Oregon Health & Science University, Portland, USA. Electronic address: wintersk@ohsu.edu.
authors.forename: Kerri M
authors.initials: KM
authors.lastname: Winters-Stone
authors.affiliation: Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands. Electronic address: M.Velthuis@iknl.nl.
authors.forename: Miranda J
authors.initials: MJ
authors.lastname: Velthuis
authors.affiliation: Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia. Electronic address: d.taaffe@ecu.edu.au.
authors.forename: Dennis R
authors.initials: DR
authors.lastname: Taaffe
authors.affiliation: Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: w.vanmechelen@vumc.nl.
authors.forename: Willem
authors.initials: W
authors.lastname: van Mechelen
authors.affiliation: Department of Hematology, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: m.j.kersten@amc.uva.nl.
authors.forename: Marie-José
authors.initials: MJ
authors.lastname: Kersten
authors.affiliation: Department of Rehabilitation Medicine, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: f.nollet@amc.uva.nl.
authors.forename: Frans
authors.initials: F
authors.lastname: Nollet
authors.affiliation: Johns Hopkins School of Nursing, Johns Hopkins School of Medicine, Sidney Kimmel Comprehensive Cancer Center, Baltimore, USA. Electronic address: jwenzel@jhu.edu.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Wenzel
authors.affiliation: Lane Fox Respiratory Research Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK. Electronic address: joachim.wiskemann@nct-heidelberg.de.
authors.forename: Joachim
authors.initials: J
authors.lastname: Wiskemann
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands; Department of Clinical Psychology, Vrije Universiteit Amsterdam, The Netherlands. Electronic address: im.verdonck@vumc.nl.
authors.forename: Irma M
authors.initials: IM
authors.lastname: Verdonck-de Leeuw
authors.affiliation: Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands; Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Amsterdam, The Netherlands. Electronic address: j.brug@uva.nl.
authors.forename: Johannes
authors.initials: J
authors.lastname: Brug
mesh_terms: D015444:Exercise / Q000502:physiology*; D006801:Humans; D009369:Neoplasms / Q000503:physiopathology* / Q000628:therapy*; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic
keywords: Exercise; Individual patient data meta-analysis; Neoplasm; Physical function; Quality of life