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outcomes of physical exercise regimens in advanced cancer

outcomes of physical exercise regimens in advanced cancer

The number of people that suffer from oncological diseases is ever rising. This has sparked interest into all treatment modalities to provide comprehensive care, one of which is physical exercise programs for these patients. There are varied causes of cancer, such as genetic factors, environmental exposure, chronic infection, or lifestyle.  Due to this complicated clinical picture, prevention and early diagnosis are vital and have become one of the main objectives of the scientific community. There are also many studies that have identified factors that can reduce the development of cancer. Based on studies, the most proven way to reduce the development of cancer is physical exercise. In fact, many hospitals and health services are including regular exercise in palliative, dynamic, social, and recreational therapy inpatient care. 

Study Design and Methods 

This study is a systematic review of the impact of physical exercise on severe cancer patients. The study involves a literature search that was done on eight different databases. It focused on randomized controlled trials (RCTs) that were published in the last decade. To assess the quality of the sample, 15 RCTs were obtained and the PEDro scale was used. 

The study includes aerobic and strength training methods. A combination of aerobic and strength training methods was reported. At the same time, different psychological and physical variables were recorded for where improvements were seen in the following aspects: fatigue, independence, quality of life, and sleep, among others. 

After eliminating duplicate articles, two reviewers (SRC and JALA) independently and blinded to one another assessed the titles and abstracts. Afterward, the reviewers evaluated the full text of selected articles. If any discrepancy arose between the 2 independent reviewers, a third reviewer (JMCT) was consulted. The inclusion criteria were as follows: 

(I) articles and/or studies published in the last 10 years, from 2011 to 2021; 

(II) patients who had advanced cancer (stages IIIA or B and IV) at the time of the intervention, without distinction of gender, sex, or age; 

(III) studies that specified the intervention and/or physical exercise program as an adjuvant therapy to the main therapy; 

(IV) randomized controlled trials (RCTs) and nonrandomized clinical trials; and (V) articles written in English or Spanish. 

The exclusion criteria were the following: 

(I) studies with samples composed of people with cancer in a non- advanced-stage or who have overcome the disease; 

(II) articles outside the established publication period; 

(III) studies that did not specify the type of intervention or did not quantify the physical exercise performed; 

(IV) studies that used programs that were not prescribed and controlled by a professional; 

(V) studies that were not performed in humans; and 

(VI) studies with a score lower than 8/10 on the PEDro scale, because this score is when studies are considered, methodologically, as of very good or excellent quality. 

The effect size of each study was calculated as the standardized mean difference (SMD) in fatigue. The effect size of the parameters from pre- to post-intervention between groups in each study was calculated and pooled using the random-effects model (DerSimonian– Laird approach), assuming a correlation coefficient of 0.5. Finally, the effect sizes of all studies included were combined to estimate an overall summary effect size, with a 95% confidence interval (CI) and a random-effects model.

Study heterogeneity was assessed using the I2 statistic, and the following values were used for interpretation: 0% to 40% might not be important, 30% to 60% moderate heterogeneity, 50% to 90% substantial heterogeneity, and 75% to 100% considerable heterogeneity; the corresponding p- values were also taken into account.

To analyze the influence of each study on the overall ES, a sensitivity analysis was conducted. For this, each study was deleted from the model, and the pooled analysis recalculated.To test publication bias the visual inspection of the funnel plot and the Egger test was used.37 Significance was set at 0.05. Statistical analyses were performed using  STATA®  SE software, version 16 (StataCorp, College Station, TX, USA).


From the 8 databases used for this systematic review, a total of 571 results were obtained. Following the criteria established for the search, a total of 556 studies were eliminated from the sample.

Following the PRISMA selection criteria, the final sample for the development of this systematic review consisted of 15 randomized and nonrandomized clinical trials. The 15 studies included in the final sample met the proposed inclusion criteria. All the included studies were written in English or Spanish in the last 10 years, presenting a randomized or nonrandomized clinical trial design in which all physical exercise interventions were specified and all included patients had an advanced stage of cancer at the time of the intervention. 

The descriptive characteristics of the sample reflect a total of 1072 patients, of whom 60% were women and 40% were men. The cancers most commonly addressed in the different interventions were heterogeneous tumors (50%), breast cancer (22%), lung cancer (18%), colorectal cancer (6%), and prostate or gastrointestinal cancer (2%). 

Notably, this sample was distributed across different countries, such as Germany, the United States, Australia, Taiwan, Great Britain, Norway, and Poland. The final sample was obtained following the criteria of physical exercise as an adjuvant therapy to the main therapy in the different interventions. This therapy of prescribed and scheduled physical exercise, such as aerobic and strength training, stands out for its requirements for proper supervision by physical exercise/rehabilitation specialists as well as by a multidisciplinary team. 


Based on the data found in this study, physical exercise programs have a positive impact on the health of advanced-stage cancer patients. In addition to being a good preventive therapy, exercise has also positive effects on advanced stages cancer patients. 

Exercise programs can serve as adjuvant therapy and help improve the quality of life of patients. At the same time, aerobic, strength, and other exercise programs can help increase the muscle mass of patients and reduce hypotonia. Hypotonia is one of the main side effects of people with advanced stages of cancer. 

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