TY - JOUR
T1 - Targeting exercise interventions to patients with cancer in need
T2 - An individual patient data meta-analysis
AU - Sweegers, Maike G.
AU - May, Anne M.
AU - Chinapaw, Mai J.
AU - Van Vulpen, Jonna K.
AU - Newton, Rob U.
AU - Galvão, Daniel A.
AU - Aaronson, Neil K.
AU - Stuiver, Martijn M.
AU - Jacobsen, Paul B.
AU - Verdonck-De Leeuw, Irma M.
AU - Steindorf, Karen
AU - Irwin, Melinda L.
AU - Hayes, Sandi
AU - Griffith, Kathleen A.
AU - Lucia, Alejandro
AU - Herrero-Roman, Fernando
AU - Mesters, Ilse
AU - Van Weert, Ellen
AU - Knoop, Hans
AU - Goedendorp, Martine M.
AU - Mutrie, Nanette
AU - Daley, Amanda J.
AU - McConnachie, Alex
AU - Bohus, Martin
AU - Thorsen, Lene
AU - Schulz, Karl Heinz
AU - Short, Camille E.
AU - James, Erica L.
AU - Plotnikoff, Ronald C.
AU - Arbane, Gill
AU - Schmidt, Martina E.
AU - Potthoff, Karin
AU - Van Beurden, Marc
AU - Oldenburg, Hester S.
AU - Sonke, Gabe S.
AU - Van Harten, Wim H.
AU - Garrod, Rachel
AU - Schmitz, Kathryn H.
AU - Winters-Stone, Kerri M.
AU - Velthuis, Miranda J.
AU - Taaffe, Dennis R.
AU - Van Mechelen, Willem
AU - Kersten, Marie Jose
AU - Nollet, Frans
AU - Wenzel, Jennifer
AU - Wiskemann, Joachim
AU - Brug, Johannes
AU - Courneya, Kerry S.
AU - Buffart, Laurien M.
N1 - Publisher Copyright:
© 2018 Oxford University Press. All Rights Reserved.
PY - 2018/11/1
Y1 - 2018/11/1
N2 - Background: Exercise effects in cancer patients often appear modest, possibly because interventions rarely target patients most in need. This study investigated the moderator effects of baseline values on the exercise outcomes of fatigue, aerobic fitness, muscle strength, quality of life (QoL), and self-reported physical function (PF) in cancer patients during and posttreatment. Methods: Individual patient data from 34 randomized exercise trials (n ¼ 4519) were pooled. Linear mixed-effect models were used to study moderator effects of baseline values on exercise intervention outcomes and to determine whether these moderator effects differed by intervention timing (during vs post-treatment). All statistical tests were two-sided. Results: Moderator effects of baseline fatigue and PF were consistent across intervention timing, with greater effects in patients with worse fatigue (Pinteraction ¼.05) and worse PF (Pinteraction ¼.003). Moderator effects of baseline aerobic fitness, muscle strength, and QoL differed by intervention timing. During treatment, effects on aerobic fitness were greater for patients with better baseline aerobic fitness (Pinteraction ¼.002). Post-treatment, effects on upper (Pinteraction <.001) and lower (Pinteraction ¼.01) body muscle strength and QoL (Pinteraction <.001) were greater in patients with worse baseline values. Conclusion: Although exercise should be encouraged for most cancer patients during and post-treatments, targeting specific subgroups may be especially beneficial and cost effective. For fatigue and PF, interventions during and post-treatment should target patients with high fatigue and low PF. During treatment, patients experience benefit for muscle strength and QoL regardless of baseline values; however, only patients with low baseline values benefit post-treatment. For aerobic fitness, patients with low baseline values do not appear to benefit from exercise during treatment.
AB - Background: Exercise effects in cancer patients often appear modest, possibly because interventions rarely target patients most in need. This study investigated the moderator effects of baseline values on the exercise outcomes of fatigue, aerobic fitness, muscle strength, quality of life (QoL), and self-reported physical function (PF) in cancer patients during and posttreatment. Methods: Individual patient data from 34 randomized exercise trials (n ¼ 4519) were pooled. Linear mixed-effect models were used to study moderator effects of baseline values on exercise intervention outcomes and to determine whether these moderator effects differed by intervention timing (during vs post-treatment). All statistical tests were two-sided. Results: Moderator effects of baseline fatigue and PF were consistent across intervention timing, with greater effects in patients with worse fatigue (Pinteraction ¼.05) and worse PF (Pinteraction ¼.003). Moderator effects of baseline aerobic fitness, muscle strength, and QoL differed by intervention timing. During treatment, effects on aerobic fitness were greater for patients with better baseline aerobic fitness (Pinteraction ¼.002). Post-treatment, effects on upper (Pinteraction <.001) and lower (Pinteraction ¼.01) body muscle strength and QoL (Pinteraction <.001) were greater in patients with worse baseline values. Conclusion: Although exercise should be encouraged for most cancer patients during and post-treatments, targeting specific subgroups may be especially beneficial and cost effective. For fatigue and PF, interventions during and post-treatment should target patients with high fatigue and low PF. During treatment, patients experience benefit for muscle strength and QoL regardless of baseline values; however, only patients with low baseline values benefit post-treatment. For aerobic fitness, patients with low baseline values do not appear to benefit from exercise during treatment.
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U2 - 10.1093/jnci/djy161
DO - 10.1093/jnci/djy161
M3 - Review article
C2 - 30299508
AN - SCOPUS:85056588080
SN - 0027-8874
VL - 110
JO - Journal of the National Cancer Institute
JF - Journal of the National Cancer Institute
IS - 11
M1 - djy161
ER -