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Cochrane Database of Systematic Reviews

Interventions for promoting habitual exercise in people living with and beyond cancer

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DOI:
https://doi.org/10.1002/14651858.CD010192.pub2Copy DOI
Database:
  1. Cochrane Database of Systematic Reviews
Version published:
  1. 24 September 2013see what's new
Type:
  1. Intervention
Stage:
  1. Review
Cochrane Editorial Group:
  1. Cochrane Gynaecological, Neuro-oncology and Orphan Cancer Group

Copyright:
  1. Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Authors

  • Liam Bourke

    Correspondence to: Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK

    [email protected]

  • Kate E Homer

    Queen Mary University of London, Barts & The London School of Medicine and Dentistry, Centre for Primary Care and Public Health, London, UK

  • Mohamed A Thaha

    Academic Surgical Unit, National Centre for Bowel Research & Surgical Innovation, Centre for Digestive Diseases, Blizard Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University London, London, UK

  • Liz Steed

    Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK

  • Derek J Rosario

    Department of Oncology, University of Sheffield, Sheffield, UK

  • Karen A Robb

    Physiotherapy Department, Bart's Hospital, London, UK

  • John M Saxton

    School of Allied Health Professions, University of East Anglia, Norwich, UK

  • Stephanie JC Taylor

    Centre for Primary Care and Public Health, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK

Contributions of authors

All authors contributed to the design, development and drafting of the protocol for this review. LB and KEH conducted screening and data extraction, with assistance from DJR and SJCT. LS conducted analysis of the trials according to the CALO‐RE taxonomy. MAT, LS, DJR, KAR, SJCT and JMS assisted with interpretation of results and drafting of the final report. LB led the final report.

Sources of support

Internal sources

  • None, Not specified.

External sources

  • None, Not specified.

Declarations of interest

The authors have no conflicts of interest to report.

Acknowledgements

We thank Jane Hayes for designing the search strategy and Clare Jess, Gail Quinn and Dr Chris Williams for their contributions to the editorial process. We thank Mr David Salisbury for assisting with the organisation of the screening process. We thank Dr Dawn Carnes for independently reviewing the risk of bias in the lead authors' published trials. We would like to thank Mr John Batchelor for assistance in drafting the plain language summary of findings.

The National Institute for Health Research (NIHR) is the largest single funder of the Cochrane Gynaecological Cancer Group. The views and opinions expressed herein are those of the authors and do not necessarily reflect those of the NIHR, the NHS or the Department of Health.

Version history

Published

Title

Stage

Authors

Version

2018 Sep 19

Interventions for promoting habitual exercise in people living with and beyond cancer

Review

Rebecca R Turner, Liz Steed, Helen Quirk, Rosa U Greasley, John M Saxton, Stephanie JC Taylor, Derek J Rosario, Mohamed A Thaha, Liam Bourke

https://doi.org/10.1002/14651858.CD010192.pub3

2013 Sep 24

Interventions for promoting habitual exercise in people living with and beyond cancer

Review

Liam Bourke, Kate E Homer, Mohamed A Thaha, Liz Steed, Derek J Rosario, Karen A Robb, John M Saxton, Stephanie JC Taylor

https://doi.org/10.1002/14651858.CD010192.pub2

2012 Nov 14

Interventions for promoting habitual exercise in people living with and beyond cancer.

Protocol

Liam Bourke, Kate E Homer, Mohamed A Thaha, Liz Steed, Derek Rosario, Karen A Robb, John Saxton, Stephanie JC Taylor

https://doi.org/10.1002/14651858.CD010192

Differences between protocol and review

  • We have highlighted reasons why we contacted corresponding authors and have quantified how many times we attempted to do this by email (please see Selection of studies; Excluded studies).

  • We have provided a justification for exclusion of cross‐over trials and for when during the screening process they were screened out (please see Unit of analysis issues).

  • We did not examine funnel plots because too few studies were identified (please see Assessment of risk of bias in included studies).

  • We reported only a subset of excluded trials because of the large number of manuscripts that needed to be full text screened and the large proportion of these that were excluded (please see Excluded studies).

  • We highlighted when a manuscript reported insufficient information to allow judgement of an aspect of bias (please see Other potential sources of bias).

  • We were not able to find any trials describing "pattern" of resistance exercise (i.e. the period of rest in between sets) and hence did not discount any studies for not reporting this. We judged that it would be more informative to include the studies that we found than to not report on resistance exercise interventions at all.

Keywords

MeSH

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

PRISMA flow diagram.
Figures and Tables -
Figure 1

PRISMA flow diagram.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figures and Tables -
Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figures and Tables -
Figure 3

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Comparison 1 Aerobic exercise tolerance, Outcome 1 Aerobic exercise tolerance (all cancers: 8 to 12 weeks of follow‐up).
Figures and Tables -
Analysis 1.1

Comparison 1 Aerobic exercise tolerance, Outcome 1 Aerobic exercise tolerance (all cancers: 8 to 12 weeks of follow‐up).

Comparison 1 Aerobic exercise tolerance, Outcome 2 Aerobic exercise tolerance (all cancers: 8 to 12 weeks of follow‐up sensitivity analysis).
Figures and Tables -
Analysis 1.2

Comparison 1 Aerobic exercise tolerance, Outcome 2 Aerobic exercise tolerance (all cancers: 8 to 12 weeks of follow‐up sensitivity analysis).

Comparison 1 Aerobic exercise tolerance, Outcome 3 Aerobic exercise tolerance (all cancers: 6 months).
Figures and Tables -
Analysis 1.3

Comparison 1 Aerobic exercise tolerance, Outcome 3 Aerobic exercise tolerance (all cancers: 6 months).

Comparison 2 Strength tests (all cancers), Outcome 1 Strength tests.
Figures and Tables -
Analysis 2.1

Comparison 2 Strength tests (all cancers), Outcome 1 Strength tests.

Comparison 2 Strength tests (all cancers), Outcome 2 Strength tests (all cancers: sensitivity analysis).
Figures and Tables -
Analysis 2.2

Comparison 2 Strength tests (all cancers), Outcome 2 Strength tests (all cancers: sensitivity analysis).

Table 1. Summary of included studies

Study

Exercise components

n

Meets Rock et al guidelines?

Adherence summary

At least 75% adherence?

High risk of bias?

Change in AET reported?

Adverse effects

Cadmus 2009

Aerobic

37, 38 (intervention vs control)

33% reported 150 minutes/wk of moderate intensity aerobic exercise at an average of 76% HR, for six months

75% of women were doing between 90 and 119 minutes of moderate intensity aerobic activity per week at six months

Yes; for up to 119 minutes per week

No

No

Five of the 37 women randomly assigned to exercise experienced an adverse effect; two were related to the study (plantar fasciitis)

Daley 2007a

Aerobic

34, 36, 38 (intervention,

sham, control, respectively)

No

77% of the exercise therapy; attended 70% (at least 17 of 24 sessions) or more of sessions

Unclear

Yes; outcome assessors were not blinded to participants’ group allocation

Yes

Three withdrawals in the intervention group: unclear as to why this occurred. Some withdrawals because of medical complications in placebo and control arms but unclear whether study related

Drouin 2005

Aerobic

13 intervention, 8 placebo stretching controls

Unclear

Participants in the intervention group averaged 3.6 days per week of aerobic exercise over an 8‐week period

Unclear

No

Yes

None reported

Kaltsatou 2011

Aerobic

14, 13 (intervention vs control)

Unclear

Not reported

Not reported

Yes; method of measuring exercise and adherence not reported

No

None reported

Kim 2006

Aerobic

22,19 (intervention vs control).

No

Average weekly frequency of exercise was 2.4 ± 0.6 sessions, and average duration of exercise within prescribed target HR was 27.8 ± 8.1 minutes per session. Overall adherence was 78.3% ± 20.1%

Yes

Yes; data missing for 45% of the cohort

Yes

Reasons for withdrawal included personal problems (n = 2), problems at home (n = 2), problems related to chemotherapy (n = 3), thrombophlebitis in the lower leg (n = 2), non-exercise‐related injuries (n = 1), and death (n = 1). Unclear to which arm of the trial these date relate

Pinto 2003

Aerobic

12, 12 (intervention vs

control)

Unclear

Participants attended a mean of 88% of the 36‐session supervised exercise programme

Yes

Yes; 38% lost to follow‐up. Exercise tolerance test was performed but no control group comparison data were reported

Yes

None reported; however, it is unclear why the six controls dropped out

Pinto 2005

Aerobic

43, 43 (intervention vs control)

Unclear

At week 12, intervention participants reported a mean of 128.53 minutes/wk of moderate intensity exercise. However, no changes were reported in the accelerometer data in the intervention group (change score = ‐0.33 kcal/h)

Less than 75% of the intervention group was meeting the prescribed goal after week 4

Yes; significantly more control group participants were receiving hormone treatment. Accelerometer data do not support the self‐reported physical activity behaviour

Yes

Not clear whether chest pain was related to exercise in dropout whose participation was terminated

Pinto 2011

Aerobic

20, 26 (intervention vs control)

Three‐day PAR questionnaire indicates that 64.7% of the intervention group and 40.9% of the control group were achieving the guidelines at three months

Correlation between self‐reported moderate intensity exercise and accelerometer data at three‐month follow‐up, when the only significant between‐group change is reported: r = 0.32

No

Yes; accelerometer data were not reported; also, cited correlation is weak (0.32). Further, substantial contamination was noted in the control group

Yes

One cancer recurrence in the control group at three months

Bourke 2011a

Aerobic and resistance

9, 9 (intervention vs control)

Six weeks of resistance exercise twice a week

90% attendance at the supervised sessions. 94% of independent exercise sessions were completed

Yes

No

Yes

One stroke in the intervention group, unrelated to the exercise programme

Bourke 2011b

Aerobic and resistance

25, 25 (intervention vs control)

Six weeks of resistance exercise twice a week

95% attendance at supervised exercise sessions. Compliance with self‐directed exercise aspect of the lifestyle intervention was 87%

Yes

Yes; high dropout rate at postintervention six‐month follow‐up assessment

Yes

Two men in the intervention arm were discontinued because of cardiac complications before the 12‐week assessments. Two more reported musculoskeletal complaints before the six‐month assessment. Five men reported various health problems in the control group that prohibited them from attending the six‐month assessment

Hayes 2009

Aerobic and resistance

16, 16 (intervention vs control)

Unclear

Most women (88%) allocated to the intervention group participated in 70% or more of scheduled supervised exercise sessions

Unclear

Yes; adherence data on unsupervised aspect of the intervention are not clear

No

None reported

McKenzie 2003

Aerobic and resistance

7,7 (intervention vs control)

No

Unclear

Unclear

Yes; adherence to exercise not reported

No

None reported

Musanti 2012

Aerobic and resistance

Flexibility group (n = 13), aerobic group (n = 12), resistance group (n = 17), aerobic and resistance group (n = 13)

12 weeks of resistance exercise two or three times per week

Mean percentages of adherence were as follows: flexibility = 85%, aerobic = 81%, resistance = 91% and aerobic plus resistance = 86%

Unclear

Yes; a significant number of dropouts belonged to the resistance exercise group (n = 8/13). Only 50% of activity logs were returned

Yes

Adverse effects were reported in two women during the study. In both cases, the women developed tendonitis: one in the shoulder and the other in the foot. Both had a history of tendonitis, and both received standard treatment

Perna 2010

Aerobic and resistance

51 participants in total. Numbers randomly assigned to each arm are unclear

Three months of resistance exercise three times per week

Women assigned to the structured intervention completed an average of 83% of their scheduled hospital‐based exercise sessions (only 4 weeks in duration), and 76.9% completed all 12 sessions. Home‐based component (8 weeks in duration)

Unclear

Yes; numbers randomly assigned to intervention and control groups are unclear, as are numbers completing in each arm

No

Unclear

AET = aerobic exercise tolerance.

Figures and Tables -
Table 1. Summary of included studies
Table 2. Behaviour change components

Behaviour change technique

Bourke 2011a

Bourke 2011b

Cadmus 2009

YALE

Daley 2007a

Drouin 2005

Hayes 2009

Kaltsatou 2011

McKenzie 2003

Musanti 2012

Perna 2010

Kim 2006

Pinto 2003

Pinto 2005

Pinto 2011

Theory

TTM

EXSEM

TTM

TTM

TTM SCT

1. Provide Info on consequences of behaviour in general

X

X

X

X

2. Provide Info on consequences of behaviour to the individual

3. Provide Info about others' approval

4. Provide normative info about others' behaviour

Programme set goal

X

X

X

X

X

X

X

X

X

X

X

X

X

X

5. Goal setting (behaviour)

X

X

X

X

X

X

6. Goal setting (outcome)

7. Action planning

8. Barrier identification/Problem solving

X

X

X

X

X

X

9. Setting of graded tasks

X

X

X

X

X

X

X

X

X

10. Prompt review of behavioural goals

X

X

11. Prompt review of outcome goals

12. Prompt rewards contingent on effort or progress towards goal

X

X

X

13. Provide rewards contingent on successful behaviour

X

14. Shaping

15. Prompt generalisation of a target behaviour

X

X

X

X

X

16. Prompt self‐monitoring of behaviour

X

X

X

X

X

X

X

X

X

X

17. Prompt self‐monitoring of behavioural outcome

X

X

X

X

X

X

18. Prompt focus on past success

X

19. Feedback on performance provided

X

X

X

X

20. Information provided on where and when to perform behaviour

X

X

21. Instruction provided on how to perform the behaviour

X

X

X

X

X

X

X

X

X

X

22. Modelling/Demonstration of behaviour

X

X

X

23. Teaching to use prompts/cues

X

X

X

24. Environmental restructuring

X

X

25. Agreement on behavioural contract

X

26. Prompt practise

X

X

X

X

X

X

X

X

X

X

X

X

X

X

27. Use of follow‐up prompts

X

X

28. Facilitating social comparison

29. Planning social support/social change

X

X

X

30. Prompt identification as role model/position advocate

31. Prompt anticipated regret

32. Fear arousal

33. Prompt self‐talk

34. Prompt use of imagery

35. Relapse prevention/coping planning

X

X

36. Stress management/emotional control training

X

37. Motivational interviewing

38. Time management

39. General communication skills training

40. Stimulation of anticipation of future rewards

EXSEM = exercise self‐esteem model; SCT = social cognitive theory; TTM = transtheroretical model.

Figures and Tables -
Table 2. Behaviour change components
Comparison 1. Aerobic exercise tolerance

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Aerobic exercise tolerance (all cancers: 8 to 12 weeks of follow‐up) Show forest plot

7

330

Std. Mean Difference (IV, Fixed, 95% CI)

0.73 [0.51, 0.95]

2 Aerobic exercise tolerance (all cancers: 8 to 12 weeks of follow‐up sensitivity analysis) Show forest plot

3

154

Std. Mean Difference (IV, Fixed, 95% CI)

0.84 [0.51, 1.17]

3 Aerobic exercise tolerance (all cancers: 6 months) Show forest plot

5

271

Std. Mean Difference (IV, Fixed, 95% CI)

0.70 [0.45, 0.94]

Figures and Tables -
Comparison 1. Aerobic exercise tolerance
Comparison 2. Strength tests (all cancers)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Strength tests Show forest plot

3

91

Std. Mean Difference (IV, Fixed, 95% CI)

0.51 [0.09, 0.93]

2 Strength tests (all cancers: sensitivity analysis) Show forest plot

2

68

Std. Mean Difference (IV, Fixed, 95% CI)

0.47 [‐0.01, 0.96]

Figures and Tables -
Comparison 2. Strength tests (all cancers)