Exercise for women receiving adjuvant therapy for breast cancer

Martina Markes; Thomas Brockow; Karl‐Ludwig Resch

doi:10.1002/14651858.CD005001.pub2

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Analysis 1.1

Comparison 1 Exercise versus control, Outcome 1 Cardiorespiratory fitness.

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Analysis 1.2

Comparison 1 Exercise versus control, Outcome 2 Strength.

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Analysis 1.3

Comparison 1 Exercise versus control, Outcome 3 Fatigue.

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Analysis 1.4

Comparison 1 Exercise versus control, Outcome 4 Weight change.

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Analysis 1.5

Comparison 1 Exercise versus control, Outcome 5 Cancer specific quality of life.

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Analysis 1.6

Comparison 1 Exercise versus control, Outcome 6 Cancer site‐specific quality of life.

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Analysis 1.7

Comparison 1 Exercise versus control, Outcome 7 Anxiety.

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Analysis 1.8

Comparison 1 Exercise versus control, Outcome 8 Mood disturbance.

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Analysis 1.9

Comparison 1 Exercise versus control, Outcome 9 Depression.

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Analysis 1.10

Comparison 1 Exercise versus control, Outcome 10 Natural killer cells.

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Analysis 1.11

Comparison 1 Exercise versus control, Outcome 11 T‐cells.

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Analysis 1.12

Comparison 1 Exercise versus control, Outcome 12 Oxidative stress.

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Analysis 1.13

Comparison 1 Exercise versus control, Outcome 13 Nausea relief.

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Analysis 1.14

Comparison 1 Exercise versus control, Outcome 14 Sleep disturbances.

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Table 1. Eligibility assessment

Eligibility criteria

1. Number of groups involved in the trial (at least two groups required);
2. Proportion of patients with breast cancer (> 80% breast cancer patients required);
3. Intervention examined (exercise training);
4. Time of exercise training (concurrent with adjuvant treatment);
5. Duration of exercise intervention (at least six weeks) and
6. Type of outcomes as specified.

Table 1. Eligibility assessment

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Table 2. Methodological quality assessment tool

Quality criteria

1.Were the eligibility criteria specified?
2.Was a method of randomisation performed?
3.Was the treatment allocation concealed?
4.Were groups similar at baseline?
5.Were interventions explicitly described?
6.Were co‐interventions either avoided or comparable?
7.Was adherence acceptable in all groups?
8.Was the outcome assessor blinded to the intervention?
9.Were outcome measures relevant?
10.Were adverse effects described?
11.Was the withdrawal/ drop‐out rate acceptable and were reasons described?
12.Was short‐term follow‐up measurement performed?
13.Was long‐term follow‐up measurement performed?
14.Was timing of outcome assessment comparable in both groups?
15.Was the sample size described for each group at randomisation?
16.Did the analysis include intention‐to‐treat analysis?
17.Were point estimates and measures of variability presented for the primary outcome measures?

Table 2. Methodological quality assessment tool

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Table 3. Analysis of training stimulus

Aerobic exercise	Resistive exercise
1. Intensity: 55 ‐ 85% of maximum heart rate or 40 ‐ 75% of maximum heart rate reserve or 40 ‐ 75% of maximum oxygen uptake reserve; 2. Duration of sessions: 20 ‐ 60 min (minimum of 10 min. continuous bouts throughout the day) or exercise to tolerance; 3. Frequency: at least three days per week; 4. Total exercise period: at least six weeks.	1. Intensity: 10‐15 repetitions to near fatigue or at least 60% of one Repetition Maximum; 2. Number of sets completed (duration): at least 1set; 3. Frequency: two or three days per week; 4. Total exercise period: at least six weeks.

Table 3. Analysis of training stimulus

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Table 4. SMD/WMD calculation

Outcome	Study‐ID	Instruments, units	Calculation base
Cardiorespiratory Fitness	Campbell 2005; Drouin 2002; Mock 1997; Segal 2001 SD; Segal 2001 SU	metres (12‐minute walk); peak VO2; feet (12‐minute walk); peak VO2; peak VO2	final values
Strength	Drouin 2002	kg	final values
Fatigue	Campbell 2005; Drouin 2002; Mock 1997; Mock 2004; Segal 2001 SD; Segal 2001 SU	Piper Fatigue Scale; Piper Fatigue Scale; Symptom Assessment Scale; Piper Fatigue Scale; SF‐36 vitality reversed; SF‐36 vitality reversed;	final values
Weight change	Mac Vicar 1989; Segal 2001 SD; Segal 2001 SU	kg	change scores
Cancer specific quality of life	Campbell 2005	Functional Assessment of Cancer Therapy ‐ general (FACT‐G)	change scores
Cancer ‐site specific quality of life	Campbell 2005	Functional Assessment of Cancer Therapy‐Breast (FACT‐B)	change scores
Anxiety	Mock 1997	Symptom Assessment Scale	final values
Mood Disturbance	Drouin 2002	Profile of Mood States (POMS)	final values
Depression	Mock 1997	Symptom Assessment Scale	final values
T‐Cells	Drouin 2002	CD4+/CD8+	final values
Natural Killer Cells	Drouin 2002	Natural killer cytotoxic activity, lytic units	final values
Oxidative Stress	Drouin 2002	8‐Isoprostane	final values
Sleep disturbances	Mock 1997	Symptom Assessment Scale	final values

Table 4. SMD/WMD calculation

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Table 5. Methodological Scores

Study	Internal Validity	Descriptive Validity	Statistical Validity	Total Score
	Items	Items	Items
	2, 3, 6, 7, 8, 9, 11, 14, 16; Score	1, 4, 5, 10, 12, 13; Score	15, 17; Score
Campbell 2005	+, ?, +, +, ?, +, +, +, ‐, 6	+, +, +, +, +, ‐, 5	+, +, 2	13
Crowley 2003	+, +, +, +, +, +, +, +, +, 9	+, ‐, ‐, +, +, ‐, 3	+, ‐, 1	13
Drouin 2002	+, +, ?, +, ?, +, +, +, ‐, 6	+, +, ‐, +, +, ‐, 4	+, +, 2	12
MacVicar 1986	‐, ?, ?, ?, ?, +, +, +, ?, 3	+, ?, +, ‐, +, ‐, 3	+, ‐, 1	7
MacVicar/ Winningham 1989	?, ?, +, +, ?, +, ‐, +, ‐, 4	+, +, ‐, ‐, +, ‐, 3	+, ‐, 1	8
Mock 1997	‐, ‐, +, +, ?, +, +, +, ‐, 5	+, +, +, +, +, ‐, 5	‐, ‐, 0	10
Mock 2004	+, +, +, ‐, ‐, +, +, +, +, 7	+, +, +, +, +, ‐, 5	+, +, 2	14
Segal 2001	+, +, ?, +, ?, +, ‐, +, +, 6	+, +, +, +, +, ‐, 5	+, +, 2	13
Winningham 1988	?, ?, +, ?, ?, +, +, +, +, 5	+, +, +, ‐, +, ‐ , 4	+, ‐, 1	10

Table 5. Methodological Scores

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Comparison 1. Exercise versus control

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Cardiorespiratory fitness Show forest plot	5	207	Std. Mean Difference (IV, Random, 95% CI)	0.66 [0.20, 1.12]

2 Strength Show forest plot	1		Std. Mean Difference (IV, Random, 95% CI)	Totals not selected

3 Fatigue Show forest plot	6	317	Std. Mean Difference (IV, Random, 95% CI)	‐0.12 [‐0.37, 0.13]

4 Weight change Show forest plot	3	147	Mean Difference (IV, Random, 95% CI)	‐1.11 [‐2.44, 0.22]

5 Cancer specific quality of life Show forest plot	1		Std. Mean Difference (IV, Random, 95% CI)	Totals not selected

6 Cancer site‐specific quality of life Show forest plot	1		Std. Mean Difference (IV, Random, 95% CI)	Totals not selected

7 Anxiety Show forest plot	1		Std. Mean Difference (IV, Random, 95% CI)	Totals not selected

8 Mood disturbance Show forest plot	1		Std. Mean Difference (IV, Random, 95% CI)	Totals not selected

9 Depression Show forest plot	1		Std. Mean Difference (IV, Random, 95% CI)	Totals not selected

10 Natural killer cells Show forest plot	1		Std. Mean Difference (IV, Random, 95% CI)	Totals not selected

11 T‐cells Show forest plot	1		Std. Mean Difference (IV, Random, 95% CI)	Totals not selected

12 Oxidative stress Show forest plot	1		Std. Mean Difference (IV, Random, 95% CI)	Totals not selected

13 Nausea relief Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

14 Sleep disturbances Show forest plot	1		Std. Mean Difference (IV, Random, 95% CI)	Totals not selected

Comparison 1. Exercise versus control

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