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Cancer – Improves cardiorespiratory fitness

Evidence summary (Updated 2022)
Systematic reviews and meta-analyses of randomised controlled trials (RCTs) and non-RCTs have shown consistent improvements in cardiorespiratory fitness in cancer patients pre-surgery.(1–4) Most studies prescribed an aerobic intervention programme and used the 6-minute walk test as an outcome measure.
In a recent review of the evidence 52 reviews were shown to have a definite positive effect on cardio-respiratory fitness outcome measures(5–56).
Six of 52 studies reported an improvement seen before the treatment stage/ prehabilitation before surgery(12,18,23,25,45,51). Sixteen of 52 studies reported an improvement seen during the treatment stage(6,10,15,22,24–32,49,55,57). Sixteen of 52 reported on interventions before, during and post treatment(5,9,11,13,14,17,33,37–39,41–44,48,53). Nine of 52 studies reported on improved cardiorespiratory fitness with PA interventions following cancer treatment(8,19–21,34,35,46,47,56). Four of 52 did not specify the treatment stage of the interventions(7,36,40,54).
While 17 reported on multiple cancer types(8,9,37,38,41,46,47,52,10–16,36), these included any combination of the following: head and neck, lung, breast, colorectal, endometrial, cervical, ovarian, testicular, bladder, stomach, prostate or haematological and with bone metastases(40). Several reported on a single cancer only; improved cardio-respiratory fitness (CRF) with the physical activity intervention group was seen in breast(5–7,17,28,39,50,53–56), gastrointestinal(18–25,48,49,51), prostate(26,27,29–32,58), urological(42,45), brain(43), lung(33–35), head and neck(44) cancer patients.
When considering the intervention type studies considered multiple or combination physical activity/exercise interventions(5,7,15,18,25–27,29–32,34,40,43,44,47–49,51). Combined aerobic and anaerobic activities were evaluated(6,13,14,21–25,28,33,35–37,41,42,45,56). Other interventions shown to be effective included Pilates(17), aerobic exercises(10,19,20,46,54,55), Nordic walking(53), HIIT(9,11,12,16,38,39), resistance(26,50), mind-body activities(52) such as Tai Chi, Yoga, Qigong, and dance. Rossi et al assessed aerobic interventions through the use of behaviour change(8).
Interventions of any frequency, intensity and duration were included in several the studies. Improvements in CRF were seen in moderate(10), moderate-vigorous(9,11–14,25,28,31,39,41,43) and vigorous(38) intensity interventions.

Quality of evidence
A – High quality

Strength of recommendation
1 – Strong

Conclusion
A large number of systematic reviews and meta-analyses support the improvements of cardio-respiratory fitness both before, during and post treatment, in patients with a variety of types of cancer. Several different PA modalities were found to be effective, this should be recommended to patients.

References

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