I Study ID

II Method

III Patient characteristics

IV Intervention(s)

V Results primary outcome

VI Results secondary and all other outcomes

VII Critical appraisal of study quality

1. Reference

1. Study design

2. Source of funding/conflicts of interest

3. Setting

4. Sample size

5. Duration of the Study

1. Eligibility criteria

2. Patient characteristics

3. Group comparability

1. Intervention(s)

2. Intervention 2

2. Comparator(s)

1. Effect size primary outcome

1. Effect size secondary outcome(s)

2. Effect size all other outcomes, endpoints

1.Level of evidence

2. Dropouts

3. Results critical appraisal

First author

Journal

Publication year

Specify the type of study

Registration number

Specify the source of funding

presence of declaration of interest.

Databases

Study designs

Setting

Included studies

Search date

Inclusion criteria

Exclusion criteria

Age

Gender (M:F)

Tumor

Stage

Palliative stage

including dose, length, regimen and timing if relevant

Functioning

Fatigue

Quality of life

Participation

Other (primary as defined in the study)

Brief description of secondary outcome(s) and p values.

including adverse effects, toxicity

Amstar score

Dittus

Preventive Medicine

2017

Design: Systematic review (Non-Cochrane)

NR

Funding: Government

NIH

Databases: PubMed, Ovid Medline and CINHAL

Study designs: RCTs, single-arm pre/post interventions, pragmatic studies and prospective cohort studies evaluating programs

Setting NR

N included studies: 26 (14 RCT)

Search date: March 2017

Eligibility criteria: English language articles; RCTs, single-arm pre/post interventions, pragmatic studies and prospective cohort studies; evaluating programs; testing an intervention with a component of exercise and where at least one third of the sample population had advanced cancer; parameters of physical capacity including aerobe fitness, strength and standard measures of physical function, fatigue and overall QOL.

Excluded: NR

Mean age: NR

NR

Tumor types: Mixed population of advanced cancer patients 58% of studies (n=15), single cancer type 42% of studies (n = 11, of which 7 lung)

Tumor stages: advanced stage

Palliative stage: NR

No information about group comparability

Interventions: Sixteen focused on exercise (62%) and ten (38%) were multi-modality interventions that included exercise. Interventions varied in length, intensity, exercise activity included, location, and supervision.

NR or 6-16 weeks

Control: diverse, mostly usual care

Three RCTs showed significant improvement in functional tests compared to controls, not significantly different between groups in one RCT, Another RCT reported significantly better self-reports of physical function compared to control (not tested)

Three RCTs identified a significant reduction in fatigue between groups who did and did not receive an exercise intervention; One RCT, in individuals with metastatic breast cancer receiving chemotherapy, identified a significant difference in fatigue between the two groups, using chair exercise; Six RCTs observed no significant difference in fatigue between groups. In summary RCT trials did not clearly identify improved fatigue with exercise interventions compared to controls

Three RCTs (n=367 participants) identified significant improvements in QOL compared to controls; Six RCTs (n = 231 participants) reported no improvements in QOL compared to controls.

NR

NR

Systematic review

Dropouts: NR

Amstar score: 4/11 (downgraded for lack of protocol, descriptions, quality assessment, publication bias, grey literature)

Salakari

Acta Oncologica

2015

Design: Systematic review (Non-Cochrane)

NR

Funding: NR

NR

Databases: Medline, Cochrane

Study designs: RCT

Setting NR

N included studies: 13 RCT

Search date: September 2014

Eligibility criteria: Advanced cancer or palliative care and rehabilitation; 2009-2014; RCT; adults; abstract and full text available

Excluded: Incomplete studies; non-English; non-controlled; non-randomized; case reports; clinical practice presentation; treatment protocols and models

Mean age: NR

NR

Tumor types: all

Tumor stages (RCTs): Advanced cancer and palliative care and rehabilitation

Palliative stage: NR

No information about group comparability

Intervention: Physical exercise; Physical exercise and massage; football training; Resistance training and aerobe exercise

NR

Control: Variable, but not systematically reported

Exercise improves physical performance and has positive effects on several other domains of QoL. Effective rehabilitation also improves the overall QoL.

NR

We found no adverse effects related to or caused by rehabilitation.

Systematic review

NR

Amstar score 5/11 downgraded for lack of protocol, grey literature, quality assessment, assessment of publication bias, and conflict of interest information

Albrecht

CLIN J Oncol Nurs

2012

Design: Systematic review (Non-Cochrane)

NR

Funding: Public research funds, government

National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health (#5-K07-AT002943).

Databases: Ovid, MEDLINE, CINAHL, and PubMed

Study designs: retrospective chart reviews, feasibility studies, case studies, and randomized trials

Setting NR

N included studies: 16 (2 RCT)

Search date: NR

Eligibility criteria: English, published after 1991, and focus on adult participants with advanced-stage cancer, and examine the effects of a form of PA.

No exclusion criteria

Mean age: NR

NR

Tumor types: all types

Tumor stages: advanced stage

Palliative stage: NR

Group comparability not reported

Intervention: Any form of additional physical movement that resulted in increased energy expenditure (e.g., physical aerobe activity, group exercise, rehabilitation exercises)

NR

Comparators: None or Usual care

Seated exercise intervention showed statistically lower fatigue scores compared to the usual care group
(p=0.02; 1 study). The intervention group showed clinically significant improvements when compared to the standard care group (p-values NR; 1 study).

Seated exercise had a slower decrease in reported HRQOL through four cycles of chemotherapy, with trends toward significance than usual care (p=0.07; 1 study)

The intervention group was more likely to be discharged home

(p= 0.05; 1 study) and die at home (p=0.01; 1 study).

Systematic review

Amstar score: 4/11 (downgraded for lack of protocol, descriptions, quality assessment, publication bias, grey literature)

Beaton

Physiotherapy Canada

2009

Design: Systematic review (Non-Cochrane)

NR

Funding: NR

No conflict of interest (stated)

Databases: MEDLINE, EMBASE, CINAHL, PsycINFO, the Cochrane Central Register of Controlled Trials, the Cochrane Databases of Systematic Reviews (EBM Reviews—Ovid), and PEDro

Study designs: Case series and RCT

Setting NR

N included studies: 8 (3 RCT)

Search date: May 2008

Eligibility criteria: (1) population: persons with metastatic, advanced, or palliative cancer; (2) intervention: exercise as the intervention or a component of the intervention; (3) publication in a peer-reviewed journal.

Excluded: Studies of persons with lymphoma, melanoma, or myeloma (these are not considered to be metastatic cancers) and studies in which results of those with metastatic cancer could not be separated from those with non-metastatic cancer; Studies in languages other than English or French, newspaper editorials, critical reviews of individual articles, and qualitative research studies; less than one-third of the sample had metastatic or advanced cancer.

Mean age: NR

NR

Tumor types: all types

Tumor stages (RCTs): Advanced and palliative intent

Palliative stage: NR

Group comparability not reported

Intervention: Either (2 studies) 12 weeks exercise, as seated repetitive motion exercises based on a fitness video at home; individualized resistance program with warm-up and cool-down periods, in public facility, or (1 study) 3 weeks, 2-3 /per week Exercise interventions in cancer center involved group-based conditioning and relaxation combined with cognitive, social, emotional, and spiritual interventions.

3 weeks (1 study); 12 weeks (2 studies)

Control intervention: usual level of care (3 studies); plus, waitlisted with an offer to participate in the exercise intervention at a later date (1 study).

No aggregate analysis

No aggregate analysis

Three of the eight studies specifically reported on adverse effects, and no adverse effects occurred.

Systematic review

Amstar score 7/11 downgraded for lack of protocol, grey literature, publication bias. Included RCT scores 8/11

Lowe

Journal of Supportive Oncology

2009

Design: Systematic review (Non-Cochrane)

NR

Funding: NR

No conflict of interest (stated)

Databases: NR

Study designs: all

Setting NR

N included studies: 6 (1 RCT)

Search date: NR

Eligibility criteria: examine physical activity intervention; palliative care patients; >18 years; PROMs QoL physical functioning or fatigue

Excluded: mixed populations without subgroup analysis

Mean age: NR

NR

Tumor types: all

Tumor stages: NR

Palliative stage: NR

No information about group comparability

Interventions: Aerobe exercise interventions, mix of aerobe and resistance training

4-52 weeks

Control: NR

No significant difference (1 RCT)

NR

Slower decrease of well-being for intervention (1 RCT)

NR

NR

NR

NR

Systematic review

Dropouts: NR

Amstar score 6/11 downgraded for lack of protocol, search information, grey literature, publication bias.

I Study ID

II Method

III Patient characteristics

IV Intervention(s)

V Results primary outcome

VI Results secondary and all other outcomes

VII Critical appraisal of study quality

1. Reference

1. Study design

2. Source of funding/conflicts of interest

3. Setting

4. Sample size

5. Duration of the Study

1. Eligibility criteria

2. Patient characteristics

3. Group comparability

1. Intervention(s)

2. Intervention 2

2. Comparator(s)

1. Effect size primary outcome

1. Effect size secondary outcome(s)

2. Effect size all other outcomes, endpoints

1.Level of evidence

2. Dropouts

3. Results critical appraisal

First author

Journal

Publication year

Specify the type of study

Trial number

Specify the source of funding

presence of declaration of interest.

Number of centers

Countries

Setting

Randomized

Inclusion dates

Inclusion criteria

Exclusion criteria

Age

Gender (M:F)

Tumor

Stage

Palliative stage

p for group comparability.

including dose, length, regimen and timing if relevant

Duration of intervention

Functioning

Fatigue

Quality of life

Participation

Other (primary as defined in the study)

Brief description of secondary outcome(s) and p values.

including adverse effects, toxicity

Classification of intervention studies.

Number of dropouts/withdrawals in each group

Cochrane Score

Bourke

European Urology

2014

Design: RCT

ISRCTN88605738

Funding: None

No conflict of interest (stated)

Number of centers: NR

Country: UK

Setting NR

n=100

Inclusion dates: 2008 to 2011

Eligibility criteria: ADT; locally advanced or metastatic prostate cancer; sedentary (ie, exercising < 90 min per week at a moderate intensity); receiving continuous ADT for a minimum of 6 mo prior to recruitment; planned long-term retention on ADT

Excluded: Unstable angina; uncontrolled hypertension; recent myocardial infarction; pacemakers; painful or unstable bony metastases

Mean age: 71

M:F: 100:0

Tumor types: Prostate cancer

Tumor stages: Locally advanced or metastatic

Palliative stage: Disease directed treatment

There were no significant differences between groups at baseline (p > 0.05 for all variables).

Intervention: Combined tapered (ie, a tapering of supervised support for behaviour change) 30 min aerobe (stationary cycles, rowing ergometers, and treadmills) and resistance exercise and dietary advice intervention delivered with integrated behaviour change support; supervised by an exercise physiologist. Twice a week from weeks 1–6, and once per week from weeks 7–12. self-directed independent exercise session once a week from weeks 1–6, and twice per week from weeks 7–12. Small-group healthy eating seminars, lasting approximately 20 min, were carried out every 2 w.

12 weeks

Control: Usual care

FACT-F: 12 weeks adjusted MD: 5.3 points; 95%CI, 2.7–7.9, p<0.001; 6 months: adjusted MD: 3.9 points; 95%CI, 1.1–6.8, p=0.007

FACT-G: 12 weeks adjusted MD: 8.9 points; 95%CI, 3.7–14.2, p=0.001; 6 months: adjusted MD: 3.3 points; 95%CI, 2.6 to 9.3, p=0.27

No other differences for other secondary outcomes, except better aerobe exercise tolerance at 6 months for intervention group

Ex: atrial fibrillation (n=1); C: death (n=1); no skeletal related adverse events

RCT

Dropouts: 85% of the cohort completing 12-wk follow-up and 68% of men attending follow-up at 6 mo.

Cochrane Score 4/7 downgraded for blinding and possible selective reporting

Cheville

Cancer

2010

Design: RCT

NR

Funding: NR

No conflict of interest (stated)

Number of centers: 1

Country: US

Setting: Mixed

n=103

Inclusion dates: NR

Eligibility criteria: Adult advanced cancer patients; scheduled to undergo radiation therapy; diagnosis within the last 12 months; an expected survival time of at least 6 months; a 5-year survival probability of no more than 50%; and a treatment recommendation of radiation therapy of at least 2 weeks

Excluded: previous radiation therapy; recurrent disease after a disease-free period of greater than 6 months; previous cancer diagnosis within 5 years; Mini Mental Status Examination score of less than 20; ECOG performance score of 3 or more; active alcohol or substance dependence (except nicotine); active thought disorder; suicidal plans; were participating in another psychosocial research trial

Mean age: 59.5 (range 31-85)

M:F: 66:37

Tumor types: all types

Tumor stages: advanced stage

Palliative stage: Disease directed treatment

There were no significant differences between the groups at baseline

Intervention: Structured, multidisciplinary intervention; 8 sessions delivered by a PT and a psychiatrist or psychologist with cofacilitation provided by an advanced practice nurse, licensed social worker, or certified hospital chaplain depending on the theme; 3-day-per week schedule for 90 mins; truncal and upper-limb strengthening exercises; Lower limb strengthening activities

4 weeks

Control: Usual care

LASA fatigue (change from baseline): 4 weeks: Ex: -8.3 (23.2), C: 6.3 (29.9), p=0.72; 8 weeks: Ex: -6.6 (27.1), C: -5.1 (28.8), p=0.96; 27 weeks Ex: -9.5 (27.1), C: -6.5 (26.27), p=0.92

LASA overall QoL (mean): 4 weeks: Ex: 72.8 (20.62), C: 64.1 (22.53), p=0.0469; 8 weeks: Ex: 71.9 (19.41), C: 68.4 (23.48), p=0.42; 27 weeks Ex: 72.1 (19.49), C: 72.1 (18.97), p=0.99

NR

NR

RCT

Dropouts: Ex: 6 lost; C: 3 lost

Cochrane score 3/7 downgraded for randomization, allocation concealment and blinding

Cheville

Journal of Pain and Symptom Management

2013

Design: RCT

NCT01334983

Funding: Government

National Institutes of Health grant KL2 RR024151-01.

Number of centers: 1

Country: US

Setting: Oncology clinic (Urban)

n=66

Inclusion dates: May 2010 to July 2010

Eligibility criteria: Patients with pathology-confirmed Stage IV lung and colorectal cancers; Ambulatory Post Acute Care (AM-PAC) Computer Adaptive Test (CAT) scores between 50 and 75

Excluded: Folstein Mini-Mental State Examination score of 25 or less; inadequate English proficiency, hospice enrollment; an average pain numeric rating scale score of>= 6 of 10

Mean age: Ex: 63.8 (12.5; C: 65.5 (8.9)

M:F: 35:31

Tumor types: lung and colorectal

Tumor stages: IV

Palliative stage: Mixed

The groups were well balanced with respect to demographic, cancer type, and treatment characteristics

Intervention: Instructional session in REST as well as a pedometer-based walking program; bimonthly telephone calls; delivered by two PTs; wo sets of five-exercise routines, one targeting the upper and the other the lower body; participants were instructed to perform 10 repetitions of each REST exercise in the upper and lower body routines at least twice a week for a total of four sessions (two upper and two lower body); participants gradually increased their repetitions to 15; pedometers; participants were instructed to walk briskly.

8 weeks

Control: Nothing

There was no difference in activity short form (mean change from 0 to 8 week): Ex: 1.56 (5.53) 95%CI -0.72 to 3.84); C: 0.94 (5.91) 95%CI -1.26 to 3.14; p=0.74

FACT-F favored the intervention group (mean change from 0 to 8 week): Ex: 4.46 (8.56) 95%CI0.81 to 8.11); C: -0.79 (9.11) 95%CI -4.26 to 2.67; p=0.03

There was no difference in FACT-G (mean change from 0 to 8 week): Ex: 1.07 (11.60) 95%CI -5.97 to 3.83); C: 0.12 (10.22) 95%CI -3.19 to 4.74; p=0.54

Mobility short form favored the intervention group (mean change from 0 to 8 week): Ex: 4.88 (4.66) 95%CI 2.96 to 6.80); C: 0.23 (5.22) 95%CI -1.76 to 2.22; p=0.002

Sleep favored the intervention group (mean change from 0 to 8 week): Ex: 1.46 (1.88) 95%CI 0.70 to 2.22); C: -0.10 (1.71) 95%CI -0.74 to 0.54; p=0.002; There was no difference in pain (mean change from 0 to 8 week): Ex: -0.62 (2.59) 95%CI -1.66 to 0.43); C: -0.50 (2.01) 95%CI -1.25 to 0.25; p=0.87

Deaths Ex: 5, C: 2; no adverse events occurred during or within hours of performing the REST exercises or the walking program.

RCT

Dropouts: Ex: 7 lost (5 died); C: 3 lost (2 died)

Cochrane score 5/7 downgraded for blinding

Cormie

Prostate Cancer and Prostatic Disease

2013

Design: RCT

NR

Funding: Government

Cancer Council of Western Australia. Author supported by Movember through the Prostate Cancer Foundation

Number of centers: 1

Country: Australia

Setting: Urban

n=20

Inclusion dates: July 2011 to July 2012

Eligibility criteria: Histological diagnosis of prostate cancer, established bone metastatic disease as determined by a whole-body bone scan

Excluded: Moderate–severe bone pain that limited activities of daily living (i.e., National Cancer Institute’s Common Terminology Criteria for Adverse Events grade 2–3 bone pain19) or had musculoskeletal, cardiovascular and/or neurological disorders that could inhibit them from exercising

Mean age: Ex: 73.1 (7.5), C: 71.2 (6.9)

M:F: 20:0

Tumor types: Prostate cancer

Tumor stages: Bone Metastases

Palliative stage: NR

The two groups were well balanced, with no significant differences in characteristics at baseline or in any of the outcome measures assessed.

Intervention: Twice-weekly resistance exercise sessions for 12 weeks in an exercise clinic; small groups of one to five participants; supervised by accredited exercise physiologists; 60 min sessions, eight exercises that target the major muscle groups of the upper and lower body

12 weeks

Control: Usual care

SF-36 physical functioning (group difference in mean change): 0.0 (95%CI -4.2 to 4.2), p=0.996

Fatigue (MFSI-SF) (group difference in mean change): -4.2 (95%CI -17.6 to 9.2), p=0.521

SF-36 general health (group difference in mean change): 1.9 (95%CI -4.1 to 7.9), p=0.508; SF-36 physical health composite (group difference in mean change): -0.1 (95%CI -4.6 to 4.4), p=0.957; SF-36 mental health composite (group difference in mean change): 2.8 (95%CI -5.3 to 11.0), p=0.475

No differences in other SF-36, fatigue outcomes (MSFI-SF), BSI; Significant difference in leg extension (p=0.016), 400m walk (p=0.010), 6m walk (p=<0.001); whole body lean mass (p=0.026), appendicular lean mass (p=0.003)

No adverse events or skeletal complications occurred during the exercise sessions; Ex: 1 fracture due to fall; Ex: 3 (advancing disease requiring chemotherapy, increased bone pain and fall); C: 1 (advancing disease requiring chemotherapy); P=0.264

RCT

Dropouts: Only some assessments missing

Cochrane score 5/7 downgraded for blinding

Dhillon

Annals of Oncology

2017

Design: RCT

ACTRN12609000971235

Funding: Non-governmental organization

Lance Armstrong Foundation/National Lung Cancer Alliance Partnership as a Young Investigator Award (no grant number) to JV; the Vojakovic Fellowship from Slater and Gordon Asbestos Research Fund (no grant number); Cancer Institute NSW Clinical Fellowships (05/CRF/1-06, 2006; 09/RIG1-13, 2010) to JV; the ALTG to HD (no grant number), and PoCoG to HD (no grant number)

Number of centers: 5

Country: Australia

Setting: Hospitals (Urban)

n=112

Inclusion dates: July 2009 to October 2014

Eligibility criteria: Histological diagnosis of cancer; an ECOG performance status (PS) 2; life expectancy>6 months; sufficient English to complete questionnaires; and assessed medically fit by treating physician and Physical Activity Readiness Questionnaire (PAR-Q).

Excluded: NR

Median age: 64 (34-80)

M:F: 61:50

Tumor types: Non-small cell lung cancer (NSCLC) or small cell lung cancer (SCLC)

Tumor stages: III/IV

Palliative stage: Mixed

Group comparability not reported

Intervention: Cancer-specific individualized, 8-week supervised Physical Activity (PA) intervention exercise (Move Your Body, behaviour change sessions) and nutrition (Eat for Health) education materials plus General health education materials. Individualized to baseline fitness and interests. It included a behaviour change program based on Theory of Planned Behaviour. week. Sessions lasted 1h: 45-min PA; 15-min behaviour support. PA was predominantly aerobe, and home-based PA was encouraged. EX participants received a pedometer, PA diary, and workbook.

8 weeks

Control: Usual care (UC) (nutrition and PA education materials)

EORTC-QLQ-C30 physical functioning (6 months): EX: 76.67, C: 73.07 (diff 3.6; 95%CI -5.8 to 12.99; p=0.45)

FACT Fatigue (6 months, adjusted): EX: 37.07, C: 35.76 (diff 1.31; 95%CI -3.51 to 6.12; p=0.59)

EORTC-QLQ-C30 Global QOL (6 months) EX: 61.21, C: 54.42 (diff 6.79; 95%CI -4.39 to 17.97; p=0.23)

No differences at any other EORTC-QLQ-C30 QOL domains (Role functioning, Social functioning); GHQ, Pittsburg Sleep inventory; San Diego shortness of breath Questionnaire; (independent) Activities of daily living. Social cognitive determinants of exercise: EX: 26.64, C: 22.07 (diff 4.57, 95%CI 1.34 to 7.80, p=0.006)

No SAE; Other AE: EX: 4 musculoskeletal events likely related to exercise (back or muscle soreness) resolving without treatment, 4 minor adverse events, which resolved without intervention.

RCT

Dropouts: Missing’s/too unwell/deceased: Intervention (n=56): 2/6/12, control (n=55): 6/12/8

Cochrane score 4/7 (downgraded due to lack of blinding and incomplete outcome assessment)

Galvao

Journal of Clinical Oncology

2010

Design: RCT

ACTRN12607000263493

Funding: Government

Cancer Council of Western Australia.

Number of centers: 1

Country: Australia

Setting: Urban

n=57

Inclusion dates: July 2007 to September 2008

Eligibility criteria: Histologically documented prostate cancer; minimum prior exposure to AST longer than 2 months; without PSA evidence of disease activity; anticipated to remain hypogonadal for the subsequent 6 months.

Excluded: Bone metastatic disease; musculoskeletal, cardiovascular, or neurological disorders that could inhibit them from exercising; inability to walk 400 meters or undertake upper and lower limb exercise; and resistance training in the previous 3 months

Mean age: Ex: 69.5 (7.3); C: 70.1 (7.3)

M:F: 57:0

Tumor types: Prostate cancer

Tumor stages: localized and nodal metastases

Palliative stage: NR

There were no significant differences between groups at baseline.

Intervention: Combined progressive resistance (chest press, seated row, shoulder press, triceps extension, leg press, leg extension and leg curl, with abdominal crunches) and aerobe training (15 to 20 minutes of cardiovascular exercises (cycling and walking/ jogging) at 65% to 80% maximum heart rate and perceived exertion at 11 to 13 (6 to 20 point, Borg scale) twice a week for 12 weeks; one to five participants under direct supervision of an exercise physiologist.

12 weeks

Control: Usual care

No difference in SF36 Physical functioning from 0-12 weeks: Ex: 81.7 (14.8) to 82.9 (17.3); C: 74.0 (28.9) to 77.5 (18.7); p=0.441

QLQ-C30-fatigue favored exercise from 0-12 weeks, p=0.021

SF-36 general health favored exercise from 0-12 weeks: Ex from 66.0 (23.1) to 71.4 (17.5); C: from 67.3 (23.1) to 60.2 (26.7), p=0.022

No differences for whole body fat, trunk fat, %fat mass, whole body weight

Soft tissue composition and dynamic muscle strength favored the exercise group. Quality of life assessed by the SF-36 (Table 6) showed better change scores for vitality (P .019), and the physical health composite scores (P .020) for the EX group. Assessments using the QLQ-C30 identified better change scores for EX in role (P .001), cognitive (P .007), nausea (P .025), and dyspnea (P .017), and a borderline difference for physical (P .062), emotional (P .098), pain (P .092), and insomnia (P .055).

There were no adverse events during testing or the exercise intervention.

RCT

Dropouts: 4 patients in each group had missing data

Cochrane score 5/7 downgraded for blinding

Hojan

Polish Archives of Internal Medicine

2017

Design: RCT

ISRCTN80765858

Funding: NR

No conflict of interest (stated)

Number of centers: 1

Country: Poland

Setting: Regional cancer center

n=72

Inclusion dates: December 2012 to December 2014

Eligibility criteria: Histologically confirmed diagnosis of high-risk or intermediate-risk PCa; ADT scheduled for a total period of 36 months; patients before RT (a total dose of 76 Gy in 38 fractions); ECOG 0–1; >= 18 years

Excluded: Distant metastases and/or disease progression resulting in RT or the introduction of chemotherapy; with insufficiently controlled arterial hypertension or cardiac diseases resulting in circulation failure (heart failure above class II according to the New York Heart Association classification) or uncontrolled asthma; with insufficiently controlled metabolic diseases or endocrine, rheumatic, and absorption disorders, as well as other tumors; with preexisting bone metastases at high risk for fracture; or with a psychiatric illness or dementia or organic brain disease.

Mean age: 66.2 (4.94)

M:F: 72:0

Tumor types: Prostate cancer

Tumor stages: NR

Palliative stage: NR

There were no significant differences between groups at baseline.

Intervention: 5 exercise sessions/wk for 8 weeks (during RT—between assessments I and II), and 3 d/wk for the next 10 months; either individually (strength training performed with the assistance of a physiotherapist) or in groups (exercises on treadmills or cycle ergometers, supervised by a therapist); brisk walking, running indoors or on a treadmill, various cycling activities (30 min); 25-minute resistance exercises; 65 to 70 minutes total; workout of 60 minutes

12 months

Control: Usual care

QLQ-C30 physical functioning at baseline ex: 79.7 (18.9) C: 81.9 (15.4); 12 months Ex: 78.4 (17.8) C: 65.1 (19.5), p<0.01

FACT-F at baseline ex 113.4 (3.5) C:112.9 (3.9); 12 months Ex: 105.8 (7.7) C: 75.5 (8.1), p<0.001

QLQ-C30 global health at baseline ex: 53.7 (18.2) C: 54.1 (23.0); 12 months Ex: 57.4 (19.7) C: 52.3 (17.8), p=0.11

Significant advantage of exercise for distance 6min walk test (p<0.001), significant differences in blood markers only for total Psa, Il-6

Significant advantage of exercise for weight, BMI, waist-to-hip ratio (p<0.001)

NR

RCT

Dropouts: Ex: 1, C: 5

Cochrane score 5/7 downgraded for blinding

Jensen

Support Care Cancer

2014

Design: RCT

NR

Funding: Non-governmental organization

foundation “Stiftung Leben mit Krebs”

Number of centers: 1

Country: Germany

Setting: Outpatient oncology clinic, University hospital

n=26

Inclusion dates: NR

Eligibility criteria: Advanced gastrointestinal cancer, including gastric, colorectal, pancreatic, and biliary tract cancer; ≥18 years; life expectancy ≥6 months; beginning of a new palliative treatment line

Excluded: Symptomatic brain metastases; uncontrolled cardiovascular diseases; higher grades of osteoporosis; peripheral arterial insufficiency; insufficiently controlled coronary heart disease; arterial hypertension; metabolic diseases

Mean age: 55 (13.1)

M:F: 11:10

Tumor types: gastric, colorectal, pancreatic, and biliary tract cancer

Tumor stages: advanced stage

Palliative stage: Disease directed treatment

There were no significant differences between groups at baseline.

Intervention: RET: resistance exercise training: supervised training sessions over 45 min; twice a week until a total of 24 sessions; 12 weeks; Resistance training of large muscle groups, including the legs, arms, back, and knees, was performed; Strength exercises were performed at 60–80 % of the one repetition maximum (1-RM) and consisted of two to three sets of 15–25 repetitions each.

Intervention: AET: aerobe exercise training; supervised sessions lasting 45 min on a bicycle ergometer twice a week for 12 weeks. Starting with 60 % of their predetermined pulse rate in week 1–4, the working load was intensified to 70–80 % in week 5– 12. The exercise duration started with 10 min in week one and was increased up to 30 min in week 12.

12 weeks

QLQ-C30-physical functioning (change from baseline) RET: -2.4 (95%CI -8.5 to 3.7), AET: -3.3 (95%CI -9.8 to 3.3)

QLQ-C30-fatigue (change from baseline) RET: 24.2 (95%CI 0.2 to 48.3), AET: 21.1 (2.5 to 39.6)

QLQ-C30-global health status (change from baseline) RET: -14.4 (95%CI -31.6 to 2.8), AET: -13.3 (-26.2 to -0.3)

NR

NR

RCT

Dropouts: RET: 2 AET: 3

Cochrane score 2/7 (downgraded due to unclear randomization, lack of blinding and incomplete outcome assessment)

Ligibel

Cancer

2016

Design: RCT

NCT00405782

Funding: Non-governmental organization

McMackin Foundation.

Number of centers: 2

Country: US

Setting: Cancer centers (Urban)

n=101

Inclusion dates: September 2006 to March 2011

Eligibility criteria: Metastatic breast cancer or locally advanced disease not amenable to surgical resection, a life expectancy of 12 months, baseline performance of 150 minutes of recreational physical activity per week, and an Eastern Cooperative Oncology Group performance status of 0 to 1

Excluded: Untreated brain metastases, uncontrolled cardiac disease, or other contraindications to moderate-intensity exercise.

Mean age: 49

M:F: 0:101

Tumor types: Metastatic breast cancer or locally advanced disease not amenable to surgical resection

Tumor stages: NR

Palliative stage: Disease directed treatment

“Baseline characteristics were distributed similarly”

Intervention: 16-week, moderate-intensity aerobe exercise program, delivered through a series of in-person (4 weeks monthly) and telephone contacts (weekly) by an exercise physiologist. Sessions focused on building exercise self-efficacy, overcoming barriers to exercise, documenting any injuries, and reviewing safe exercise practices. Heart rate monitor, a pedometer, and an exercise journal; 6-week membership to a gym in their local area.

16 weeks

Control: Usual care for 16 weeks and was then offered participation in the exercise intervention

EORTC-QLQ-C30 physical functioning (16 weeks, change from baseline): EX: 4.79 (SD 2.4), C: 0.93 (SD 2.1), p=0.23

FACIT-fatigue (16 weeks, change from baseline): EX: 2.7 (SD 8.4), C: 2.7 (SD 9.3) p=0.63

EORTC-QLQ-C30 Global QOL (16 weeks, change from baseline) EX: 6.0 (SD 17.5), C: -1.0 (SD 21.5), p=0.17

Treadmill test (16 weeks, min. change from baseline): EX: 0.61 (SD 0.2), C: 0.37 (SD 0.2), p=0.35

No differences at any other EORTC-QLQ-C30 QOL domains (Role functioning, Emotional functioning, Cognitive functioning, Social functioning); Nausea/vomiting; Pain; Insomnia; Appetite loss; constipation; Diarrhea. Dyspnea (16 weeks, change from baseline): EX: -6.3 (SD 23.1), C: 4.0 (SD 19.8), p=0.04

No injuries or other adverse events were reported

RCT

Dropouts: Missings/discontinued/never started: Intervention (n=48): 10/10/1, control (n=53): 7/3/2

Cochrane score 2/7 (downgraded due to unclear randomization, lack of blinding and incomplete outcome assessment)

Litterini

Archives of Physical Medicine and Rehabilitation

2013

Design: RCT

NR

Funding: Non-governmental organization

Northern New England Clinical Oncology Society and Exeter Hospital

Number of centers: 1

Country: US

Setting: Cancer center, palliative care service, rehabilitation department, and a local hospice.

n=66

Inclusion dates: February 2010-March 2012

Eligibility criteria; >=18 years; advanced cancer

Excluded: debilitating psychiatric illness; mental confusion; decreased mental capacity; difficulty communicating in English; lacked medical clearance.

Mean age: 62.35 (12.49)

M: F: 30:36

Tumor types: All: most with breast, lung, or colorectal cancer

Tumor stages: advanced stage

Palliative stage: Terminal phase

There were no significant differences in age or seks between groups.

Intervention: Resistance exercises on circuit weight training equipment; Amount of resistance, repetitions, and sets were as tolerated.

Intervention: Intervention: Cardiovascular exercises; >1 machine; duration and intensity were progressed as tolerated.

10 weeks

VAS Fatigue (mean difference in change from baseline): 9.03 (95%CI -0.02 to 18.08), p=0.050

SPPB total score (mean difference in change from baseline): 0.75 (95%CI 0.44 to 1.06, p<0.001

VAS pain (Mean difference in change from baseline): 1.71 (95%CI -3.39 to 6.81), p=0.50

No adverse events were reported

RCT

Dropouts: Resistance: 11, Cardio: 3

Cochrane score 3/5 downgraded for allocation concealment, blinding and incomplete outcome data

Lopez-Sendin

Journal of Alternative & Complementary Medicine

2012

Design: RCT

NR

Funding: NR

No conflict of interest (stated)

Number of centers: 1

Country: Spain

Setting: Oncology department, university hospital (Urban)

n=24

Inclusion dates: NR

Eligibility criteria: >18 years old; any type of tumor in stage III-IV; intensity of pain > 4 on a numerical pain rate scale

Excluded: fragile tissue (skin, hair, or bone); systemic status (e.g., neutropenia, hypercalcemia, hypothyroidism, or anemia); unconscious; unable to complete the questionnaires used; projected to have less than 20 days to live; undergone manual therapy within the past 4 weeks

Mean age: Ex: 55 (21), C: 54 (8)

M:F: 18:6

Tumor types: all (lung, melanoma, sarcoma, pancreas, breast)

Tumor stages: III/IV

Palliative stage: Terminal phase

No significant differences on baseline characteristics between both groups were found

Intervention: physiotherapy: several different therapeutic massage techniques: effleurage, petrissage, and strain/counter strain techniques over the tender points; passive mobilization; active-assisted or active-resisted exercises, and local- and global-resisted exercises, as well as proprioceptive neuromuscular facilitation (PNF) applied over joints and tight/painful muscles; six sessions of 30–35 minutes in duration over a 2-week period.

2 weeks

Control: Sham: simple hand contact or ‘‘simple touch,’’ six sessions of 30–35 minutes in duration over a 2-week period

BPI (2 weeks, difference in change from baseline) worst pain: -1.5 (95%CI -3.08 to -0.08); BPI index: -2.68 (95%CI -4.17 to -1.18); BPI least pain 1.1 (95%CI -1.64 to 3.64); BPI pain on the average -1.33 (95%CI -3.26 to 0.6); BPI pain right now -2.0 (95%CI -3.9 to -0.1)

NR

NR

RCT

Dropouts: Ex: 4 (2 sedation, 1 refused, 1 died), C: 5 (1 sedated, 1 chemotherapy, 2 refused, 1 died)

Cochrane score 3/5 downgraded for allocation concealment, blinding and incomplete outcome data

Mayo

Clinical Rehabilitation

2014

Design: RCT

NR

Funding: Non-governmental organization

MUHC and Research Institute of Pilot Project Competition.

Number of centers: 1

Country: Canada

Setting: University hospital (Urban)

n=26

Inclusion dates: NR

Eligibility criteria: Adults, advanced cancer, undergoing interdisciplinary assessment and rehabilitation, moderate to severe rating of fatigue (VAS≥ 4/10, Cramp et al)

Excluded: Unable to walk 100m unaided, waiting for a bone marrow transplant or surgery, uncontrolled pelvic or lower extremity metastatic disease.

Mean age: Group 1: 59.6 (11.4) [44–78] Group 2: 57.1 (14.9) [34–88] Group 3: 54.4(12.2) [38–71]

M:F: 14:12

Tumor types: all

Tumor stages: 2-5

Palliative stage: NR

Group comparability not reported

Intervention: During: Individualized 8 weeks walking program based on the participants’ current walking status and progressed according to fatigue level; pedometer; weekly standardized telephone call, during cancer rehabilitation program

Intervention: After: Individualized 8 weeks walking program based on the participants’ current walking status and progressed according to fatigue level; pedometer; weekly standardized telephone call, after cancer rehabilitation program

8 weeks

Control: Only the cancer rehabilitation program, daily fatigue diary, weekly standardized telephone call

Physical function (2min walktest,adapted CHAMPS, RAND-36) Response: During group: 39%, after group: 67%, Control: 50%

Person Fatigue Measures (PFM): Response During Group: 43%, After Group: 68%, Control: 25%

EQ-5D VAS response: During group: 64%, after group: 33%, Control: 28%

NR

NR

RCT

Dropouts: Loss n=12, ITT performed

Cochrane score 2/7 (downgraded due to unclear randomization, lack of blinding and selective reporting)

Oldervoll

The Oncologist

2011

Design: RCT

NCT00397774

Funding: Non-governmental organization

Norwegian Foundation for Health and Rehabilitation and the Norwegian Cancer Society

Number of centers: 6

Country: Norway

Setting: Palliative care units, local/regional hospitals (Mixed)

n=231

Inclusion dates: October 2006 and May 2009.

Eligibility criteria: Incurable and metastatic cancer (either locoregional or distant metastases); a life expectancy of 3 months to 2 years; a Karnofsky performance status (KPS) score 60; adequate pain relief (pain intensity 3 on a 0–10 numerical rating scale); the ability to walk; and unimpaired cognitive function

Excluded: NR

Mean age: Ex: 62.6 (11.3), C: 62.2 (10.7)

M:F: 87:143

Tumor types: Gastrointestinal, Lung, Breast, Urological, Gynecological, other

Tumor stages: metastatic (100%)

Palliative stage: Symptom oriented palliation

At baseline, the groups were well balanced with respect to demographics, level of physical activity over the past year, and medical characteristics such as diagnosis, ongoing chemotherapy and radiation treatment, and comorbidities

Intervention: Six circuit stations: exercise for 2 minutes; continuing for 30 minutes in total; lower and upper limb muscle strength, standing balance, and aerobe endurance; Strengthening of the lower limb; Balance: stand on either a trampoline or a thick mat; Strengthening of the upper limb; General functioning: start in the standing position, descend to the floor, lie on back, then roll from side to side, and stand up again; Aerobe endurance: stationary bicycling or treadmill walking.

8 weeks

Control: Usual care

Fatigue questionnaire (difference in change from baseline) total fatigue: -0.5 (95%CI -2.0 to 1.0), p=0.53; physical fatigue -0.3 (95%CI -1.6 to 1.0), p=0.62; mental fatigue -0.3 (95%CI -0.6 to 0.3), p=0.53

Other (difference in change from baseline) SWT 60 (95%CI 16 to 103.4), p=0.008; sit to stand 0.5 (95%CI -0.5 to 1.5), p=0.34; maximal stepping 3.0 (95%CI -1.9 to 7.7), p=0.22; handgrip strength 2.0 (95%CI 0.4 to 3.5), p=0.01

NR

RCT

Dropouts: Ex: 43 (5 death, 27 disease progression, 11 other), C: 25 (5 death, 16 disease progression, 4 other)

Cochrane score 3/5 downgraded for allocation concealment, blinding and incomplete outcome data

Pyszora

Support Care Cancer

2017

Design: RCT

NR

Funding: Non-governmental organization

Nicolaus Copernicus University CollegiumMedicum, Bydgoszcz, Poland

Number of centers: 1

Country: Poland

Setting: Palliative care department, University hospital

n=60

Inclusion dates: January 2010 - May 2011

Eligibility criteria: Advanced cancer; intensity of fatigue ≥4 in a 10- point NRS (Numerical Rating Scale); survival expectancy of a month at the very least; functional status allowing the patient to participate in the proposed therapy; ≥18 years old

Excluded: anaemia (haemoglobin ≤8 g/dl); the existence of comorbidities causing fatigue (e.g. multiple sclerosis, Parkinson’s disease, heart failure); infection requiring antibiotics; age <18; inability to understand written and spoken Polish.

Mean age: Ex: 72.4 (9.5), C: 69.3 (13.7)

M:F: 21:39

Tumor types: alimentary system, urogenital system, lung, CNS, mammary gland, hematological, indefinite

Tumor stages: advanced stage

Palliative stage: Symptom oriented palliation

Study groups did not differ significantly with respect to age, tumor location and the study site. However, a significant gender difference was observed (p=0.03).

Intervention: Physiotherapy program. 2-weeks; six therapy sessions (three per week); 30 min per session; active exercises of the upper and lower limbs; selected techniques of myofascial release (MFR); selected techniques of proprioceptive neuromuscular facilitation (PNF); dedicated therapist, licensed in PNF method and trained in the application of myofascial release techniques.

2 weeks

Control: no exercise

ESS fatigue Ex: 4.6 (1.6), C: 6.3 (1.2), p<0.01

ESAS (12 days): Pain Ex: 1.2 (1.5), C: 1.7 (2.0), p=0.2; nausea Ex: 0.3 (0.8), C: 0.9 (2.0), p=0.1; depression Ex: 2.7 (2.1), C: 2.8 (2.6), p=0.8; anxiety Ex: 2.5 (2.1), C: 2.5 (2.5), p=0.9; drowsiness Ex: 2.3 (2.5), C: 3.8 (2.7), p=<0.05; appetite 3.1 (2.5), C: 3.8 (2.8), p=0.4; well-being Ex: 3.0 (1.2), C: 5.0 (1.3),p=<0.01; breathlessness Ex 0.8 (1.5), 0.9 (1.6), p=0.7

NR

NR

RCT

Dropouts: Ex: 1 death: C: 1 death

Cochrane score 4/7 downgraded for blinding, unclear allocation concealment

Rief

Radiation Oncology

2014

Design: RCT

NCT01409720

Funding: NR

NR

Number of centers: 1

Country: Germany

Setting: Radio oncology department, university hospital (Urban)

n=60

Inclusion dates: September 2011-March 2013

Eligibility criteria: Histologically confirmed cancer of any primary and bone metastases of the thoracic or lumbar segments of the vertebral column, or of the os sacrum; age of 18 to 80 years; a Karnofsky performance score ≥ 70; already initiated bisphosphonate therapy

Excluded: NR

Mean age: Ex: 61.3 (10.1), C: 64.1 (10.9)

M:F: 33:27

Tumor types: spinal metastases of any origin

Tumor stages: metastatic

Palliative stage: Disease directed treatment

No information about group comparability

Intervention: RT: resistance training; 2 weeks; 30 min. under the guidance of a physiotherapist; practice at homes three times a week and continued the resistance training themselves until the last investigation after six months.

2 weeks

Control: Sham-like PT: physical therapy; 2 weeks; 15 min. passive physical therapy in form of breathing exercises for a period of two weeks.

EORTC QLQ-FA 13: Physical fatigue: Treatment effect (t0-t2) after 3 month

p= 0.637, (t0-t3) after 6 month p=0.013; Effect size (t0-t2) after 3 month -0.04, (t0-t3) after 6 month -0.71; Emotional fatigue: Treatment effect (t0-t2) after 3 month

p= 0.796, (t0-t3) after 6 month p=0.156; Effect size (t0-t2) after 3 month -0.14, (t0-t3) after 6 month -0.35; Cognitive fatigue: Treatment effect (t0-t2) after 3 month

p=0.248, (t0-t3) after 6 month p=0.433; Effect size (t0-t2) after 3 month -0.24, (t0-t3) after 6 month -0.19; Interference with daily life: Treatment effect (t0-t2) after 3 month

p=0.093, (t0-t3) after 6 month p=0.006; Effect size (t0-t2) after 3 month -0.48, (t0-t3) after 6 month -0.91; Social sequelae: Treatment effect (t0-t2) after 3 month

p=0.129, (t0-t3) after 6 month p=0.363; Effect size (t0-t2) after 3 month -0.40, (t0-t3) after 6 month -0.37

EORTC QLQ-BM 22: Painful sites: Treatment effect (t0-t2) after 3 month p=0.399, (t0-t3) after 6 month

p=0.445; Effect size (t0-t2) after 3 month -0.24, (t0-t3) after 6 month -0.43; Pain characteristics: Treatment effect (t0-t2) after 3 month p=0.905, (t0-t3) after 6 month

p= 0.761; Effect size (t0-t2) after 3 month -0.09, (t0-t3) after 6 month -0.24; Functional interference: Treatment effect (t0-t2) after 3 month p=0.285, (t0-t3) after 6 month

p=0.081; Effect size (t0-t2) after 3 month -0.21, (t0-t3) after 6 month -0.56; Psychosocial aspects: Treatment effect (t0-t2) after 3 month p=0.001, (t0-t3) after 6 month

p=0.010; Effect size (t0-t2) after 3 month -0.79, (t0-t3) after 6 month -0.77

NR

During the trial there were no adverse events.

RCT

Dropouts: 3 months Ex: 5, C: 8; 6 months Ex: 12, C: 12

Cochrane score 4/7 (downgraded due to lack of blinding and incomplete outcome assessment)

Taaffe

European Urology

2017

Design: RCT

ACTRN12609000200280

Funding: Public research funds, government

National Health and Medical Research Council 534409, Prostate Cancer Foundation of Australia, Cancer Council of Western Australia, and Cancer Council of Queensland.

Number of centers: NR

Country: Australia

Setting: Urban

n=163

Inclusion dates: 2009 to September 2012

Eligibility criteria: Histologically documented PCa; minimum exposure to ADT of 2 mo; without prostate-specific antigen (PSA) evidence of disease activity; anticipated to receive ADT for the subsequent 12 mo

Excluded: Bone metastatic disease; musculoskeletal, cardiovascular, or neurological conditions that could inhibit them from exercising; inability to walk 400m or undertake exercise; structured resistance and aerobe training in the previous 3 mo.

Mean age: ILRT 68.9 (9.1); ART 69.0 (9.3); 68.4 (9.1)

M:F: 163:0

Tumor types: Prostate cancer

Tumor stages: localized and nodal metastases

Palliative stage: Disease directed treatment

There were no significant differences among groups at baseline

Intervention: ILRT month 1-12 (impact loading (bounding, skipping, drop jumping, hopping, and leaping activities) + resistance training (chest press, seated row, shoulder press, leg press, leg extension, and leg curl)): twice weekly in University-affiliated exercise clinics; supervised (up to 10 participants); home training twice weekly that consisted of two to four rotations of skipping/hopping/ leaping/drop jumping.

Intervention: ART month 1-6: (aerobe (20–30 min of exercise at 60–75% of estimated maximal heart rate using various modes which included walking/jogging and cycling or rowing) + resistance training (as in ILRT)): supervised exercise in the clinic twice weekly; home-based aerobe activity such as walking or cycling with the goal to accumulate 150 min/wk of aerobe activity; month 7-12: home-based maintenance program

12 months

Control: DEL month 1-6: (usual care/delayed exercise) were provided with a printed booklet with information about exercise; month 7-12: twice weekly supervised exercise on a cycle ergometer at an intensity of 70% maximal heart rate and flexibility exercises in the clinic.

From 0 to 12 months: ILRT 27.9 (20.7) to 22.5 (16.6), ART: 23.4 (18.1) to 17.7 (15.0), DEL: 25.8 (20.2) to 20.3 (15.3)

Vitality: With training, there was no significant interaction (p=0.525); from 0-12 months: ILRT 50.0 (10.8) to 22.5 (16.6), ART: 51.5 (10.7) to 17.7 (15.0), DEL: 50.3 (10.0) to 20.3 (15.3)

No other differences for cardiorespiratory fitness. For muscle strength there was a significant interaction with treatment

No withdrawals due to adverse effects from exercise; ILRT compressed spinal discs (n=1); ILRT shoulder issues (n=1); ART cardiovascular problems (n=2), with one requiring heart bypass surgery; ART back pain (n=1); DEL difficulty walking (n=1); DEL back surgery (n=1).

RCT

Dropouts: Three men had missing data for fatigue and one participant had missing data for vitality

Cochrane score 3/7 downgraded for blinding, unclear allocation concealment, selective reporting

Uster

Clinical Nutrition

2017

Design: RCT

NCT01540968

Funding: Non-governmental organization

Krebsliga Schweiz (Swiss Cancer Foundation, Switzerland), Number: KFS- 2833-08-2011; Werner und Hedy Berger-Janser Stiftung

Number of centers: 1

Country: Switzerland

Setting: Cancer center

n=58

Inclusion dates: March 2012-October 2014

Eligibility criteria: Metastatic or locally advanced tumors; gastrointestinal or lung tract cancer; ECOG <= 2; Life expectancy >6 months

Excluded: enteral tube feeding or parenteral nutrition; brain metastases or symptomatic bone metastases; ileus within the last month

Mean age: 63.0 (10.1)

M:F: 40:18

Tumor types: Metastatic after Colorectal; Oesophago-gastric; NSCLC; SCLC; Pancreas; Others

Tumor stages: III/IV

Palliative stage: NR

At baseline, the groups were well-balanced with regard to demographics, diagnoses, medical characteristics and primary endpoint (p > 0.05).

Intervention: Physical exercise (alongside nutritional intervention): twice a week; groups of two to six patients; supervised by an experienced physiotherapist; 60 min/session; strength and balance training exercises; large muscle groups (arms, pectoral and abdominal muscles, lower back, thighs, and gluteal region); leg press, leg flexion, pull down, abdominal trainer and bench press; Balance training included (i) single leg stance, (ii) tandem stance, (iii) marching in place and (iii) heel raises

3 months

Control: Usual care

Physical functioning (change from baseline): 3 months: Ex: 0 (3.3), C: -8.7 (3.8); 6 months: Ex: -1.2 (3.6), C: -2.0 (4.0); p=0.34

Fatigue (change from baseline): 3 months: Ex: -1.5 (4.4), C: 2.2 (5.2); 6 months: Ex -1.3 (4.7), C: -4.9 (5.3); p=0.75

Global health (QoL) (change from baseline): 3 months: Ex: 4.5 (3.4), C: 2.7 (4.0); 6 months: Ex 5.7 (3.7), C: 2.7 (4.1); p=0.72

All other function and symptom scales were not significantly different between groups, except for nausea and vomiting (p<0.01)

NR

RCT

Dropouts: Ex: 4 death, 1 withdrawal, 4 death; C: 6 death, 3 withdrawal

Cochrane score 4/7 (downgraded due to lack of blinding and incomplete outcome assessment)

Vanderbyl

Support Care Cancer

2017

Design: RCT

NCT01374100

Funding: Non-governmental organization

Peter Brojde Lung Cancer Centre; Backler Foundation; Jewish General Hospital Foundation; Angel Ball, Stephen and Lillian Vineberg and the Lila Sigal Hockey Marathon.

Number of centers: 1

Country: Canada

Setting: Cancer center, general hospital (Urban)

n=36

Inclusion dates: 2009 to 2011

Eligibility criteria: Scheduled or eligible for anti-cancer treatment; ECOG 0–2; life expectancy estimated at >4 months.

Excluded: exercise contraindicated; active psychiatric conditions; simultaneous participation in interventions to address anxiety or depressive symptoms; history of severe cardiac, neuromuscular or skeletal disease or brain metastases.

Mean age: QG 66.1 (11.7), SET: 63.7 (7.7)

M:F: 14:10

Tumor types: Gastrointestinal, Lung

Tumor stages: III/IV

Palliative stage: Disease directed treatment

Intervention: Qigong: 12 group sessions; 45 mins; 6-weeks; Dedicated physiotherapist; walking exercise program; Dedicated physiotherapist; coordinated arm movements while in a state of deep relaxation or meditation; breathing pattern

Intervention: SET: Standard endurance and strength training intervention: either individually or in a group; Dedicated physiotherapist

6 weeks

6MWT: 6 weeks: change from baseline: QG: -4.0 (45.7), SET: 73.3 (60.1), p=0.002; further physical tests not significant (speed walk, Sit-to-stand, reach forward, reach up)

FACT-G: 6 weeks: change from baseline: QG: 3.6 (6.6), SET: 3.5 (14.1), p=0.98

HADS anxiety: 6 weeks: change from baseline: QG: -0.6 (2.1), SET: -0.4 (3.3), p=0.82

All other HADS sub scores not significantly different except for poor sleep p=0.03, impaired wellbeing p=0.03, weakness p=0.01)

NR

RCT

Dropouts: QG: 8, SET: 4

Cochrane score 4/7 (downgraded due to lack of blinding and incomplete outcome assessment)