Persoon, S., Kersten, M.J., van der Weiden, K., Buffart, L.M., Nollet, F., Brug, J., & Chinapaw, M.J. (2013). Effects of exercise in patients treated with stem cell transplantation for a hematologic malignancy: A systematic review and meta-analysis. Cancer Treatment Reviews, 39, 682–690. 

DOI Link

Purpose

STUDY PURPOSE: To evaluate the effectiveness of exercise interventions compared with usual care on physical fitness, fatigue, and quality of life in patients treated with hematopoietic stem cell transplantation (HSCT)

TYPE OF STUDY: Meta-analysis and systematic review

Search Strategy

DATABASES USED: PubMed, EMBASE, PsycINFO, CINAHL, Pedro, Cochrane Collaboration
 
INCLUSION CRITERIA: Randomized, controlled trials in peer-reviewed journal sample in which at least 75% were treated with HSCT for a hematologic malignancy; intervention was a physician exercise program or multimodal intervention aimed at aerobic capacity or muscle strength; the outcome measure included fitness, muscle strength, fatigue, and/or health-related quality of life
 
EXCLUSION CRITERIA: Not specified

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 6,877
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Cochrane Collaboration Risk of Bias tool

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 9
  • TOTAL PATIENTS INCLUDED IN REVIEW = 472
  • SAMPLE RANGE ACROSS STUDIES: 19-105
  • KEY SAMPLE CHARACTERISTICS: All had HSCT. Mean ages ranged from 29.1-55 years.

Phase of Care and Clinical Applications

PHASE OF CARE: Active antitumor treatment

Results

Six studies showed a positive effect on cardiorespiratory fitness (effect size [ES] = 0.53, 95% confidence interval [CI] [0.13, 0.94]) compared to usual care. Positive effects were seen in muscle strength. Five studies showed positive effects on quality of life (QOL) in global QOL (ES = 0.41, p = 0.0005), cognitive functioning (ES = 0.36, 95% CI [0.13, 0.59], p = 0.002) from the European Organization of Research on Treatment and Cancer (EORTC) self-report instrument. Compared to usual care, exercise had a moderate and significant positive effect on fatigue (ES = 0.53, 95% CI [0.27, 0.79], p < 0.0001).

Conclusions

Exercise interventions were shown to have a positive effect on cardiorespiratory fitness and fatigue, and might show some benefit in terms of several aspects of health-related quality of life for patients undergoing HSCT.

Limitations

  • Limited number of studies included
  • Mostly low quality/high risk of bias studies
  • Low sample sizes
  • Single-item scale data were used for outcome measurement in areas of cognitive function and quality of life, and in two of those related to fatigue.
  • High variability in the content, timing, and duration of interventions

Nursing Implications

This review adds to the body of evidence showing the effectiveness of exercise interventions for fatigue among various types of patients with cancer. Exercise may also have an impact on various aspects of health-related quality of life; however, the evidence in this area is weak, and additional research is needed to determine efficacy in this area.

Legacy ID

6308