Targeting exercise interventions to patients with cancer in need: an individual patient data meta-analysis
Open accessAbstract
Background: Exercise effects in cancer patients often appear modest, possibly because interventions rarely target patients most in need. This study investigated the moderator effects of baseline values on the exercise outcomes of fatigue, aerobic fitness, muscle strength, quality of life (QoL), and self-reported physical function (PF) in cancer patients during and post-treatment. Methods: Individual patient data from 34 randomized exercise trials (n = 4519) were pooled. Linear mixed-effect models were used to study moderator effects of baseline values on exercise intervention outcomes and to determine whether these moderator effects differed by intervention timing (during vs post-treatment). All statistical tests were two-sided. Results: Moderator effects of baseline fatigue and PF were consistent across intervention timing, with greater effects in patients with worse fatigue (Pinteraction = .05) and worse PF (Pinteraction = .003). Moderator effects of baseline aerobic fitness, muscle strength, and QoL differed by intervention timing. During treatment, effects on aerobic fitness were greater for patients with better baseline aerobic fitness (Pinteraction = .002). Post-treatment, effects on upper (Pinteraction < .001) and lower (Pinteraction = .01) body muscle strength and QoL (Pinteraction < .001) were greater in patients with worse baseline values. Conclusion: Although exercise should be encouraged for most cancer patients during and post-treatments, targeting specific subgroups may be especially beneficial and cost effective. For fatigue and PF, interventions during and post-treatment should target patients with high fatigue and low PF. During treatment, patients experience benefit for muscle strength and QoL regardless of baseline values; however, only patients with low baseline values benefit post-treatment. For aerobic fitness, patients with low baseline values do not appear to benefit from exercise during treatment.
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Randomized trials of aerobic exercise during adjuvant chemotherapy show preservation or improvement in cardiorespiratory fitness, especially in those with low initial values, while others report better improvement in those with higher initial values.
“Randomized trials of aerobic exercise during adjuvant chemotherapy demonstrate a preservation of, or an improvement in, cardiorespiratory fitness, especially in those with low initial values(86), while others report better improvement in those with higher initial values(91).”
From Exercise Guidelines for Cancer Survivors: Consensus Statement from International Multidisciplinary Roundtable (2019) · cites this paper as [91]
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References 85 · Cited by 103
- Authors
- Buffart, L. M., Sweegers, M. G., May, A. M., Chinapaw, M. J., van Vulpen, J. K., Newton, R. U., Galvão, D. A., Aaronson, N. K., Stuiver, M. M., Jacobsen, P. B., Verdonck-de Leeuw, I. M., Steindorf, K., Irwin, M. L., Hayes, S., Griffith, K. A., Lucia, A., Herrero-Roman, F., Mesters, I., van Weert, E., Knoop, H., Goedendorp, M. M., Mutrie, N., Daley, A. J., McConnachie, A., Bohus, M., Thorsen, L., Schulz, K.-H., Short, C. E., James, E. L., Plotnikoff, R. C., Arbane, G., Schmidt, M. E., Potthoff, K., van Beurden, M., Oldenburg, H. S., Sonke, G. S., van Harten, W. H., Garrod, R., Schmitz, K. H., Winters-Stone, K. M., Velthuis, M. J., Taaffe, D. R., van Mechelen, W., José Kersten, M., Nollet, F., Wenzel, J., Wiskemann, J., Brug, J., & Courneya, K. S.
- Affiliations
- Amsterdam Public Health (NL)
- Utrecht University (NL)
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia
- Amsterdam University Medical Centers (NL)
- The Netherlands Cancer Institute (NL)
- National Institutes of Health (US)
- Department of Clinical Psychology, VU University Amsterdam, Amsterdam, the Netherlands
- German Cancer Research Center (DE)
- Yale University (US)
- School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD, Australia
- George Washington University (US)
- European University and Research Institute, Madrid, Spain
- Fundación GIAFyS Cancer, Miranda de Ebro, Spain
- Maastricht University (NL)
- University Medical Centre Groningen, University of Groningen, Center for Rehabilitation, Groningen, the Netherlands
- University Medical Center Groningen (NL)
- University of Edinburgh (GB)
- Loughborough University (GB)
- University of Glasgow (GB)
- University of Antwerp (BE)
- Oslo University Hospital (NO)
- University Medical Center Hamburg-Eppendorf (DE)
- Freemasons Foundation Centre for Men's Health (AU)
- University of Newcastle Australia (AU)
- Guy's and St Thomas' NHS Foundation Trust (GB)
- Heidelberg University (DE)
- Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
- Division of Psychosocial Research and Epidemiology (NKA) and Center for Quality of life, Netherlands Cancer Institute, Amsterdam, the Netherlands
- King's College London (GB)
- Pennsylvania State University (US)
- Knight Cancer Institute and School of Nursing, Oregon Health & Science University, Portland, OR
- Edith Cowan University (AU)
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Department of Hematology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Johns Hopkins University (US)
- University of Amsterdam (NL)
- University of Alberta (CA)
- Corresponding author
- Buffart, Laurien M
- ORCID
- Buffart, Laurien M
- Sweegers, Maike G
- May, Anne M
- Chinapaw, Mai J
- Aaronson, Neil K
- Stuiver, Martijn M
- Jacobsen, Paul B
- Steindorf, Karen
- Irwin, Melinda L
- Griffith, Kathleen A
- Mesters, Ilse
- Knoop, Hans
- Goedendorp, Martine M
- Mutrie, Nanette
- Daley, Amanda J
- McConnachie, Alex
- Bohus, Martin
- Thorsen, Lene
- Short, Camille E
- James, Erica L
- Plotnikoff, Ronald C
- Schmidt, Martina E
- Potthoff, Karin
- Oldenburg, Hester S
- Sonke, Gabe S
- Schmitz, Kathryn H
- Velthuis, Miranda J
- Taaffe, Dennis R
- Nollet, Frans
- Wenzel, Jennifer
- Wiskemann, Joachim
- Brug, Johannes
- Courneya, Kerry S
- Venue
- JNCI: Journal of the National Cancer Institute
- Publisher
- Oxford University Press (OUP)
- Published
- 2018-10-09
- Volume
- 110
- Issue
- 11
- Pages
- 1190-1200
- ISSN
- 0027-8874 (ISSN-L)
- 1460-2105
- PMC
- PMC6454466
- OpenAlex
- W2896229709
- Cited by
- 103
- References
- 85
- Citations by year
- 2026: 4 · 2025: 17 · 2024: 11 · 2023: 14 · 2022: 15 · 2021: 11 · 2020: 15 · 2019: 16
- FWCI
- 1.10
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- JNCI Journal of the National Cancer Institute (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (publishedVersion, other-oa)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion)
- VU Research Portal (publishedVersion, other-oa)
- University of Twente Research Information (publishedVersion)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion, cc-by-sa)
- Pure Amsterdam UMC (acceptedVersion, cc-by)
- Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, other-oa)
- Radboud Repository (Radboud University) (submittedVersion)
- Australasian Journal of Paramedicine (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- ABACUS. Repositorio de Producción Científica (Universidad Europea) (submittedVersion)
- Loughborough University Institutional Repository (Loughborough University) (submittedVersion, cc-by-nc-nd)
- Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
- Loughborough University Research Repository (Loughborough University) (submittedVersion, cc-by-nc-nd)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (submittedVersion, other-oa)
- Griffith Research Online (submittedVersion, other-oa)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
- Research Publications (Maastricht University) (submittedVersion)
- Utrecht University Repository (Utrecht University) (submittedVersion)
- NOVA (University of Newcastle Australia) (submittedVersion)
- University of Twente Research Information (submittedVersion)
- Funders
- Alpe d’HuZes foundation/Dutch Cancer Society (VU 2011–5045)
- Topics
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Keywords
- exercise intervention, cancer patients, fatigue, cardiorespiratory fitness, muscle strength, quality of life, physical function, baseline values, moderator effects, intervention timing
- MeSH terms
- Patient Reported Outcome Measures, Exercise Therapy, Humans, Neoplasms, Quality of Life, Exercise, Randomized Controlled Trials as Topic
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