Cited by 492Cancer survivorship and careCardiovascular and exercise physiologyCancer-related cognitive impairment studies

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Effect of a multimodal high intensity exercise intervention in cancer patients undergoing chemotherapy: randomised controlled trial

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Adamsen, L., Quist, M., Andersen, C., Moller, T., Herrstedt, J., Kronborg, D., Baadsgaard, M. T, Vistisen, K., Midtgaard, J., Christiansen, B., Stage, M., Kronborg, M. T, Rorth, M.·2009·BMJ

DOI 10.1136/bmj.b3410PMC PMC2762035

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Abstract

OBJECTIVE: To assess the effect of a multimodal group exercise intervention, as an adjunct to conventional care, on fatigue, physical capacity, general wellbeing, physical activity, and quality of life in patients with cancer who were undergoing adjuvant chemotherapy or treatment for advanced disease. DESIGN: Randomised controlled trial. SETTING: Two university hospitals in Copenhagen, Denmark. PARTICIPANTS: 269 patients with cancer; 73 men, 196 women, mean age 47 years (range 20-65) representing 21 diagnoses. Main exclusion criteria were brain or bone metastases. 235 patients completed follow-up. INTERVENTION: Supervised exercise comprising high intensity cardiovascular and resistance training, relaxation and body awareness training, massage, nine hours weekly for six weeks in addition to conventional care, compared with conventional care. MAIN OUTCOME MEASURES: European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), Medical Outcomes Study Short Form (MOS SF-36), Leisure Time Physical Activity Questionnaire, muscular strength (one repetition maximum), maximum oxygen consumption (Vo(2)max). Statistical methods The general linear model was used for continuous outcome while analysis of associates between categorical outcomes was performed as analysis of marginal homogeneity in contingency tables. RESULTS: Adjusted for baseline score, disease, and demographic covariates, the intervention group showed an estimated improvement at six weeks for the primary outcome, fatigue, of -6.6 points (95% confidence interval -12.3 to -0.9, P=0.02; effect size=0.33, 0.04 to 0.61). Significant effects were seen on vitality (effect size 0.55, 95% CI 0.27 to 0.82), physical functioning (0.37, 0.09 to 0.65), role physical (0.37, 0.10 to 0.64), role emotional (0.32, 0.05 to 0.59), and mental health (0.28, 0.02 to 0.56) scores. Improvement was noted in physical capacity: estimated mean difference between groups for maximum oxygen consumption was 0.16 l/min (95% CI 0.1 to 0.2, P<0.0001) and for muscular strength (leg press) was 29.7 kg (23.4 to 34.9, P<0.0001). No significant effect was seen on global health status/quality of life. CONCLUSION: A supervised multimodal exercise intervention including high and low intensity components was feasible and could safely be used in patients with various cancers who were receiving adjuvant chemotherapy or treatment for advanced disease. The intervention reduced fatigue and improved vitality, aerobic capacity, muscular strength, and physical and functional activity, and emotional wellbeing, but not quality of life. TRIAL REGISTRATION: Current Controlled trials ISRCTN05322922.

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Attention to principles of exercise training: an updated systematic review of randomized controlled trials in cancers other than breast and prostate
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“…exercise FITT Non-exercise components Disciplines involved Group size Program Information topics core additional duration sessions Adamsen 2009 42 Hospital F: 3/wk I: high T: RT, AT, balance T: 90 min Relaxation (30 min, 4/wk), massage (30 min, 2/wk), body awareness and…”
Background
Safety and efficacy of resistance training in germ cell cancer patients undergoing chemotherapy: a randomized controlled trial
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Updated systematic review of the effects of exercise on understudied health outcomes in cancer survivors
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Hematologic Patients' Clinical and Psychosocial Experiences With Implanted Long-term Central Venous Catheter
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Interdisciplinary Diagnosis, Therapy and Follow-up of Patients with Endometrial Cancer. Guideline (S3-Level, AWMF Registry Number 032/034-OL, April 2018) – Part 2 with Recommendations on the Therapy and Follow-up of Endometrial Cancer, Palliative Care, Psycho-oncological/Psychosocial Care/Rehabilitation/Patient Information and Healthcare Facilities
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Exercise may reduce depression but not anxiety in self-referred cancer patients undergoing chemotherapy. Post-hoc analysis of data from the ‘Body & Cancer’ trial
Midtgaard, J., Stage, M., Møller, T., Andersen, C., Quist, M., Rørth, M. R., Herrstedt, J., Vistisen, K. K., Christiansen, B., & Adamsen, L. (2011) · Acta Oncologica · doi:10.3109/0284186x.2010.543145 · Cited by 37
“In 2001, we initiated the ‘ Body & Cancer ’ trial assessing the effect of a multimodal group exercise intervention, on fatigue, physical capacity, general well-being, physical activity, and QOL in patients undergoing adjuvant chemotherapy or treatment for advanced cancer [21].”
BackgroundMethodResultInfluentialSelf-citation
Effects of high-intensity training on the quality of life of cancer patients and survivors: a systematic review with meta-analysis
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Exercise interventions on health related quality of life for people with cancer during active treatment
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“It is important to inform patients about the positive effects of physical exercise, which has a strong potential to improve physical and mental wellbeing in cancer patients [15,16].”
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Hansen, A., Søgaard, K., Minet, L. R., & Jarden, J. O. (2017) · Disability and Rehabilitation · doi:10.1080/09638288.2017.1295472 · Cited by 33
“The adherence is higher than comparable interventions in mixed groups of cancer patients [14] supporting the feasibility of implementing a large scale RCT among patients with gliomas whose KPS is 70.”
Background
Heavy-Load Lifting
Bloomquist, K., Oturai, P., Steele, M. L., Adamsen, L., Møller, T., Christensen, K. B., Ejlertsen, B., & Hayes, S. C. (2017) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000001443 · Cited by 33
“A convenience sample of women receiving standard adjuvant chemotherapy for stage I–III breast cancer were screened for eligibility (918 yr of age, first diagnosis of breast cancer, unilateral breast surgery, axillary node dissection) at the Copenhagen Centre for Cancer and Health and from a wait list to the Body & Can…”
MethodSelf-citation
Adherence to a long-term progressive resistance training program, combining supervised and home-based exercise for breast cancer patients during adjuvant treatment
Lund, L. W., Ammitzbøll, G., Hansen, D. G., Andersen, E. W., & Dalton, S. O. (2019) · Acta Oncologica · doi:10.1080/0284186x.2018.1560497 · Cited by 35
Heavy-load resistance exercise during chemotherapy in physically inactive breast cancer survivors at risk for lymphedema: a randomized trial
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“The first six weeks consisted of a previously described exercise program ‘Body and Cancer’ [20,23,24], which entailed multimodal sessions including low- and high-intensity components.”
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Which Exercise Approaches Work for Relieving Cancer-Related Fatigue? A Network Meta-analysis
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“EXHALE”: exercise as a strategy for rehabilitation in advanced stage lung cancer patients: a randomized clinical trial comparing the effects of 12 weeks supervised exercise intervention versus usual care for advanced stage lung cancer patients
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BackgroundSelf-citation
High‐intensity exercise to improve cardiorespiratory fitness in cancer patients and survivors: A systematic review and meta‐analysis
Pérez, A. M. L., Collado‐Mateo, D., Mayo, X., Humphreys, L. J., Liguori, G. A., Copeland, R. J., Álvarez, F. D. V., & Jiménez, A. (2020) · Scandinavian Journal of Medicine and Science in Sports · doi:10.1111/sms.13861 · Cited by 34
Poly‐cyclodextrin functionalized porous bioceramics for local chemotherapy and anticancer bone reconstruction
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Treatment-related cardiovascular late effects and exercise training countermeasures in testicular germ cell cancer survivorship
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Exercise Adherence and Effect of Self-Regulatory Behavior Change Techniques in Patients Undergoing Curative Cancer Treatment: Secondary Analysis from the Phys-Can Randomized Controlled Trial
Mazzoni, A., Brooke, H. L., Berntsen, S., Nordin, K., & Demmelmaier, I. (2020) · Integrative Cancer Therapies · doi:10.1177/1534735420946834 · Cited by 30
“Age (years), mean (SD) 59 (13) 58 (12) 58 (11) 59 (12) Sex, n (%) Male 29 (20) 27 (19) 28 (19) 28 (19) Female 115 (80) 118 (81) 116 (81) 116 (81) Study site, n (%) Malmö/Lund 65 (45) 68 (47) 66 (46) 64 (45) Linköping 21 (15) 18 (12) 19 (13) 22 (15) Uppsala 58 (40) 59 (41) 59 (41) 58 (40) Education, n (%) Primary 16 (1…”
Effects of aerobic, resistance, and mixed exercises on quality of life in patients with cancer: A systematic review and meta-analysis
Fukushima, T., Nakano, J., Hashizume, K., Ueno, K., Matsuura, E., Ikio, Y., Ishii, S., Morishita, S., Tanaka, K., & Kusuba, Y. (2020) · Complementary Therapies in Clinical Practice · doi:10.1016/j.ctcp.2020.101290 · Cited by 31
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Grigoriou, S. S., Krase, A. A., Karatzaferi, C., Giannaki, C. D., Lavdas, E., Mitrou, G. I., Bloxham, S., Stefanidis, I., & Sakkas, G. K. (2021) · International Urology and Nephrology · doi:10.1007/s11255-020-02711-8 · Cited by 32
“Irrespective of the instrument used, the average score of fatigue in HD patients is the worst of all chronic disease patients [11], even those with severe depression [12], chemotherapy patients [13], and lupus patients [14].”
Background
At cancer diagnosis: a ‘window of opportunity’ for behavioural change towards physical activity. A randomised feasibility study in patients with colon and breast cancer
Møller, T., Lillelund, C., Andersen, C., Ejlertsen, B., Nørgaard, L. N., Christensen, K. B., Vadstrup, E. S., Diderichsen, F., Hendriksen, C., Bloomquist, K., et al. (2013) · BMJ Open · doi:10.1136/bmjopen-2013-003556 · Cited by 32
“well-established screening criteria for symptomatic competitive cardiac diseases and comorbidity developed during the ‘Body & Cancer’ programme in Denmark.(51) Furthermore, these criteria are based on general guidelines for cardiorespiratory exercise testing in clinical oncology research(52) (ie, symptomatic cardiac d…”
BackgroundInfluentialSelf-citation
Effectiveness of a 16-Week High-Intensity Cardioresistance Training Program in Adults
Greenlee, T. A., Greene, D. R., Ward, N., Reeser, G. E., Allen, C. M., Baumgartner, N. W., Cohen, N. J., Kramer, A. F., Hillman, C. H., & Barbey, A. K. (2017) · The Journal of Strength and Conditioning Research · doi:10.1519/jsc.0000000000001976 · Cited by 33
“Some scientists fear risk of injury with high-intensity exercise training and claim the required intensity may be too difficult for nonathletes (16,54,73), though HIIT has been determined safe and well tolerated (2,18,86).”
Background
Perioperative rehabilitation in operation for lung cancer (PROLUCA) – rationale and design
Sommer, M. S., Trier, K., Vibe-Petersen, J., Missel, M., Christensen, M., Larsen, K. R., Langer, S. W., Hendriksen, C., Clementsen, P. F., Pedersen, J. H., et al. (2014) · BMC Cancer · doi:10.1186/1471-2407-14-404 · Cited by 30
“This is supported by a Danish randomized controlled trial with 269 cancer patients (different diagnoses) according to which patients receiving chemotherapy tolerate intensive physical exercise and experience reduced fatigue, depression, and nausea [25].”
Background
Progressive resistance training in head and neck cancer patients during concomitant chemoradiotherapy -- design of the DAHANCA 31 randomized trial
Lønkvist, C. K., Lønbro, S., Vinther, A., Zerahn, B., Rosenbom, E., Primdahl, H., Højman, P., & Gehl, J. (2017) · BMC Cancer · doi:10.1186/s12885-017-3388-0 · Cited by 31
“One RM tests are widely used when evaluating changes in maximal muscle strength in cancer patients [34, 35].”
Method
Effect of Exercise on Physical Function and Psychological Well-being in Older Patients With Colorectal Cancer Receiving Chemotherapy—A Systematic Review
Lund, C. M., Dolin, T. G., Mikkelsen, M. K., Juhl, C. B., Vinther, A., & Nielsen, D. L. (2020) · Clinical Colorectal Cancer · doi:10.1016/j.clcc.2020.05.012 · Cited by 29
“Most studies have been performed in cancer survivors (27) and only few studies have investigated and shown effect of exercise on treatment-related adverse events during chemotherapy, but not especially for patients with CRC (28, 29).”
Efectividad del ejercicio físico en la fatiga de pacientes con cáncer durante el tratamiento activo: revisión sistemática y metaanálisis
Meneses-Echavez, J. F., González‐Jiménez, E., Correa‐Bautista, J. E., Schmidt‐RioValle, J., & Ramírez‐Vélez, R. (2015) · Cadernos de Saúde Pública · doi:10.1590/0102-311x00114414 · Cited by 29
Physical activity and advanced cancer: The views of chartered physiotherapists in Ireland
Sheill, G., Guinan, E. M., O’Neill, L. M., Hevey, D., & Hussey, J. M. (2018) · Physiotherapy Theory and Practice · doi:10.1080/09593985.2017.1422821 · Cited by 29
“In the past, patients with advanced cancer were excluded from many physical activity programs due to the risks associated with bone metastasis (Adamsen et al., 2009).”
Background
Prehabilitation in perioperative care
Moorthy, K., & Wynter-Blyth, V (2017) · British Journal of Surgery · doi:10.1002/bjs.10516 · Cited by 27
Review of attrition and adherence in exercise studies following hematopoietic stem cell transplantation
Hacker, E. D., & Mjukian, M. (2013) · European Journal of Oncology Nursing · doi:10.1016/j.ejon.2013.10.013 · Cited by 26
Physical and Psychological Effects of a 12-Session Cancer Rehabilitation Exercise Program
Smith, T. M., Broomhall, C. N., & Crecelius, A. R. (2016) · Clinical journal of oncology nursing · doi:10.1188/16.cjon.653-659 · Cited by 27
“Together, these can lead to loss of physical function, weight management issues, depression, decreased cardiovascular health, and, ultimately, an overall decline in quality of life (QOL) (Adamsen et al., 2009; Campbell, Mutrie, White, McGuire, & Kearney, 2005; Sandel et al., 2005; Vallance, Courneya, Plotnikoff, Yasui…”
BackgroundInfluential
Physical activity and physiotherapy: perception of women breast cancer survivors
Rangel, J. C., Tomás, M. T., & Fernandes, B. (2018) · Breast Cancer · doi:10.1007/s12282-018-0928-7 · Cited by 27
Exercise interventions to combat cancer-related fatigue in cancer patients undergoing treatment: a review
Hussey, C., & Gupta, A. (2022) · Cancer Investigation · doi:10.1080/07357907.2022.2105349 · Cited by 27
“High-intensity exercise has been shown to significantly improve the symptoms of fatigue experienced by cancer patients undergoing chemotherapy (68).”
Background
Influence of endurance exercise on the risk of pneumonia and Fever in leukemia and lymphoma patients undergoing high dose chemotherapy. A pilot study.
Baumann, F. T., Zimmer, P., Finkenberg, K., Hallek, M. J., Bloch, W., & Elter, T. (2012) · Europe PMC (PubMed Central) · Cited by 27
Prehabilitation program composed of blood flow restriction training and sports nutrition improves physical functions in abdominal cancer patients awaiting surgery
Wooten, S. V., Fleming, R., Wolf, J. S., Stray-Gundersen, S. O., Bartholomew, J. B., Mendoza, D., Stanforth, P. R., Stanforth, D., Hernandez, L. M., & Tanaka, H. (2021) · European Journal of Surgical Oncology · doi:10.1016/j.ejso.2021.05.038 · Cited by 28

Authors: Adamsen, L., Quist, M., Andersen, C., Moller, T., Herrstedt, J., Kronborg, D., Baadsgaard, M. T., Vistisen, K., Midtgaard, J., Christiansen, B., Stage, M., Kronborg, M. T., & Rorth, M.
Affiliations: University of Copenhagen (DK)
Copenhagen University Hospital (DK)
Odense University Hospital (DK)
Copenhagen Business School (DK)
Herlev Hospital (DK)
Corresponding author: Adamsen, L.
ORCID: Quist, M.
Herrstedt, J.
Kronborg, D.
Midtgaard, J.
Venue: BMJ
Publisher: BMJ
Published: 2009-10-13
Volume: 339
Issue: oct13 1
Pages: b3410-b3410
ISSN: 0007-1447 (ISSN-L)
0959-8138
1468-5833
DOI: 10.1136/bmj.b3410
PMC: PMC2762035
OpenAlex: W2041918383
Cited by: 492
References: 61
Citations by year: 2026: 17 · 2025: 21 · 2024: 13 · 2023: 26 · 2022: 30 · 2021: 33 · 2020: 32 · 2019: 30 · 2018: 36 · 2017: 42 · 2016: 29 · 2015: 34 · 2014: 26 · 2013: 31 · 2012: 34
FWCI: 15.00
Type: journal article
Language: en
Open access: hybrid
doi.org
Licence: cc-by-nc
Locations: BMJ (publishedVersion, cc-by-nc)
Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
PubMed Central (publishedVersion, cc-by-nc)
PubMed (publishedVersion)
University of Southern Denmark Research Portal (University of Southern Denmark) (publishedVersion)
Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
CBS Research Portal (Copenhagen Business School) (submittedVersion, other-oa)
Funders: Kræftens Bekæmpelse
Aase og Ejnar Danielsens Fond
Lundbeckfonden
Novo Nordisk Fonden
Egmont Fonden
H. Lundbeck A/S
Topics: Health Sciences › Medicine › Oncology › Cancer survivorship and care
Health Sciences › Medicine › Physiology (medical) › Cardiovascular and exercise physiology
Health Sciences › Medicine › Oncology › Cancer-related cognitive impairment studies
Keywords: high-intensity training, cancer patients, chemotherapy, cancer-related fatigue, quality of life, physical capacity, aerobic exercise, resistance training, relaxation training, massage, physical activity, muscle strength, oxygen consumption, well-being, advanced cancer, adjuvant chemotherapy, mental health, physical function, vitality, role physical, emotional role
MeSH terms: Adult, Aged, Antineoplastic Combined Chemotherapy Protocols, Exercise Therapy, Feasibility Studies, Female, Health Status, Humans, Leisure Activities, Male, Middle Aged, Neoplasms, Quality of Life, Exercise, Treatment Outcome, Muscle Strength, Young Adult

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Effect of a multimodal high intensity exercise intervention in cancer patients undergoing chemotherapy: randomised controlled trial

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