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Effect of a multimodal high intensity exercise intervention in cancer patients undergoing chemotherapy: randomised controlled trial
Open accessAbstract
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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“Walking exercise [64, 65], HIIT and weight lifting [66, 67] is considered safe and does not cause undesirable events, such as lymphedema in patients who are undergoing treatment.”
From Empowerment in the treatment of fatigue in breast cancer patients (2021) · cites this paper as [66]
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“The methodological quality and risk of bias of the studies were assessed using the Physiotherapy Evidence Database (PEDro) scale [23].”
From Effects of Supervised Multimodal Exercise Interventions on Cancer-Related Fatigue: Systematic Review and Meta-Analysis of Randomized Controlled Trials (2015) · cites this paper as [23]
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BackgroundResultInfluentialA systematic review on the use of exercise interventions for individuals with myeloid leukemia
Smith‐Turchyn, J., & Richardson, J. A. (2015) · Supportive Care in Cancer · doi:10.1007/s00520-015-2752-3 · Cited by 24
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Adams, S. C., McMillan, J., Salline, K., Lavery, J. A., Moskowitz, C. S., Matsoukas, K., Chen, M. M. Z., Mina, D. S., Scott, J. M., & Jones, L. W. (2021) · BMJ Open · doi:10.1136/bmjopen-2020-048218 · Cited by 25
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“For studies utilising a waitlist control or delayed intervention group, the timepoint before this group started the intervention was used [25, 26].”
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“To our knowledge only 3 exercise studies for cancer patients undergoing chemotherapy have included TC patients - these are data from phase 1, 2 and 3 of the “Body and Cancer” study at our institution [26].”
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Exercise—A Panacea of Metabolic Dysregulation in Cancer: Physiological and Molecular Insights
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“[20]) ‘ Body and Cancer ’ (B & C) has been offered as an exercise intervention for cancer patients undergoing chemotherapy in the Copenhagen area since 2007.”
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Can we HIIT cancer if we attack inflammation?
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Determination of Cutpoints for Low and High Number of Symptoms in Patients with Advanced Cancer
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“Our study did not show an improvement in the quality of life or reduction in fatigue with exercise, similar to other studies with this patient population.(13,17,18) The improvement in physical function with exercise that we found has been reported in this patient population(17,18) but not universally.”
The physical activity of colorectal cancer survivors during chemotherapy
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“Being allowed to talk openly with peers in a confidential setting, appeared to have a therapeutic effect, an effect also found in another study of 17 men with various cancers (Adamsen et al., 2009).”
ResultRandomised controlled trials: understanding effect sizes
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“Previous studies have shown this test to be suitable when estimating cardiorespiratory fitness in clinical populations (19).”
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“Further, exercise programs improve also mental health [38,39] with reduction in perceived fatigue, anxiety, and depression [1,40].”
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“Body & Cancer, a multimodal exercise intervention offer for cancer patients undergoing chemotherapy in Denmark (26,27), offers a six‐week intervention comprising resistance exercise, aerobic exercise, massage sessions, relaxation therapy and body awareness.”
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“One study adopted high-intensity intermittent exercise combined with resistance as part of exercise intervention (61), two studies combined resistance, aerobic, and fl exibility as part of exercise intervention (57, 68), and two studies included stretching and massage relaxation exercises (45, 73).”
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Rehabilitation for elderly patients with cancer
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BackgroundResultInfluentialAssessment of Quality of Life and Fatigue among Haemodialysis Patients
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“In addition to increasing physical function [2–4], PA during and after cancer treatment has been found associated with improved psychological functioning [2], increased quality of life [3, 5], reduced fatigue [4, 6, 7] and an increased sense of control [8].”
BackgroundHjorth, M., Egan, C. L., Telles, G. D., Pál, M., Gallego‐Ortega, D., Fuller, O. K., McLennan, E. D., Gillis, R. D., Oh, T. G., Muscat, G. E. O., et al. (2024) · Journal of sport and health science/Journal of Sport and Health Science · doi:10.1016/j.jshs.2024.100991 · Cited by 13
“44 The program was a 6-week exercise program for all cancer patients undergoing chemotherapy, consisting of group-based, supervised training sessions with multi-modal high-and low-intensity exercise.”
InfluentialSelf-citationGlobal sensitivity analysis of clinical trials with missing patient-reported outcomes
Scharfstein, D. O., & McDermott, A. (2018) · Statistical Methods in Medical Research · doi:10.1177/0962280218759565 · Cited by 14
“[1] L Adamsen, M Quist, C Andersen, T Moller, J Herrstedt, D Kronborg, MT Baadsgaard, K Vistisen, J Midtgaard, B Christiansen, M Stage, MT Kronborg, and M Rorth.”
BackgroundSupervised physical therapy in women treated with radiotherapy for breast cancer
Leal, N. F. B. D. S., de Oliveira, H. F., & Carrara, H. H. A. (2016) · Revista Latino-Americana de Enfermagem · doi:10.1590/1518-8345.0702.2755 · Cited by 13
“Physical therapy can help reduce pain, fatigue, and lymphedema, and improve muscle strength, shoulder ROM, functional status, and the quality of life of women undergoing treatment for breast cancer(17-20).”
BackgroundThe combined effect of creatine and resistance training on doxorubicin-induced muscle dysfunction
Bredahl, E. C., Busekrus, R. B., & Hydock, D. S. (2019) · Nutrition and Cancer · doi:10.1080/01635581.2019.1670852 · Cited by 13
“A 6-wk RT training protocol was used because it has been reported to be the minimal amount of time necessary to reduce fatigue, improve muscular strength, and increase physical and functional activity in cancer patients undergoing chemotherapy (22).”
Methodde Seixas, R. J., Kessler, A., & Frison, V. B. (2010) · Revista Brasileira de Cancerologia · doi:10.32635/2176-9745.rbc.2010v56n3.1480 · Cited by 13
He, K., Jiang, J., Chen, M., Wang, T., Huang, X., Zhu, R., Zhang, Z., Chen, J., & Zhao, L. (2023) · Medicine · doi:10.1097/md.0000000000034484 · Cited by 12
Herranz‐Gómez, A., Suso‐Martí, L., Varangot‐Reille, C., Barrachina-Gauchia, L., Casaña, J., López, L., Calatayud, J., & Cuenca‐Martínez, F. (2023) · Physical Therapy · doi:10.1093/ptj/pzad132 · Cited by 12
Tan, X., Xiong, H., Gui, S., Wan, Y., Yan, W., Wang, D., Tong, L., & Zeng, G. (2019) · European Journal of Cancer Care · doi:10.1111/ecc.13120 · Cited by 12
Kumar, N. B. (2021) · Journal of Cachexia Sarcopenia and Muscle · doi:10.1002/jcsm.12681 · Cited by 12
Meneses-Echavez, J. F., González‐Jiménez, E., Correa‐Bautista, J. E., & Ramírez‐Vélez, R. (2014) · LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) · doi:10.3305/nh.2014.30.3.7635 · Cited by 12
Klika, R. J., Golik, K. S., Drum, S. N., Callahan, K. E., & Thorland, W. (2010) · European Journal of Applied Physiology · doi:10.1007/s00421-010-1749-3 · Cited by 12
“…based on twice per week, high intensity aerobic exercise programs are superior at enhancing aerobic capacity, steady state lactate, optimal body fat, and overall health-risk profiles (Adamsen et al. 2009; Helgerud et al. 2007; Irving et al. 2008; Swain and Franklin 2006; Wisløff et al. 2007).”
InfluentialWalsh, J., Hussey, J. M., Guinan, E. M., & Donnell, D. O. (2010) · BMC Cancer · doi:10.1186/1471-2407-10-42 · Cited by 14
“Many cancer rehabilitation programs and/or trials which include a physical rehabilitation are lengthy in duration, extremely intensive [36] and have tight eligibility criteria.”
Hutchison, N. A., Deval, N., Rabusch, S., Rich, H., Kelley, T., Flinn, N. A., & Banerji, N. (2019) · PM&R · doi:10.1002/pmrj.12128 · Cited by 14
“improved by the exercise intervention.(23) Other than fatigue, cancer-related symptoms such as nausea and pain are not the main rationale for exercise interventions.”
BackgroundRozich, N., Jones, C. E., & Morris, K. T. (2019) · Annals of Pancreatic Cancer · doi:10.21037/apc.2019.02.01 · Cited by 11
“studied 269 patients undergoing active treatment, including surgery, for various cancers, and compared an intensive exercise regimen to standard, nonstructured activity (78).”
BackgroundRosbjerg, R., Hansen, D. G., Zachariae, R. H., Stapelfeldt, C. M., Højris, I., Rasmussen, M. T., Drysdale, S. W., & Labriola, M. (2020) · European Journal of Cancer Care · doi:10.1111/ecc.13373 · Cited by 11
Jinbo, R., Kasahara, R., Morishita, S., Kubota, J., Takano, A., Takahashi, S., Kisara, S., Jinbo, K., Yamamoto, Y., Kai, T., et al. (2023) · Medicine · doi:10.1097/md.0000000000032901 · Cited by 11
Bloomquist, K., Hayes, S. C., Adamsen, L., Møller, T., Christensen, K. B., Ejlertsen, B., & Oturai, P. (2016) · BMC Cancer · doi:10.1186/s12885-016-2548-y · Cited by 11
“the Copenhagen area and from a waiting list to the Body and Cancer program [11, 12], at the University Hospitals”
BackgroundSelf-citationSchoenau, M. N., Hansen, M., Ulvestad, S., Sommer, M. S., Pedersen, J. H., & Missel, M. (2019) · Qualitative Health Research · doi:10.1177/1049732319886564 · Cited by 11
“and side effects of treatment in patients with other cancer diagnoses (Adamsen et al., 2009; Midtgaard et al., 2011).”
BackgroundFee-for-Service Cancer Rehabilitation Programs Improve Health-Related Quality of Life
Kirkham, A. A., Neil‐Sztramko, S., Morgan, J., Hodson, S., Weller, S., McRae, T., & Campbell, K. L. (2016) · Current Oncology · doi:10.3747/co.23.3038 · Cited by 11
Cancer-related fatigue: a review
Campos, M. P. D. O., Hassan, B. J., Riechelmann, R. P., & del Giglio, A. (2011) · Revista da Associação Médica Brasileira (English Edition) · doi:10.1016/s2255-4823(11)70046-7 · Cited by 11
Standing up to the cardiometabolic consequences of hematological cancers
Howden, E. J., Gerche, A. L., Arthur, J. F., McMullen, J. R., Jennings, G., Dunstan, D. W., Owen, N. G., Avery, S., & Kingwell, B. A. (2018) · Blood Reviews · doi:10.1016/j.blre.2018.02.005 · Cited by 11
Satish, M. S., Vidhubala, E., Veeraiah, S., Vijay, S., Krishnamurthy, A., & Ganesharajah, S. (2023) · Indian Journal of Medical and Paediatric Oncology · doi:10.1055/s-0043-1766134 · Cited by 11
Young, J. K., Lloyd, A., & Haraldsdóttir, E. (2024) · Frontiers in Rehabilitation Sciences · doi:10.3389/fresc.2023.1298553 · Cited by 9
Musculoskeletal Aging, Sarcopenia, and Cancer
Cesari, M., Calvani, R., & Marzetti, E. (2020) · Springer eBooks · doi:10.1007/978-3-319-57415-8_59 · Cited by 10
Kjeldsted, E., Ammitzbøll, G., Jørgensen, L. B., Lodin, A., Bojesen, R. D., Ceballos, S. G., Rosthøj, S., Lænkholm, A., Skou, S. T., Jack, S., et al. (2023) · BMC Cancer · doi:10.1186/s12885-023-11284-5 · Cited by 10
“The test has been used previously to measure aerobic capacity in cancer patients during chemotherapy [49].”
MethodHigh-intensity interval training and hyperoxia during chemotherapy
Freitag, N., Weber, P. D., Sanders, T. C., Schulz, H., Bloch, W., & Schumann, M. (2018) · Medicine · doi:10.1097/md.0000000000011068 · Cited by 9
“Consistent with other studies investigating the effects of exercise in CRC patients, we also showed improvements in patient-related outcomes, such as QoL as well as emotional and physical functioning.([22,23]) Interestingly, the EORTC QLQ-C30 revealed no changes in cancer-related symptom scales, including fatigue, whi…”
ResultWiskemann, J., Schommer, K., Jaeger, D., & Scharhag‐Rosenberger, F. (2016) · Medicine · doi:10.1097/md.0000000000004309 · Cited by 9
Incorporating Exercise Into the Cancer Treatment Paradigm
Haas, B. K., Hermanns, M., & Kimmel, G. T. (2016) · Clinical journal of oncology nursing · doi:10.1188/16.cjon.s2.17-24 · Cited by 12
“Studies have repeatedly demonstrated the safety of supervised aerobic and resistance exercise (Adamsen et al., 2009; Rajotte et al., 2012; Schmitz et al., 2005, 2010).”
BackgroundMyers, A., Barlow, R., Baldini, G., Campbell, A., Carli, F., Carr, E., Collyer, T. C., Danjoux, G. R., Davis, J., Denehy, L., et al. (2024) · British Journal of Anaesthesia · doi:10.1016/j.bja.2024.02.021 · Cited by 9
Update on Exercise in Persons With Muscle Disease
Mamarabadi, M., Kudritzki, V., Li, Y., & Howard, I. M. (2025) · Muscle & Nerve · doi:10.1002/mus.28356 · Cited by 9
“…in other disease populations historically thought to be too fragile to engage in vigorous exercise, including most recently stroke survivors [39, 40] and cancer patients undergoing chemotherapy [41], have been liberalized with increasing shift toward progressive and higher-intensity activities.”
Aerobic physical activity and salivary cortisol levels among women with a history of breast cancer
Lambert, M., Brunet, J., Couture-Lalande, M.-È., & Bielajew, C. H. (2018) · Complementary Therapies in Medicine · doi:10.1016/j.ctim.2018.10.018 · Cited by 8
Yan, R., Che, B., Lv, B., Wu, P., Lu, X., Zhang, Y., Wang, J., & Yu, J. (2021) · Health and Quality of Life Outcomes · doi:10.1186/s12955-020-01575-x · Cited by 8
Akbari, P. S., Hassan, Y., Archibald, L. M. D., Tajik, T., Dunn, K., Berris, M., & Smith‐Turchyn, J. (2022) · Physiotherapy Canada · doi:10.3138/ptc-2021-0032 · Cited by 9
Does Physical Activity Improve Quality of Life in Cancer Patients Undergoing Chemotherapy?
Kripp, M., Heußer, A.-L., Belle, S., Gerhardt, A., Merx, K., Hofmann, W., & Hofheinz, R. (2015) · Oncology Research and Treatment · doi:10.1159/000381734 · Cited by 8
Metadata
- 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.
- 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
- 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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