The effect of training during treatment with chemotherapy on muscle strength and endurance capacity: A systematic review

Figures & data

Table I. Quality assessment of the studies.

	Randomization	Allocation concealment	Blinding	Baseline criteria	Follow-up	Intention-to-treat	Contamination	Total max =7
Hornsby et al.	+	+	+	-	+	?	+	5
Coleman et al.	+	?	?	+	-	-	-	2
Lin et al.	-	+	?	+	?	+	+/-+	3,5
Oechsle et al.	+	?	?	+	+	-	+	4
Courneya et al.	+	+	?	+	+	+	+	6
Adamsen et al.	+	+	+	+	+	+	+	7
Dimeo et al.	+	?	+	+	+	+	+/-	5,5
Campbell et al.	+	?	?	+	+	+/-	+	4,5
Schwartz et al.	+	?	?	+	-	+	-	3
Baumann et al.	+	?	-	-	-	-	-	1
Segal et al.	+	+	?	+	+	+	+	6
Chang et al.	+	?	-	+	+	?	+	4
Griffith et al.	+	?	?	+	-	-	-	2
Al-Majid et al.	+	?	?	+	+	+	+	5

+ = 1 point, +/- = 0.5 point.

Table II. Overview of the study populations.

Primary author of the study	Number of participants	Cancer/stage	Age (meanyrs)	Male/female (number)	Treatment	Design of study
Hornsby et al., 2014	E = 10 C = 10	Breast, IIB-IIIC	E = 51 (+/−6) C = 46 (+/−11)	Females only	Ch	phase II RCT
Coleman et al., 2012	E = 95 C = 92	Multiple myeloma	E = 56 (+/−10) C = 56 (+/−9)	Male (109), female (78)	MC + PBST	repeated measures experimental design
Lin et al., 2013	E = 21 C = 24	Colorectal, II-III	E = 59 (+/−9) C = 54 (+/−10)	Male (26), female (19)	Ch	CT
Oechsle et al., 2014	E = 24 C = 24	AML, NHL, MM, germcelltumor	E = 52 (+/−13) C = 53 (+/−15)	Male (34) female (14)	Ch, MC + PBST	prospective pilot RCT
Courneya et al., 2007	AET = 78 RET = 82 C = 82	Breast, I-IIIA	AET = 49 RET = 50 C = 49	Females only	Ch	RCT
Adamsen et al., 2009	E = 135 C = 134	All	E = 47 (+/−10) C = 47 (+/−10)	Male (73) female (196)	Ch	RCT
Dimeo et al., 1997	E = 33 C = 37	Breast, germcell, sarcoma, (non)small cell lung cancer, adenocarcinoma, neuroblastoma	E = 39 (+/−10) C = 40 (+/−11)	Male (19) female (51)	Ch + PBST	RCT
Campbell et al., 2005	E = 12 C = 10	Breast	E = 48 (+/−10) C = 47 (+/−5)	Females only	Ch/R/combination	pilot RCT
Schwartz and Winters-Stone, 2009	AET = 34 RET = 34 C = 33	Breast, lymphoma, colon II-III	AET = 48 RET = 47 C = 48	Females only	Ch	RCT
Baumann et al., 2011	E = 17 C = 16	Hematologic malignancies	E = 41 (+/−12) C = 43 (+/−14)	Male (16) female (17)	Ch + HSCT	RCT
Segal et al., 2001	SD = 40 SV = 42 C = 41	Breast	SD = 51 (+/−9),SV = 51 (+/−9), C = 50 (+/−9)	Females only	Ch	RCT
Chang et al., 2008	E = 11 C = 11	AML	E= 49 (+/−15) C = 53 (+/−13)	Male(12) female (10)	Ch	RCT
Griffith et al., 2009	E = 68 C = 58	Breast, colorectal, prostate, other	E = 60 (+/−11) C = 61 (+/−11)	Male (49) female (77)	Ch/R	RCT
Al-Majid et al., 2015	E= 7 C = 7	Breast	E = 48 (+/−10) C = 53 (+/−11)	Females only	Ch	Pilot RCT

AET, aerobic exercise training group; AML, acute myeloid leukemia; C, control group; Ch, chemotherapy; CT, controlled trial; E, exercise group; HSCT, hematopoietic stem cell transplantation; MC, myeloablative chemotherapy; MM, multiple myeloma; NHL, non-Hodgkin lymphoma; PBST, peripheral blood stem cell transplantation; R, radiotherapy; RCT, randomized controlled trial; RET, resistance exercise training group; SD, self-directed exercise group; SV, supervised exercise group.

Table III. Overview of the training programs.

Primary author	Duration (weeks)	Frequency (session/week)	Supervised/ home-based
Hornsby et al., 2014	12	3	Supervised
Coleman et al., 2012	15	3–4	Home-based
Lin et al., 2013	12	2	Supervised
Oechsle et al., 2014	∼3	5	Supervised
Courneya et al., 2007	18	3	Supervised
Adamsen et al., 2009	6	5	Supervised
Dimeo et al., 1997	Unspecified	7	Supervised
Campbell et al., 2005	12	2	Supervised
Schwartz and Winters-Stone, 2009	52	4	Home-based
Baumann et al., 2011	∼2.5	7	Supervised
Segal et al., 2001	26	5	Supervised   + home-based
Chang et al., 2008	3	5	Supervised
Griffith et al., 2009	13	5	Home-based
Al-Majid et al., 2015	9–12	5–6	Supervised

Table IV. Overview of training modalities and intensities of the different studies, including effect sizes (Cohen’s d).

	Resistance training				Aerobic training
Primary author	Resistance exercises	Sets and reps	Intensity	Effect size (Cohen’s d) RET	Aerobic exercises	Duration (min)	Intensity/effect size (Cohens’ d)	Effect size (Cohen’s d) AET
(Hornsby et al., 2014)					Stationary cycling	15–30min	60–100% VO2max	1.1
(Coleman et al., 2012)	Biceps curl, triceps extension, chair stands, hamstring strengthening, therabands	Us	60–80% 1-RM	NA	Aerobic walking	Us	65–80% max HR	1.1
(Lin et al., 2013)	Arm, abdomen, thigh, gluteus, therabands, dumbbell	Us	Us	Knee: 0.2 Hand: −0.1	Stationary cycling	30–40 min	60–75% max HR	0.0
(Oechsle et al., 2014)	Bridging, sit-ups, back, arm, elastic band	2 sets, 16–25 rep	40–60% 1-RM	NA	Stationary cycling	10–20 min	Us	0.3
(Courneya et al., 2007)	Leg extension, leg press, chest press, leg curl, calf raises, seated row, triceps extension, biceps curl, curl ups	2 sets, 8–12 reps	60–70% 1-RM	Leg: 0.4 Chest: 0.8	Stationary cycling	15–45 min	60–80% VO2max	0.3
(Adamsen et al., 2009)	Leg press, chest press, pull down, abd crunch, lower back, knee ext	3 sets, 5–8 rep	70–100% 1-RM	Leg: 0,6 Chest: 0,3	Stationary cycling	15 min	85–95% max HR	0.2
(Dimeo et al., 1997)					In-bed cycling	30 min interval	50% cardiac reserve	0.3
(Campbell et al., 2005)					Walking, cycling, low-level aerobics, muscle strengthening exercises, circuits	10–20 min	60–75% age-adjusted max HR	2.3
(Schwartz and Winters-Stone, 2009)	Theraband	3 sets, 12 rep/2 sets 18–20 rep	Us	Leg: 0.5 Arm: 0.5	Walking, jogging, dancing	20–30 min	Us	1.3
(Baumann et al., 2011)					Stationary cycling, walking, stair climbing, coordination, strengthening	10–40 min	80% watt load WHO test	1.0
(Segal et al., 2001)					Walking	Us	50–60% predicted VO2max	NA
(Chang et al., 2008)					Walking	12 min	resting HR +30	0.65
(Griffith et al., 2009)					Walking	20–30 min	50–70% max HR	NA
(Al-Majid et al., 2015)					Treadmill walking	Us	50–80% max HR	2.7

AET, aerobic exercise training; HR, heart rate; NA, not applicable; 1-RM, one-repetition maximum; reps, repetitions; RET, resistance exercise training; us, unspecified.

Table V. Physical outcome measures of endurance capacity in the intervention groups and control groups.

Outcome measure	Number of intervention groups assessed	Increase	Decrease	No-effect	Best evidence synthesis
Intervention groups
VO2max (ml/kg/min)	7	4	3	1	Moderate evidence
VO2max (l/min)	1	1	0	0	Low evidence
12MWT	4	4	0	0	Low evidence
6MWT	2	1	1	0	No evidence
Walking speed (km/h)	1	0	1	0	Limited evidence
Watt	1	0	0	1	No evidence
TOTAL	17	10	5	2
Control groups
VO2max (ml/kg/min)	6	0	4	2	Moderate evidence
VO2max (l/min)	1	1	0	0	Low evidence
12MWT	3	0	3	0	Low evidence
6MWT	2	1	0	1	No evidence
Walking speed (km/h)	1	0	1	0	Limited evidence
Watt	1	0	1	0	No evidence
TOTAL	14	2	9	3

Table VI. Physical outcome measures of muscle strength in the intervention groups and control groups.

Outcome measure (1-RM)	Number of intervention groups assessed	Increase	Decrease	No-effect	Best evidence synthesis
Intervention groups
Leg press	6	6	0	0	Moderate
Chest press	3	2	1	0	Strong
Hand grip strength	2	2	0	0	Indicative findings
Pull down	1	1	0	0	Low
Bridging	1	1	0	0	Indicative findings
Sit-ups	1	1	0	0	Indicative findings
Seated row	2	2	0	0	Indicative findings
Overhead press	2	2	0	0	Indicative findings
TOTAL	18	17	1	0
Control groups
Leg press	4	4	0	0	Moderate
Chest press	3	2	1	0	Strong
Hand grip strength	2	2	0	0	Indicative findings
Pull down	1	1	0	0	Low
Bridging	1	1	0	0	Indicative findings
Sit-ups	1	1	0	0	Indicative findings
Seated row	1	0	1	0	Indicative findings
Overhead press	1	0	1	0	Indicative findings
TOTAL	14	11	3	0