Effect of supervised exercise on aerobic capacity in cancer survivors: Adherence and workload predict variance in effect

Table 1 Example of medline search

(1) Exp neoplasms/

(2) (Cancer* or neoplasm* or (tumor* not tumor necrosis factor) or (tumour* not tumour necrosis factor) or malignan* or carcino* or leukaemia* or leukemi* or lymphoma* or myeloma* or adenocarcinoma*).mp.

(3) (1) or (2)

(4) Exercise therapy/or motion therapy, continuous passive/or muscle stretching exercises/or plyometric exercise/

(5) (Aerobic* or exercise or running or treadmill* or training).mp. [mp = title, abstract, original title, name of substance word, subject heading word, keyword heading word, protocol supplementary concept, rare disease supplementary concept, unique identifier]

(6) (4) or (5)

(7) (3) and (6)

(8) (VO2 or Aerobic capacity).mp. [mp = title, abstract, original title, name of substance word, subject heading word, keyword heading word, protocol supplementary concept, rare disease supplementary concept, unique identifier]

(9) (7) and (8)

(10) Limit (9) to clinical trial, all

Table 2 Description of Included Studies

Ref.	Sample size/	Age	Gender	Intervention	Comparison	Key outcomes	Adverse
	cancer type	(SD/range)	(F/M)	group	group		events
On treatment studies/subgroups
Adamsen et al[22], 2009 Denmark	n = 117 Mixed Cancer Groups	47.2 (± 6.7) yr	F: 78 M: 39	Aerobic Training with High-intensity Intervals + Resistance Exercise + Relaxation + Massage	Usual care: allowed to freely increase physical activity	Estimated VO2max	Seizure (n = 1)
Courneya et al[26], 2007 Canada	n = 133 Breast Cancer	49 yr (26-78)	F: 133	Aerobic Training	Usual care: continue usual activities	VO2peak QoL: FACT-Anemia	Hypotension (n = 1) Dizziness (n = 1)
1Courneya et al[27], 2009b Canada	n = 54 NHL, HL	253.2 yr (18-80)	2F: 50 M: 72	Aerobic Training with High-intensity Intervals	Usual Care: continue usual activities	VO2peak QoL: FACT-B/Ac/An	Back (n = 1), hip (n = 1) and knee (n = 1) pain
Hornsby et al[29], 2013 United States	n = 20 Breast Cancer	51 (± 6) yr	F: 10	Aerobic Training with High-intensity Intervals	Control: Continue usual exercise levels	VO2peak FACT-B Adverse Events	Leg pain (n = 1)
Hwang et al[30], 2012 Taiwan	n = 24 Lung	61 (± 6.3)	F: 12 M: 12	Aerobic Training	Usual Care: general patient education	VO2peak QoL: EORTC	Not reported
Jarden et al[31], 2009 Denmark	n = 42 Mixed Cancer Groups	39.1 (12.2)	F: 16 M: 26	Aerobic Training + Resistance Exercise + Flexibility	Usual Care	Estimated VO2max QoL: EORTC, FACT-An	None
Kim et al[33], 2006 United States	n = 41 Breast Cancer	51.3 (6.7) yr	F: 41	Aerobic Training	Waitlist Control	VO2peak	Not reported
MacVicar et al[34], 1989 United States	n = 34 Breast Cancer	45.4 (10.2) yr	F: 34	Aerobic Training with High-intensity Intervals	Control: Continue normal activities	VO2max L/min	Not reported
Segal et al[38], 2001 Canada	n = 66 Breast Cancer	51 (± 8.7) yr	F: 66	Aerobic Training	Control group encouraged to exercise	Estimated VO2max QoL: SF36	Not reported
Off treatment studies/comparisons
Broderick et al[23], 2013 Ireland	n = 43 Mixed Cancer Groups	52.3 (8.3) yr	F: 37 M: 6	Aerobic training	Usual Care	Estimated VO2max QoL: FACT-G, SF36	Not reported
Burnham et al[24], 2000 United States	n = 18 Mixed Cancer Groups	54.2 (8.1) yr	F: 15 M: 3	Aerobic training	Control	VO2peak QoL: LASA	Not reported
Courneya et al[25], 2003 Canada	n = 50 Breast Cancer	59 (± 6) yr	F: 54	Aerobic training	No exercise	VO2peak QoL: FACT-Breast	Lymphedema (n = 3) Gynecological complication (n = 1)
1Courneya et al[27], 2009a Canada	n = 68 NHL, HL	2As per Courneya, 2009b	2As per Courneya, 2009b	2As per Courneya, 2009b	2As per Courneya, 2009b	2As per Courneya, 2009b	2As per Courneya, 2009b
Herrero et al[28], 2005 Spain	n = 16 Breast Cancer	51 (10) yr	F: 16	Aerobic plus Resistance Training	No Exercise	VO2peak QoL: EORTC	Not reported
Kaibori et al[32], 2013 Japan	n = 51 Liver Cancer	68 (9.1) yr	F: 15 M: 36	Aerobic Training + Stretching + Diet Intervention	Diet Intervention	VO2peak	Not reported
Mehnert et al[35], 2011 Germany	n = 58 Breast Cancer	53 (7.4) yr	F: 58	Aerobic Training + Physiotherapeutic Exercises + Relaxation	Waitlist Control	VO2max QoL: BIQ	Not reported
Naumann et al[36], 2011 Australia	n = 21 Breast Cancer	49 (10) yr	F: 21	Aerobic Training + Resistance Exercise + Flexibility	Usual Care	Estimated VO2max QoL: FACT-B	Not reported
Rahnama et al[37], 2010 Iran	n = 29 Breast Cancer	58.3 (6.3) yr	F: 29	Aerobic Training + Resistance Exercise	No exercise	Estimated VO2max	Not reported
Thorsen et al[39], 2005 Norway	n = 111 Mixed Cancer Groups	39 (8.4) yr	F: 36 M: 75	Aerobic Training + Resistance Exercise	Usual Care	Estimated VO2max QoL: EORTC	Not reported

Table 3 Exercise prescription variables

Ref.	Study duration	Days/week	Mins/session	Volume	Standardized intensity	Workload	Adherence
	(wk)		(mean)		(mean)	(intensity minutes)	(attendance)
Adamsen et al[22]	6	3	15	270	0.83	224	71%
Broderick et al[23]	8	2	30	480	0.57	274	78%
Burnham et al[24]	10	3	23	690	0.41	281	70%
Courneya et al[25]	15	3	25	1125	0.73	816	98%
Courneya et al[26]	12	3	30	1080	0.70	756	70%
Courneya et al[27] (1)	12	3	30	1080	0.79	858	84%
Courneya et al[27] (2)	12	3	30	1080	0.79	858	71%
Herrero et al[28]	8	3	25	600	0.59	351	91%
Hornsby et al[29]	12	3	23	828	0.79	657	82%
Hwang et al[30]	8	3	20	480	0.60	288	71%
Jarden et al[31]	5	5	22.5	563	0.72	405	80%
Kim et al[33]	8	3	30	720	0.65	468	78%
MacVicar et al[34]	10	3	NR	-	0.73	-	NR
Mehnert et al[35]	10	2	30	600	0.60	360	NR
Naumann et al[36]	8	3	53	1272	0.50	636	84%
Rahnama et al[37]	15	2	35	1050	0.28	289	NR
Segal et al[38]	26	3	NR	-	0.55	-	72%
Thorsen et al[39]	14	2	30	840	0.62	518	NR

NR: Not reported.

Table 4 Subgroup analyses

Subgroup category	Subgroup	No. studies	Mean Difference in	P value between	No. studies	Standardized mean	P value between
			mL/kg per minute (95%CI)	subgroups		difference (95%CI)	subgroups
Level of exercise supervision	Group Exercise Class	3	1.77 (0.04, 3.51)	P = 0.07	4	0.36 (0.17, 0.56)	P = 0.003
	Individual Exercise	11	3.53 (2.64, 4.43)		14	0.87 (0.60, 1.15)
Treatment status	On Treatment	5	2.59 (0.7, 4.48)	P = 0.26	9	0.56 (0.32, 0.81)	P = 0.11
	Off Treatment	9	3.74 (3.06, 4.42)		9	0.92 (0.56, 1.29)
Cancer tumor group	Breast	8	2.41 (1.5, 3.31)		10	0.64 (0.34, 0.88)
	Hematologic	3	5.08 (4.01, 6.16)		3	1.55 (1.09, 2.02)
	Lung	1	2.10 (-1.36, 5.56)	P = 0.002	1	0.48 (-0.34, 1.30)	P = 0.0002
	Mixed Cancers	3	3.17 (1.34, 5.0)		4	0.41 (0.21, 0.61)

Table 5 Quality of life outcome

Quality of life measure	No. of studies	Mean difference	P value between	Standardized mean	P value
		(95%CI)	groups	difference (95%CI)	between groups
All combined	9	Not applicable	-	0.3 (-0.12, 0.70)	P = 0.16
EORTC Global	4	1.45 (0.58, 2.32)	P = 0.001	0.13 (-0.06, 0.33)	P = 0.17
FACT-G	4	3.25 (-0.41, 6.92)	P = 0.08	0.47 (0.14, 0.79)	P = 0.005
MOS SF36	1	2.2 (1.34, 3.06)	P < 0.001	1.22 (0.69, 1.74)	P < 0.001

EORTC Global: European Organisation for Research and Treatment of Cancer Global Quality of Life Questionnaire; FACT-G: Functional Assessment of Cancer Therapy-General scale; MOS SF36: Medical Outcomes Survey Short Form.