The effect of exercise on physical function and psychological well-being in older patients with colorectal cancer receiving chemotherapy – a systematic review

Abstract The incidence of colorectal cancer (CRC) is increasing with older age. Cancer and treatment-related side effects often leads to physical decline, poor treatment adherence and lower quality of life. The aim of this systematic review and meta-analysis was to evaluate the effect of exercise in published randomized controlled trials (RCT´s) on physical function, physical fitness (i.e. aerobic capacity and muscle strength) physical activity, and psychological well-being in older patients with CRC undergoing chemotherapy. Eight RCT´s with 552 participants were included in the meta-analysis. The mean age across the trials was 58.5 years and two studies excluded patients above 80 years. The meta-analyses showed low level of evidence for a small beneficial effect of exercise on self-reported physical function (standardized man difference (SMD) 0.26 95%: CI 0.04 to 0.48) and global QoL (SMD 0.22 95% CI: 0.02 to 0.43) and low level of evidence for a moderate effect of exercise reducing fatigue (SMD -0.49 95% CI: -0.79 to -0.19) for patients receiving chemotherapy for CRC. We found no evidence for a beneficial effect of exercise on physical fitness. No adverse events related to the exercise interventions were reported. The evidence for the effect of exercise on physical outcomes and psychological well-being during chemotherapy for patients with CRC and especially older patients is sparse. However, exercise during chemotherapy for patients with CRC is feasible and safe. We found moderate to high risk of bias in most of the included studies, small sample sizes and low number of included patients. Moreover, all studies excluded patients with comorbidities or walking impairment, which is a group of patients who probably would benefit the most of exercise. This positive result needs to be verified in larger trials including older and frail patients receiving chemotherapy for CRC.