Exercise training for improving patient-reported outcomes in patients with advanced-stage cancer: a systematic review and meta-analysis

Abstract Context Patients with advanced-stage cancer often suffer many physical and psychological symptoms. Exercise has been shown to improve quality of life (QoL), decrease cancer-related symptoms, and maintain or improve functional status in cancer survivors or early-stage cancer patients. However, the effect of exercise on these outcomes in patients with advanced-stage cancer is unclear. Objective This meta-analysis aimed to assess the effectiveness of exercise interventions for patients with advanced-stage cancer in improving cancer-related symptoms and functional status outcomes. Methods We conducted a comprehensive literature search in PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science from their inception to February 3, 2019, to include randomized controlled trials (RCTs) comparing exercise and usual care for improving outcomes in patients with advanced-stage cancer. Two reviewers independently screened the studies, extracted data of interest, and assessed the risk of bias of individual RCTs using the Cochrane Handbook Version 5.1.0. Results Fifteen RCTs enrolling 1,208 patients were included. Compared with usual care, exercise showed a significant improvement in QoL (SMD: 0.22, 95%CI: 0.06–0.38, P=.009), fatigue (SMD: -0.25, 95%CI: -0.45–-0.04, P=.02), insomnia (SMD: -0.36, 95%CI: -0.56–-0.17, P=.0002), physical function (SMD: 0.22, 95%CI: 0.05–0.38, P=.009), social function (SMD: 0.18, 95%CI: 0.02–0.34, P=.03), and dyspnea reduction (SMD: -0.18, 95%CI: -0.34–-0.01, P=.03). Conclusion Exercise serves as an effective intervention to improve QoL and alleviate fatigue, insomnia, dyspnea, and physical and social function for advanced-stage cancer patients.