Table 1

Summary of the evidence on exercise interventions among patients with metastatic cancer

Author—type of article, yearNo. of ptsConclusions
Survival
Jones et al—retrospective study, 20127 52
(breast cancer only)

  • Adjusted HR for death 0.32 (95% CI 0.16–0.67; p=0.002) for a VO2peak >1.09 L/min vs VO2peak ≤1.09 L/min

Palesh et al—prospective study, 20178 100
(breast cancer only)

  • Greater physical activity level at baseline was significantly associated with longer subsequent survival time (HR=0.90, 95% CI 0.84–0.97; p<0.01)

  • One additional hour/day of moderate activity reduced the hazard of mortality by 23% (HR=0.77; 95% CI 0.65–0.92; p<0.01)

Guercio et al—prospective cohort study, 20199 1218 (colorectal cancer only)

  • Physical activity ≥18 MET hours/week experienced an adjusted HR for OS=0.85 (95% CI 0.71–1.02; p=0.06) and for PFS of 0.83 (95% CI 0.70–0.99; p=0.01)

Quality of life/supportive care
Dittus et al—systematic review, 2017 (26 studies including
14 RCTs)12 		2153

  • Exercise improved:

    • VO2peak, 6MWT distance and strength by 6%, 8% and 35%, respectively

    • QoL in more than half of participants, but fatigue improved in less than half

Heywood et al—systematic review, 2018
(25 studies, 16 RCTs)13 		1188

  • Exercise improved:

    • Physical function, QoL, fatigue, body composition, psychosocial function and sleep quality

    • Unclear effects on pain and survival

Chen et al—systematic review and meta-analysis, 2020
(15 studies, all RCTs)14 		1208

  • Exercise showed a significant improvement in:

    • QoL—SMD=0.22 (95% CI 0.06–0.38; p=0.009)

    • Fatigue—SMD=−0.25 (95% CI −0.45 to −0.04; p=0.02)

    • Insomnia—SMD=−0.36 (95% CI −0.56 to −0.17; p=0.0002)

    • Physical function—SMD=0.22 (95% CI 0.05–0.38; p=0.009)

    • Social function—SMD=0.18 (95% CI 0.02–0.34; p=0.03)

    • Dyspnoea reduction—SMD=−0.18 (95% CI −0.34 to −0.01; p=0.03)

Peddle-McIntyre et al—meta-analysis, 2019
(6 studies, all RCTs)15 		221 (lung cancer only)

  • 6MWT distance was higher in the intervention group vs control group—MD=63.33 m (95% CI 3.70–122.96).

  • HRQoL significantly better in the intervention group vs control group—SMD=0.51 (95% CI 0.08–0.93).

  • No significant difference in:

    • Physical functioning HRQoL—SMD=0.11 (95% CI −0.36 to 0.58)

    • Dyspnoea—SMD=−0.27 (95% CI −0.64 to 0.10)

    • Fatigue—MD=0.03 (95% CI −0.51 to 0.58)

    • Feelings of anxiety—MD=−1.21 units on Hospital Anxiety and Depression Scale (95% CI −5.88 to 3.45)

    • Depression—SMD=−1.26 (95% CI −4.68 to 2.17)

  • FEV1—SMD=0.43 (95% CI −0.11 to 0.97)

Guercio et al—prospective cohort study, 20199 1218 (colorectal cancer only)

  • Patients engaging in ≥9 MET hours/week experienced an adjusted HR for grade 3 or greater treatment-related adverse events of 0.73 (95% CI 0.62–0.86; p<0.001) vs <9 MET hours/week

  • FEV1, forced expiratory volume in the first second; HRQoL, health-related quality of life; MD, mean difference; MET, metabolic equivalent of task; 6MWT, 6 min walk test; OS, overall survival; PFS, progression-free survival; Pts, patients; QoL, quality of life; RCT, randomised clinical trial; SMD, standardised mean difference; VO2peak, peak oxygen uptake.