Exercise for women receiving adjuvant therapy of breast-cancer [Elektronische Ressource] : a systematic review / vorgelegt von Martina Markes

Mmarkes

Sujets

• Gesundheit

Informations

• Publié par: technische_universitat_berlin
• Publié le: 01 janvier 2011
• Nombre de lectures: 10
• Langue: English
• Poids de l'ouvrage: 2 Mo

Extrait

Exercise for women receiving adjuvant therapy
of breast-cancer: a systematic review





Vorgelegt von
Diplom-Biologin
Martina Markes
aus Köln




an der Technischen Universität Berlin
Fakultät VII – Wirtschaft und Management
zur Erlangung des akademischen Grades
Doktorin der Gesundheitswissenschaften / Public Health
Dr. P.H.

Genehmigte Dissertation





Promotionsausschuss:

Vorsitzender: Prof. Dr. med. Reinhard Busse
Gutachterin: Prof. Dr. phil. Ulrike Maschewsky-Schneider
Gutachter: Prof. Dr. med. Karl-Ludwig Resch

Tag der wissenschaftlichen Aussprache: 9.12.2010




Berlin 2011

D 83
Abstract
Abstract
Exercise has become an integral part of breast cancer rehabilitation. A growing
body of evidence shows health benefits such as increased physical fitness and
reduced fatigue through exercise, not only after breast cancer treatment has
finished, but during treatment as well.
The aim of this systematic review was to determine the effectiveness of aerobic
and resistance exercise interventions during adjuvant treatment of breast can-
cer with respect to physical functioning and health-related physical fitness,
among other important health outcomes. The findings of controlled trial stud-
ies of aerobic, strength, and combined exercise interventions among women
undergoing adjuvant treatment of breast cancer were critically evaluated and
summarised. The potential harm associated with exercise in this vulnerable
period was also examined and discussed. This review was conducted in co-
operation with the Cochrane Breast Cancer Group, and followed the rigorous
review methodology of the Cochrane Collaboration.
Results indeed indicate that important physical and mental health outcomes,
such as health-related physical fitness, fatigue, anxiety, and depression, can be
improved through regular exercise training. There is no evidence currently in
the literature showing an association of moderate physical exercise training
during adjuvant treatment of breast cancer with increased risk of injuries, lym-
phedema, or other harm. Thus, the results of this systematic review support
recommending and encouraging women undergoing adjuvant treatment of
breast cancer to exercise.
If the benefits of participation in exercise programmes are to be preserved over
the course of cancer survivorship, sustained physical exercise is essential. Exer-
cise adherence thus plays a vital role in maintaining the benefits associated with
exercise. The review concludes that understanding the determinants of exercise
adherence and the barriers to participation is important. Applying strategies for
behaviour change to individual situations can help in developing and maintain-
ing the habits associated with a healthy lifestyle. Besides developing the evi-
dence base through further research, it is recommended that further activities
should focus as well on how research findings can be translated in to public
health practice.
Table of contents
Table of Contents
List of figures _______________________________________________IV
List of tables ________________________________________________ V
List of abbreviations, acronyms and units of measurement___________VI
Executive Summary ___________________________________________ 1
1 Introduction _____________________________________________ 5
2 Setting the context ________________________________________ 8
2.1 Logic model of the review__________________________________ 8
2.2 Breast cancer treatment 12
2.3 Rationale for exercise interventions ________________________ 13
2.3.1 Health-related physical fitness 13
2.3.2 Treatment-related symptoms ___________________________________ 19
2.3.3 Biological and physiological problems ___________________________ 21
2.3.4 Mental health_______________________________________________ 23
2.3.5 Health-related quality of life 23
2.3.6 Recurrence and survival ______________________________________ 26
2.3.7 Prevalence of treatment-related adverse effects ____________________ 26
2.4 The intervention: exercise ________________________________ 27
2.4.1 Exercise patterns in breast cancer patients ________________________ 27
2.4.2 Behaviour change theories for program planning ___________________ 28
2.4.3 Exercise adherence __________________________________________ 30
2.4.4 se prescription _________________________________________ 32
2.4.5 Exercise Testing ____________________________________________ 33
2.5 Potential harm associated with exercise _____________________ 34
2.6 Previous research _______________________________________ 36
2.7 Preliminary work: rehabilitation sport in Germany ___________ 37
3 Methods _______________________________________________ 39
3.1 The role of systematic reviews in evidence based medicine______ 40
3.2 Execution of the review___________________________________ 41
3.2.1 Review protocol ____________________________________________ 41
3.2.2 Identification of research______________________________________ 41
3.2.3 Search updates within duration of review implementation ____________ 44
3.2.4 Selection of studies __________________________________________ 45
3.2.5 Data extraction _____________________________________________ 47
3.2.6 Study quality assessment 49
3.2.7 Meta-analysis 55
3.3 Methods for the assessment of harm ________________________ 60
4 Results: Identification and description of studies_______________ 63
4.1 Studies of benefit ________________________________________ 63
4.1.1 Process of retrieval of included trials in basic search ________________ 66
4.1.2 Process of retrieval of ongoing trials_____________________________ 67
4.1.3 Characteristics of excluded studies ______________________________ 68
4.1.4 Characteristics of included studies 70
4.2 Studies of harm _________________________________________ 86

I Table of contents
5 Results: Evidence synthesis ________________________________ 89
5.1 Physical health effects____________________________________ 89
5.1.1 Physical functioning _________________________________________ 89
5.1.2 Health-related physical fitness__________________________________ 90
5.1.3 Treatment-related symptoms ___________________________________ 92
5.1.4 Biological and physiological effects _____________________________ 93
5.2 Mental health effects_____________________________________ 95
5.2.1 Emotional distress ___________________________________________ 95
5.2.2 Positive psychological function_________________________________ 95
5.3 Quality of life effects 96
5.3.1 Cancer- and cancer-site-specific quality of life _____________________ 96
5.3.2 Generic health-related quality of life_____________________________ 96
5.4 Adherence and contamination 96
5.5 Forest plots for immediate post-intervention effects __________ 100
5.6 Sustainability of effects__________________________________ 106
5.6.1 Exercise behaviour _________________________________________ 106
5.6.2 Long-term intervention effects ________________________________ 107
5.6.3 Recurrence and survival _____________________________________ 108
5.6.4 Forest plots for long-term intervention outcomes __________________ 109
5.7 Harm from exercise interventions _________________________ 111
5.8 Perception of exercise during breast cancer treatment ________ 112
6 Discussion_____________________________________________ 113
6.1 Summary of main results ________________________________ 113
6.2 Applicability and overall completeness of evidence ___________ 115
6.3 Strengths and limitations of included studies________________ 116
6.3.1 Inconsistencies of effects across studies _________________________ 117
6.3.2 Replicability of the intervention and mediational pathways __________ 118
6.4 Potential biases in the review process ______________________ 120
6.5 Agreements with other reviews ___________________________ 121
7 Conclusions and forecast_________________________________ 122
7.1 Implications for research ________________________________ 122
7.2 Implications for practice 123
7.2.1 Setting up exercise classes____________________________________ 123
8 Bibliography___________________________________________ 126
9 Appendices ____________________________________________ 138
9.1 Appendix 1 – Protocol___________________________________ 138
9.2 Appendix 2 – Search Activities ___________________________ 149
9.2.1 Journals handsearched_______________________________________ 149
9.2.2 Conference proceedings searched ______________________________ 149
9.2.3 Study registers searched _____________________________________ 150
9.2.4 Experts contacted __________________________________________ 150
9.2.5 Search strategy for electronic databases _________________________ 151
9.3 Appendix 3 – Study eligibility form________________________ 154


II Table of contents
9.4 Appendix 4 – Data extraction forms _______________________ 155
9.4.1 Data extraction of study descriptors ____________________________ 155
9.4.2 Instructions for extraction o