Effect of a multimodal high intensity exercise intervention in cancer patients undergoing chemotherapy: randomised controlled trial
Identifieur interne : 000716 ( Pmc/Curation ); précédent : 000715; suivant : 000717Effect of a multimodal high intensity exercise intervention in cancer patients undergoing chemotherapy: randomised controlled trial
Auteurs : Lis Adamsen [Danemark] ; Morten Quist [Danemark] ; Christina Andersen [Danemark] ; Tom M Ller [Danemark] ; J Rn Herrstedt [Danemark] ; Dorte Kronborg [Danemark] ; Marie T. Baadsgaard [Danemark] ; Kirsten Vistisen [Danemark] ; Julie Midtgaard [Danemark] ; Birgitte Christiansen [Danemark] ; Maria Stage [Danemark] ; Morten T. Kronborg [Danemark] ; Mikael R RthSource :
- The BMJ [ 0959-8138 ] ; 2009.
Abstract
Url:
DOI: 10.1136/bmj.b3410
PubMed: 19826172
PubMed Central: 2762035
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Mikael R Rth<affiliation><nlm:aff id="aff7">Department of Oncology, Copenhagen University Hospital</nlm:aff>
<wicri:noCountry code="subfield">Copenhagen University Hospital</wicri:noCountry>
</affiliation>
Le document en format XML
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<country xml:lang="fr">Danemark</country>
<wicri:regionArea>Department of Mathematical Sciences, University of Copenhagen, Copenhagen</wicri:regionArea>
</affiliation>
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<series><title level="j">The BMJ</title>
<idno type="ISSN">0959-8138</idno>
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<imprint><date when="2009">2009</date>
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<front><div type="abstract" xml:lang="en"><p><bold>Objective</bold>
To assess the effect of a multimodal group exercise intervention, as an adjunct to conventional care, on fatigue, physical capacity, general wellbeing, physical activity, and quality of life in patients with cancer who were undergoing adjuvant chemotherapy or treatment for advanced disease.</p>
<p><bold>Design</bold>
Randomised controlled trial.</p>
<p><bold>Setting</bold>
Two university hospitals in Copenhagen, Denmark.</p>
<p><bold>Participants</bold>
269 patients with cancer; 73 men, 196 women, mean age 47 years (range 20-65) representing 21 diagnoses. Main exclusion criteria were brain or bone metastases. 235 patients completed follow-up.</p>
<p><bold>Intervention</bold>
Supervised exercise comprising high intensity cardiovascular and resistance training, relaxation and body awareness training, massage, nine hours weekly for six weeks in addition to conventional care, compared with conventional care.</p>
<p><bold>Main outcome measures</bold>
European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), Medical Outcomes Study Short Form (MOS SF-36), Leisure Time Physical Activity Questionnaire, muscular strength (one repetition maximum), maximum oxygen consumption (Vo<sub>2</sub>
max).</p>
<p><bold>Statistical methods</bold>
The general linear model was used for continuous outcome while analysis of associates between categorical outcomes was performed as analysis of marginal homogeneity in contingency tables.</p>
<p><bold>Results</bold>
Adjusted for baseline score, disease, and demographic covariates, the intervention group showed an estimated improvement at six weeks for the primary outcome, fatigue, of −6.6 points (95% confidence interval −12.3 to −0.9, P=0.02; effect size=0.33, 0.04 to 0.61). Significant effects were seen on vitality (effect size 0.55, 95% CI 0.27 to 0.82), physical functioning (0.37, 0.09 to 0.65), role physical (0.37, 0.10 to 0.64), role emotional (0.32, 0.05 to 0.59), and mental health (0.28, 0.02 to 0.56) scores. Improvement was noted in physical capacity: estimated mean difference between groups for maximum oxygen consumption was 0.16 l/min (95% CI 0.1 to 0.2, P<0.0001) and for muscular strength (leg press) was 29.7 kg (23.4 to 34.9, P<0.0001). No significant effect was seen on global health status/quality of life.</p>
<p><bold>Conclusion</bold>
A supervised multimodal exercise intervention including high and low intensity components was feasible and could safely be used in patients with various cancers who were receiving adjuvant chemotherapy or treatment for advanced disease. The intervention reduced fatigue and improved vitality, aerobic capacity, muscular strength, and physical and functional activity, and emotional wellbeing, but not quality of life.</p>
<p><bold>Trial registration</bold>
Current Controlled trials ISRCTN05322922.</p>
</div>
</front>
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<front><journal-meta><journal-id journal-id-type="nlm-ta">BMJ</journal-id>
<journal-id journal-id-type="iso-abbrev">BMJ</journal-id>
<journal-id journal-id-type="publisher-id">bmj</journal-id>
<journal-title-group><journal-title>The BMJ</journal-title>
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<issn pub-type="ppub">0959-8138</issn>
<issn pub-type="epub">1756-1833</issn>
<publisher><publisher-name>BMJ Publishing Group Ltd.</publisher-name>
</publisher>
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<article-meta><article-id pub-id-type="pmid">19826172</article-id>
<article-id pub-id-type="pmc">2762035</article-id>
<article-id pub-id-type="publisher-id">adal632786</article-id>
<article-id pub-id-type="doi">10.1136/bmj.b3410</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Research</subject>
</subj-group>
<subj-group subj-group-type="hw-coll-titles"><subject>Clinical Trials (Epidemiology)</subject>
<subject>Immunology (Including Allergy)</subject>
<subject>Stroke</subject>
<subject>Physiotherapy</subject>
<subject>Sports and Exercise Medicine</subject>
<subject>Calcium and Bone</subject>
<subject>Sociology</subject>
</subj-group>
</article-categories>
<title-group><article-title>Effect of a multimodal high intensity exercise intervention in cancer patients undergoing chemotherapy: randomised controlled trial</article-title>
</title-group>
<contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Adamsen</surname>
<given-names>Lis</given-names>
</name>
<role>professor clinical nursing</role>
<xref ref-type="aff" rid="aff1">1</xref>
<xref ref-type="aff" rid="aff2">2</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Quist</surname>
<given-names>Morten</given-names>
</name>
<role>research physiotherapist </role>
<xref ref-type="aff" rid="aff2">2</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Andersen</surname>
<given-names>Christina</given-names>
</name>
<role>research nurse </role>
<xref ref-type="aff" rid="aff2">2</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Møller</surname>
<given-names>Tom</given-names>
</name>
<role>research nurse </role>
<xref ref-type="aff" rid="aff2">2</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Herrstedt</surname>
<given-names>Jørn</given-names>
</name>
<role>professor clinical oncology </role>
<xref ref-type="aff" rid="aff3">3</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Kronborg</surname>
<given-names>Dorte</given-names>
</name>
<role>associate professor</role>
<xref ref-type="aff" rid="aff4">4</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Baadsgaard</surname>
<given-names>Marie T</given-names>
</name>
<role>research assistant</role>
<xref ref-type="aff" rid="aff2">2</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Vistisen</surname>
<given-names>Kirsten</given-names>
</name>
<role>MD </role>
<xref ref-type="aff" rid="aff5">5</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Midtgaard</surname>
<given-names>Julie</given-names>
</name>
<role>research psychologist </role>
<xref ref-type="aff" rid="aff2">2</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Christiansen</surname>
<given-names>Birgitte</given-names>
</name>
<role>staff study nurse </role>
<xref ref-type="aff" rid="aff5">5</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Stage</surname>
<given-names>Maria</given-names>
</name>
<role>student assistant</role>
<xref ref-type="aff" rid="aff2">2</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Kronborg</surname>
<given-names>Morten T</given-names>
</name>
<role>BSc Stud Act</role>
<xref ref-type="aff" rid="aff6">6</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Rørth</surname>
<given-names>Mikael</given-names>
</name>
<role>professor </role>
<xref ref-type="aff" rid="aff7">7</xref>
</contrib>
<aff id="aff1"><label>1</label>
Institute of Public Health, University of Copenhagen, Copenhagen, Denmark</aff>
<aff id="aff2"><label>2</label>
University Hospitals Centre for Nursing and Care Research, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark</aff>
<aff id="aff3"><label>3</label>
Department of Oncology, Odense University Hospital, Odense, Denmark</aff>
<aff id="aff4"><label>4</label>
Centre for Statistics, Copenhagen Business School, Frederiksberg, Denmark</aff>
<aff id="aff5"><label>5</label>
Department of Oncology, Herlev University Hospital, Herlev, Denmark</aff>
<aff id="aff6"><label>6</label>
Department of Mathematical Sciences, University of Copenhagen, Copenhagen, Denmark</aff>
<aff id="aff7"><label>7</label>
Department of Oncology, Copenhagen University Hospital</aff>
</contrib-group>
<author-notes><corresp>Correspondence to: L Adamsen, University Hospitals Centre for Nursing and Care Research, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark <email>la@ucsf.dk</email>
</corresp>
</author-notes>
<pub-date pub-type="collection"><year>2009</year>
</pub-date>
<pub-date pub-type="epub"><day>13</day>
<month>10</month>
<year>2009</year>
</pub-date>
<volume>339</volume>
<elocation-id>b3410</elocation-id>
<history><date date-type="accepted"><day>8</day>
<month>5</month>
<year>2009</year>
</date>
</history>
<permissions><license license-type="open-access"><license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc/2.0/">http://creativecommons.org/licenses/by-nc/2.0/</ext-link>
and <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc/2.0/legalcode">http://creativecommons.org/licenses/by-nc/2.0/legalcode</ext-link>
.</license-p>
</license>
</permissions>
<self-uri xlink:title="pdf" xlink:type="simple" xlink:href="bmj.b3410_default.pdf"></self-uri>
<abstract><p><bold>Objective</bold>
To assess the effect of a multimodal group exercise intervention, as an adjunct to conventional care, on fatigue, physical capacity, general wellbeing, physical activity, and quality of life in patients with cancer who were undergoing adjuvant chemotherapy or treatment for advanced disease.</p>
<p><bold>Design</bold>
Randomised controlled trial.</p>
<p><bold>Setting</bold>
Two university hospitals in Copenhagen, Denmark.</p>
<p><bold>Participants</bold>
269 patients with cancer; 73 men, 196 women, mean age 47 years (range 20-65) representing 21 diagnoses. Main exclusion criteria were brain or bone metastases. 235 patients completed follow-up.</p>
<p><bold>Intervention</bold>
Supervised exercise comprising high intensity cardiovascular and resistance training, relaxation and body awareness training, massage, nine hours weekly for six weeks in addition to conventional care, compared with conventional care.</p>
<p><bold>Main outcome measures</bold>
European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), Medical Outcomes Study Short Form (MOS SF-36), Leisure Time Physical Activity Questionnaire, muscular strength (one repetition maximum), maximum oxygen consumption (Vo<sub>2</sub>
max).</p>
<p><bold>Statistical methods</bold>
The general linear model was used for continuous outcome while analysis of associates between categorical outcomes was performed as analysis of marginal homogeneity in contingency tables.</p>
<p><bold>Results</bold>
Adjusted for baseline score, disease, and demographic covariates, the intervention group showed an estimated improvement at six weeks for the primary outcome, fatigue, of −6.6 points (95% confidence interval −12.3 to −0.9, P=0.02; effect size=0.33, 0.04 to 0.61). Significant effects were seen on vitality (effect size 0.55, 95% CI 0.27 to 0.82), physical functioning (0.37, 0.09 to 0.65), role physical (0.37, 0.10 to 0.64), role emotional (0.32, 0.05 to 0.59), and mental health (0.28, 0.02 to 0.56) scores. Improvement was noted in physical capacity: estimated mean difference between groups for maximum oxygen consumption was 0.16 l/min (95% CI 0.1 to 0.2, P<0.0001) and for muscular strength (leg press) was 29.7 kg (23.4 to 34.9, P<0.0001). No significant effect was seen on global health status/quality of life.</p>
<p><bold>Conclusion</bold>
A supervised multimodal exercise intervention including high and low intensity components was feasible and could safely be used in patients with various cancers who were receiving adjuvant chemotherapy or treatment for advanced disease. The intervention reduced fatigue and improved vitality, aerobic capacity, muscular strength, and physical and functional activity, and emotional wellbeing, but not quality of life.</p>
<p><bold>Trial registration</bold>
Current Controlled trials ISRCTN05322922.</p>
</abstract>
</article-meta>
</front>
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