Top

Journal of Cancer Survivorship

Published in:

01-04-2019 | Cancer Fatigue | Review

High-intensity interval training in the therapy and aftercare of cancer patients: a systematic review with meta-analysis

Authors: Hendrik Mugele, Nils Freitag, Jannik Wilhelmi, Yanxiang Yang, Sulin Cheng, Wilhelm Bloch, Moritz Schumann

Published in: Journal of Cancer Survivorship | Issue 2/2019

Abstract

Purpose

This review and meta-analysis aimed to evaluate the effects of high-intensity interval training (HIIT) compared to usual care (UC) or moderate-intensity training (MIE) on physical fitness and health-related outcomes in cancer patients across all stages of therapy and aftercare.

Methods

Databases were systematically searched in accordance with the PRISMA guidelines until October 4th, 2018. Eligibility criteria included adult patients of various cancer types, performing HIIT vs. UC or MIE. Outcomes of interest included physical fitness (cardiorespiratory fitness [VO_2peak] and functional capacity) and health-related outcomes (body composition, quality of life, cancer-related fatigue, and blood-borne biomarkers). Mean differences (MD) were calculated and pooled to generate effect sizes for VO_2peak.

Results

The search identified 1453 studies, out of which 12 articles were included. The average duration of interventions was 6.7 ± 3.0 weeks, with 2.8 ± 0.5 sessions per week. The meta-analysis for VO_2peak showed superiority of HIIT compared to UC (MD 3.73; 95% CI 2.07, 5.39; p < 0.001) but not MIE (MD 1.36; 95% CI − 1.62, 4.35; p = 0.370). Similarly, no superior effects of HIIT compared to MIE were found for quality of life or changes in lean mass, while evidence was provided for a larger reduction in fat mass.

Conclusion

This systematic review showed that short-term HIIT induces similar positive effects on physical fitness and health-related outcomes as MIE but seems to be superior compared to UC. Thus, HIIT might be a time-efficient intervention for cancer patients across all stages of therapy and aftercare.

Implications for Cancer Survivors

High-intensity interval training (HIIT) is superior compared to usucal care in improving physical fitness and health-related outcomes in cancer patients across all stages of therapy and aftercare. Currently, there is no evidence for the benefits of HIIT compared to aerobic training of moderate intensity (MIE) for changes in cardiorespiratory fitness, lean mass and patient-reported outcomes. Reductions in fat mass may be more pronounced in HIIT compared to MIE when training is performed in aftercare.

Silver JK. Cancer prehabilitation and its role in improving health outcomes and reducing healthcare costs. Semin Oncol Nurs 2015;1–49. doi:https://doi.org/10.1016/j.soncn.2014.11.003.

Silver JK, Raj VS, Fu JB, Wisotzky EM, Smith SR, Kirch RA. Cancer rehabilitation and palliative care: critical components in the delivery of high-quality oncology services. Support Care Cancer. 2015;23:3633–43. https://doi.org/10.1007/s00520-015-2916-1.CrossRefPubMed

Cormie P, Atkinson M, Bucci L, Cust A, Eakin E, Hayes S, et al. Clinical Oncology Society of Australia position statement on exercise in cancer care. Med J Aust 2018;1–4. doi:https://doi.org/10.5694/mja18.00199.

Segal R, Zwaal C, Green E, Tomasone JR, Loblaw A, Petrella T, et al. Exercise for people with cancer: a clinical practice guideline. Curr Oncol. 2017;24:40–7. https://doi.org/10.3747/co.24.3376.CrossRefPubMedPubMedCentral

Fong DYT, Ho JWC, Hui BPH, Lee AM, Macfarlane DJ, Leung SSK, et al. Physical activity for cancer survivors: meta-analysis of randomised controlled trials. BMJ. 2012;344:e70. https://doi.org/10.1136/bmj.e70.CrossRefPubMedPubMedCentral

Kripp M, Heußer A-L, Belle S, Gerhardt A, Merx K, Hofmann W-K, et al. Does physical activity improve quality of life in cancer patients undergoing chemotherapy? Oncol Res Treat. 2015;38:230–6. https://doi.org/10.1159/000381734. CrossRefPubMed

Buffart LM, Galvão DA, Brug J, Chinapaw MJM, Newton RU. Evidence-based physical activity guidelines for cancer survivors: current guidelines, knowledge gaps and future research directions. Cancer Treat Rev. 2014;40:327–40. https://doi.org/10.1016/j.ctrv.2013.06.007.CrossRefPubMed

Cormie P, Zopf EM, Zhang X, Schmitz KH. The impact of exercise on cancer mortality, recurrence, and treatment-related adverse effects. Epidemiol Rev. 2017;39:71–92. https://doi.org/10.1093/epirev/mxx007.CrossRefPubMed

Scott JM, Li N, Liu Q, Yasui Y, Leisenring W, Nathan PC, et al. Association of exercise with mortality in adult survivors of childhood cancer. JAMA Oncol. 2018:1–7. https://doi.org/10.1001/jamaoncol.2018.2254.

10.

Hannan A, Hing W, Simas V, Climstein M, Coombes J, Jayasinghe R, et al. High-intensity interval training versus moderate-intensity continuous training within cardiac rehabilitation: a systematic review and meta-analysis. Oajsm. 2018;9:1–17. https://doi.org/10.2147/OAJSM.S150596.CrossRefPubMedPubMedCentral

11.

Koelwyn GJ, Quail DF, Zhang X, White RM, Jones LW. Exercise-dependent regulation of the tumour microenvironment. Nat Publ Group. 2017;17:620–32. https://doi.org/10.1038/nrc.2017.78.CrossRef

12.

Batacan RB Jr, Duncan MJ, Dalbo VJ, Tucker PS, Fenning AS. Effects of high-intensity interval training on cardiometabolic health: a systematic review and meta-analysis of intervention studies. Br J Sports Med. 2017;51:494–503. https://doi.org/10.1136/bjsports-2015-095841.CrossRefPubMed

13.

Wahl P, Hägele M, Zinner C, Bloch W, Mester J. High intensity training (HIT) for the improvement of endurance capacity of recreationally active people and in prevention & rehabilitation. Wien Med Wochenschr. 2010;160:627–36. https://doi.org/10.1007/s10354-010-0857-3. CrossRefPubMed

14.

Weston KS, Wisløff U, Coombes JS. High-intensity interval training in patients with lifestyle-induced cardiometabolic disease: a systematic review and meta-analysis. BMJ 2014;1–10. doi:https://doi.org/10.1136/bjsports-2013-092576.

15.

Mijwel S, Backman M, Bolam KA, Jervaeus A, Sundberg CJ, Margolin S, et al. Adding high-intensity interval training to conventional training modalities: optimizing health-related outcomes during chemotherapy for breast cancer: the OptiTrain randomized controlled trial. Breast Cancer Res Treat. 2017;168:79–93. https://doi.org/10.1007/s10549-017-4571-3.CrossRefPubMedPubMedCentral

16.

Devin JL, Sax AT, Hughes GI, Jenkins DG, Aitken JF, Chambers SK, et al. The influence of high-intensity compared with moderate-intensity exercise training on cardiorespiratory fitness and body composition in colorectal cancer survivors: a randomised controlled trial. J Cancer Surviv. 2016;10:467–79. https://doi.org/10.1007/s11764-015-0490-7.CrossRefPubMed

17.

Adams SC, DeLorey DS, Davenport MH, Stickland MK, Fairey AS, North S, et al. Effects of high-intensity aerobic interval training on cardiovascular disease risk in testicular cancer survivors: a phase 2 randomized controlled trial. Cancer. 2017;123:4057–65. https://doi.org/10.1002/cncr.30859. CrossRefPubMed

18.

Kampshoff CS, Dongen JM, Mechelen W, Schep G, Vreugdenhil A, Twisk JWR, et al. Long-term effectiveness and cost-effectiveness of high versus low-to-moderate intensity resistance and endurance exercise interventions among cancer survivors. 2018;1–13. doi:https://doi.org/10.1007/s11764-018-0681-0.

19.

Hofmann P. Cancer and exercise: Warburg hypothesis, tumour metabolism and high-intensity anaerobic exercise. Sports. 2018;6:10–21. https://doi.org/10.3390/sports6010010.CrossRefPubMedCentral

20.

Toohey K. High-intensity exercise interventions in cancer survivors: a systematic review exploring the impact on health outcomes. J Cancer Res Clin Oncol. 2017. https://doi.org/10.1007/s00432-017-2552-x.

21.

Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535. https://doi.org/10.1136/bmj.b2535. CrossRefPubMedPubMedCentral

22.

Karlsen T, Aamot I-L, Haykowsky M, Rognmo Ø. High intensity interval training for maximizing health outcomes. Prog Cardiovasc Dis. 2017;(1):–29. https://doi.org/10.1016/j.pcad.2017.03.006.

23.

Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14:377–81.PubMed

24.

Deshpande P, Sudeepthi B, Rajan S, Abdul Nazir CP. Patient-reported outcomes: a new era in clinical research. Perspect Clin Res. 2011;2:137–9. https://doi.org/10.4103/2229-3485.86879.CrossRefPubMedPubMedCentral

25.

Higgins JPT, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21:1539–58. https://doi.org/10.1002/sim.1186.CrossRefPubMed

26.

Gliner JA, Morgan GA, Harmon RJ. Pretest-posttest comparison group designs: analysis and interpretation. J Am Acad Child Adolesc Psychiatry. 2003;42:500–3. https://doi.org/10.1097/01.CHI.0000046809.95464.BE.CrossRefPubMed

27.

Sterne JA, Egger M, Smith GD. Systematic reviews in health care investigating and dealing with publication and other biases in meta-analysis. BMJ. 2001;323:101–5. https://doi.org/10.1136/bmj.323.7304.101.CrossRefPubMedPubMedCentral

28.

Sterne JA, Gavaghan D, Egger M. Publication and related bias in meta-analysis: power of statistical tests and prevalence in the literature. J Clin Epidemiol. 2000;53:1119–29.CrossRefPubMed

29.

Higgins JPT, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928. https://doi.org/10.1136/bmj.d5928.CrossRefPubMedPubMedCentral

30.

Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016:i4919–7. https://doi.org/10.1136/bmj.i4919.

31.

Hwang C-L, Yu C-J, Shih J-Y, Yang P-C, Wu Y-T. Effects of exercise training on exercise capacity in patients with non-small cell lung cancer receiving targeted therapy. Support Care Cancer. 2012;20:3169–77. https://doi.org/10.1007/s00520-012-1452-5.CrossRefPubMed

32.

West MA, Loughney L, Lythgoe D, Barben CP, Sripadam R, Kemp GJ, et al. Effect of prehabilitation on objectively measured physical fitness after neoadjuvant treatment in preoperative rectal cancer patients: a blinded interventional pilot study. Br J Anaesth. 2015;114:244–51. https://doi.org/10.1093/bja/aeu318.CrossRefPubMed

33.

Dolan LB, Campbell K, Gelmon K, Neil-Sztramko S, Holmes D, McKenzie DC. Interval versus continuous aerobic exercise training in breast cancer survivors—a pilot RCT. Support Care Cancer. 2016;24:119–27. https://doi.org/10.1007/s00520-015-2749-y.CrossRefPubMed

34.

Licker M, Karenovics W, Diaper J, Frésard I, Triponez F, Ellenberger C, et al. Short-term preoperative high-intensity interval training in patients awaiting lung cancer surgery: a randomized controlled trial. J Thorac Oncol. 2016:1–30. https://doi.org/10.1016/j.jtho.2016.09.125.

35.

Brunet J, Burke S, Grocott MPW, West MA, Jack S. The effects of exercise on pain, fatigue, insomnia, and health perceptions in patients with operable advanced stage rectal cancer prior to surgery: a pilot trial. BMC Cancer. 2017;17:153. https://doi.org/10.1186/s12885-017-3130-y.CrossRefPubMedPubMedCentral

36.

Karenovics W, Licker M, Ellenberger C, Christodoulou M, Diaper J, Bhatia C, et al. Short-term preoperative exercise therapy does not improve long-term outcome after lung cancer surgery: a randomized controlled study. Eur J Cardiothorac Surg. 2017;52:47–54. https://doi.org/10.1093/ejcts/ezx030.CrossRefPubMed

37.

Adams SC, DeLorey DS, Davenport MH, Fairey AS, North S, Courneya KS. Effects of high-intensity interval training on fatigue and quality of life in testicular cancer survivors. Br J Cancer 2018;1–9. doi:https://doi.org/10.1038/s41416-018-0044-7.

38.

Schmitt J, Lindner N, Reuss Borst M, Holmberg HC, Sperlich B. A 3-week multimodal intervention involving high-intensity interval training in female cancer survivors: a randomized controlled trial. Physiol Rep. 2016;4:e12693–8. https://doi.org/10.14814/phy2.12693.CrossRefPubMedPubMedCentral

39.

Toohey K, Pumpa KL, Arnolda L, Cooke J, Yip D, Craft PS, et al. A pilot study examining the effects of low-volume high-intensity interval training and continuous low to moderate intensity training on quality of life, functional capacity and cardiovascular risk factors in cancer survivors. PeerJ. 2016;4:e2613–20. https://doi.org/10.7717/peerj.2613.CrossRefPubMedPubMedCentral

40.

Devin JL, Jenkins DG, Sax AT, Hughes GI, Aitken JF, Chambers SK, et al. Cardiorespiratory fitness and body composition responses to different intensities and frequencies of exercise training in colorectal cancer survivors. Clin Colorectal Cancer. 2018:1–26. https://doi.org/10.1016/j.clcc.2018.01.004.

41.

Ramos JS, Dalleck LC, Tjonna AE, Beetham KS, Coombes JS. The impact of high-intensity interval training versus moderate-intensity continuous training on vascular function: a systematic review and meta-analysis. Sports Med. 2015;45:679–92. https://doi.org/10.1007/s40279-015-0321-z.CrossRefPubMed

42.

Schmitz KH, Courneya KS, Matthews C, Demark-Wahnefried W, GALVÃO DA, Pinto BM, et al. American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc. 2010;42:1409–26. https://doi.org/10.1249/MSS.0b013e3181e0c112.CrossRefPubMed

43.

Scharhag-Rosenberger F, Kuehl R, Klassen O, Schommer K, Schmidt ME, Ulrich CM, et al. Exercise training intensity prescription in breast cancer survivors: validity of current practice and specific recommendations. J Cancer Surviv. 2015;9:612–9. https://doi.org/10.1007/s11764-015-0437-z.CrossRefPubMed

44.

Moon H-G, Ju Y-T, Jeong C-Y, Jung E-J, Lee Y-J, Hong S-C, et al. Visceral obesity may affect oncologic outcome in patients with colorectal cancer. Ann Surg Oncol. 2008;15:1918–22. https://doi.org/10.1245/s10434-008-9891-4.CrossRefPubMed

45.

Britton KA, Massaro JM, Murabito JM, Kreger BE, Hoffmann U, Fox CS. Body fat distribution, incident cardiovascular disease, cancer, and all-cause mortality. J Am Coll Cardiol. 2013;62:921–5. https://doi.org/10.1016/j.jacc.2013.06.027.CrossRefPubMedPubMedCentral

46.

Griggs JJ, Mangu PB, Anderson H, Balaban EP, Dignam JJ, Hryniuk WM, et al. Appropriate chemotherapy dosing for obese adult patients with cancer: American Society of Clinical Oncology clinical practice guideline. JCO. 2012;30:1553–61. https://doi.org/10.1200/JCO.2011.39.9436.CrossRef

47.

Prado CMM, Baracos VE, McCargar LJ, Mourtzakis M, Mulder KE, Reiman T, et al. Body composition as an independent determinant of 5-fluorouracil-based chemotherapy toxicity. Clin Cancer Res. 2007;13:3264–8. https://doi.org/10.1158/1078-0432.CCR-06-3067.CrossRefPubMed

48.

Ferrer RA, Huedo-Medina TB, Johnson BT, Ryan S, Pescatello LS. Exercise interventions for cancer survivors: a meta-analysis of quality of life outcomes. Ann Behav Med. 2010;41:32–47. https://doi.org/10.1007/s12160-010-9225-1.CrossRef

49.

Papadopoulos E. Can we HIIT cancer if we attack inflammation? Cancer Causes Control. 2017. https://doi.org/10.1007/s10552-017-0983-y.

Title: High-intensity interval training in the therapy and aftercare of cancer patients: a systematic review with meta-analysis
Authors: Hendrik Mugele
Nils Freitag
Jannik Wilhelmi
Yanxiang Yang
Sulin Cheng
Wilhelm Bloch
Moritz Schumann
Publication date: 01-04-2019
Publisher: Springer US
Keyword: Cancer Fatigue
Published in: Journal of Cancer Survivorship / Issue 2/2019
Print ISSN: 1932-2259
Electronic ISSN: 1932-2267
DOI: https://doi.org/10.1007/s11764-019-00743-3

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Implications for Cancer Survivors

Please log in to get access to this content

Other articles of this Issue 2/2019

Translation and perceptions of the French version of the Cancer Survivor Profile-Breast Cancer (CSPro-BC): a tool to identify and manage unmet needs

Finding sexual health aids after cancer: are cancer centers supporting survivors’ needs?

Hospitalization rate in offspring of cancer survivors: a national cohort study

Associations between e-cigarette and combustible cigarette use among U.S. cancer survivors: implications for research and practice

Trends of online patient-provider communication among cancer survivors from 2008 to 2017: a digital divide perspective

Dual cigarette and e-cigarette use in cancer survivors: an analysis using Population Assessment of Tobacco Health (PATH) data

Keynote webinar | Spotlight on antibody–drug conjugates in cancer