Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Journal of Cancer Survivorship
Published in: Journal of Cancer Survivorship 3/2018

Open Access 01-06-2018

Long-term effectiveness and cost-effectiveness of high versus low-to-moderate intensity resistance and endurance exercise interventions among cancer survivors

Authors: C. S. Kampshoff, J. M. van Dongen, W. van Mechelen, G. Schep, A. Vreugdenhil, J. W. R. Twisk, J. E. Bosmans, J. Brug, M. J. M. Chinapaw, Laurien M. Buffart

Published in: Journal of Cancer Survivorship | Issue 3/2018

Login to get access

Abstract

Purpose

This study aimed to evaluate the long-term effectiveness and cost-effectiveness of high intensity (HI) versus low-to-moderate intensity (LMI) exercise on physical fitness, fatigue, and health-related quality of life (HRQoL) in cancer survivors.

Methods

Two hundred seventy-seven cancer survivors participated in the Resistance and Endurance exercise After ChemoTherapy (REACT) study and were randomized to 12 weeks of HI (n = 139) or LMI exercise (n = 138) that had similar exercise types, durations, and frequencies, but different intensities. Measurements were performed at baseline (4–6 weeks after primary treatment), and 12 (i.e., short term) and 64 (i.e., longer term) weeks later. Outcomes included cardiorespiratory fitness, muscle strength, self-reported fatigue, HRQoL, quality-adjusted life years (QALYs) and societal costs. Linear mixed models were conducted to study (a) differences in effects between HI and LMI exercise at longer term, (b) within-group changes from short term to longer term, and (c) the cost-effectiveness from a societal perspective.

Results

At longer term, intervention effects on role (β = 5.9, 95% CI = 0.5; 11.3) and social functioning (β = 5.7, 95%CI = 1.7; 9.6) were larger for HI compared to those for LMI exercise. No significant between-group differences were found for physical fitness and fatigue. Intervention-induced improvements in cardiorespiratory fitness and HRQoL were maintained between weeks 12 and 64, but not for fatigue. From a societal perspective, the probability that HI was cost-effective compared to LMI exercise was 0.91 at 20,000€/QALY and 0.95 at 52,000€/QALY gained, mostly due to significant lower healthcare costs in HI exrcise.

Conclusions

At longer term, we found larger intervention effects on role and social functioning for HI than for LMI exercise. Furthermore, HI exercise was cost-effective with regard to QALYs compared to LMI exercise.

Trial registration

This study is registered at the Netherlands Trial Register [NTR2153 [http://​www.​trialregister.​nl/​trialreg/​admin/​rctview.​asp?​TC=​2153]] on the 5th of January 2010.

Implications for Cancer Survivors

Exercise is recommended to be part of standard cancer care, and HI may be preferred over LMI exercise.
Literature
1.
Schmitz KH, Courneya KS, Matthews C, Demark-Wahnefried W, Galvao DA, Pinto BM, et al. American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc. 2010;42(7):1409–26.CrossRefPubMed
2.
Jones LW, Liang Y, Pituskin EN, Battaglini CL, Scott JM, Hornsby WE, et al. Effect of exercise training on peak oxygen consumption in patients with cancer: a meta-analysis. Oncologist. 2011;16(1):112–20.CrossRefPubMedPubMedCentral
3.
Cramp F, Byron-Daniel J. Exercise for the management of cancer-related fatigue in adults. Cochrane Database Syst Rev. 2012;11:CD006145.PubMed
4.
Mishra SI, Schrerer RW, Geigle PM, Berlanstein DR, Topaloglu O, Gotay CC, et al. Exercise interventions on health-related quality of life for cancer survivors. Cochrane Database Syst Rev. 2012;8:CD007566.
5.
Speck RM, Courneya KS, Masse LC, Duval S, Schmitz KH. An update of controlled physical activity trials in cancer survivors: a systematic review and meta-analysis. J Cancer Surviv. 2010;4(2):87–100.CrossRefPubMed
6.
Drummond MF, Sculpher MJ, Torrance GW, O’Brien BJ, Stoddart GL. Methods for the economic evaluation of health care programmes. New York: Oxford University Press; 2005.
7.
Roine E, Roine RP, Rasanen P, Vuori I, Sintonen H, Saarto T. Cost-effectiveness of interventions based on physical exercise in the treatment of various diseases: a systematic literature review. Int J Technol Assess Health Care. 2009;25(4):427–54.CrossRefPubMed
8.
Mewes JC, Steuten LM, Ijzerman MJ, van Harten WH. Effectiveness of multidimensional cancer survivor rehabilitation and cost-effectiveness of cancer rehabilitation in general: a systematic review. Oncologist. 2012;17(12):1581–93.CrossRefPubMedPubMedCentral
9.
Kampshoff CS, Chinapaw MJ, Brug J, Twisk JW, Schep G, Nijziel MR, et al. Randomized controlled trial of the effects of high intensity and low-to-moderate intensity exercise on physical fitness and fatigue in cancer survivors: results of the Resistance and Endurance exercise After ChemoTherapy (REACT) study. BMC Med. 2015;13:275.CrossRefPubMedPubMedCentral
10.
Kampshoff CS, Buffart LM, Schep G, van Mechelen W, Brug J, Chinapaw MJ. Design of the Resistance and Endurance exercise After ChemoTherapy (REACT) study: a randomized controlled trial to evaluate the effectiveness and cost-effectiveness of exercise interventions after chemotherapy on physical fitness and fatigue. BMC Cancer. 2010;10:658.CrossRefPubMedPubMedCentral
11.
De Backer I, Schep G, Hoogeveen A, Vreugdenhil G, Kester AD, van Breda E. Exercise testing and training in a cancer rehabilitation program: the advantage of the steep ramp test. Arch Phys Med Rehabil. 2007;88(5):610–6.CrossRefPubMed
12.
Karvonen J, Vuorimaa T. Heart rate and exercise intensity during sports activities. Practical application. Sports Med. 1988;5(5):303–11.CrossRefPubMed
13.
Chinapaw MJ, Buffart LM, van MW, Schep G, Aaronson NK, van Harten WH, et al. Alpe d’HuZes Cancer Rehabilitation (A-CaRe) Research: four randomized controlled exercise trials and economic evaluations in cancer patients and survivors. Int J Behav Med. 2012;19(2):143–56.CrossRefPubMed
14.
Balady GJ, Arena R, Sietsema K, Myers J, Coke L, Fletcher GF, et al. Clinician’s guide to cardiopulmonary exercise testing in adults: a scientific statement from the American Heart Association. Circulation. 2010;122(2):191–225.CrossRefPubMed
15.
Bohannon RW. Hand-grip dynamometry provides a valid indication of upper extremity strength impairment in home care patients. J Hand Ther. 1998;11(4):258–60.CrossRefPubMed
16.
Jones CJ, Rikli RE, Beam WC. A 30-s chair-stand test as a measure of lower body strength in community-residing older adults. Res Q Exerc Sport. 1999;70(2):113–9.CrossRefPubMed
17.
Smets EM, Garssen B, Bonke B, de Haes JC. The Multidimensional Fatigue Inventory (MFI) psychometric qualities of an instrument to assess fatigue. J Psychosom Res. 1995;39(3):315–25.CrossRefPubMed
18.
Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993;85(5):365–76.CrossRefPubMed
19.
Spinhoven P, Ormel J, Sloekers PP, Kempen GI, Speckens AE, van Hemert AM. A validation study of the Hospital Anxiety and Depression Scale (HADS) in different groups of Dutch subjects. Psychol Med. 1997;27(2):363–70.CrossRefPubMed
20.
Kind P. The EuroQoL instrument: an index of health-related quality of life. In: Quality of life and pharmacoeconomics in clinical trials. 2nd ed. Philadelphia: Lippincott-Raven Publishers; 1996. p. 191–201.
21.
Lamers LM, Stalmeier PF, McDonnell J, Krabbe PF, van Busschbach JJ. Measuring the quality of life in economic evaluations: the Dutch EQ-5D tariff. Ned Tijdschr Geneeskd. 2005;149(28):1574–8.PubMed
22.
23.
Hakkaart-van RL, Tan S, Bouwmand C. Handleiding voor kostenonderzoek. Methoden en standaard kostprijzen voor economische evaluaties in de gezondheidszorg. 2010.
24.
25.
Koopmanschap MA, Rutten FF, van Ineveld BM, van RL. The friction cost method for measuring indirect costs of disease. J Health Econ. 1995;14(2):171–89.CrossRefPubMed
26.
27.
White IR, Royston P, Wood AM. Multiple imputation using chained equations: issues and guidance for practice. Stat Med. 2011;30(4):377–99.CrossRefPubMed
28.
van der Leeden R, Leeuw J, Meijer E. Resampling multilevel models. In: Handbook of multilevel analysis. New York: Springer; 2008.
29.
Black WC. The CE plane: a graphic representation of cost-effectiveness. Med Decis Mak. 1990;10(3):212–4.CrossRef
30.
Fenwick E, O'Brien BJ, Briggs A. Cost-effectiveness acceptability curves—facts, fallacies and frequently asked questions. Health Econ. 2004;13(5):405–15.CrossRefPubMed
31.
Buffart LM, Kalter J, Chinapaw MJ, Heymans MW, Aaronson NK, Courneya KS, et al. Predicting OptimaL cAncer RehabIlitation and Supportive care (POLARIS): rationale and design for meta-analyses of individual patient data of randomized controlled trials that evaluate the effect of physical activity and psychosocial interventions on health-related quality of life in cancer survivors. Syst Rev. 2013;2(1):75.CrossRefPubMedPubMedCentral
32.
Strasser B, Steindorf K, Wiskemann J, Ulrich CM. Impact of resistance training in cancer survivors: a meta-analysis. Med Sci Sports Exerc. 2013;45(11):2080–90.CrossRefPubMed
33.
Foster C, Breckons M, Cotterell P, Barbosa D, Calman L, Corner J, et al. Cancer survivors’ self-efficacy to self-manage in the year following primary treatment. J Cancer Surviv. 2015;9(1):11–9.CrossRefPubMed
34.
Andrykowski MA, Donovan KA, Jacobsen PB. Magnitude and correlates of response shift in fatigue ratings in women undergoing adjuvant therapy for breast cancer. J Pain Symptom Manag. 2009;37(3):341–51.CrossRef
35.
Jung ME, Bourne JE, Little JP. Where does HIT fit? An examination of the affective response to high-intensity intervals in comparison to continuous moderate- and continuous vigorous-intensity exercise in the exercise intensity-affect continuum. PLoS One. 2014;9(12):e114541.CrossRefPubMedPubMedCentral
36.
Kalter J, Kampshoff CS, Chinapaw MJ, van MW, Galindo-Garre F, Schep G, et al. Mediators of exercise effects on HRQoL in cancer survivors after chemotherapy. Med Sci Sports Exerc. 2016;48(10):1859–65.CrossRefPubMed
37.
Craft LL, Vaniterson EH, Helenowski IB, Rademaker AW, Courneya KS. Exercise effects on depressive symptoms in cancer survivors: a systematic review and meta-analysis. Cancer Epidemiol Biomark Prev. 2012;21(1):3–19.CrossRef
38.
Aaronson NK, Mattioli V, Minton O, Weis J, Johansen C, Dalton SO, et al. Beyond treatment—psychosocial and behavioural issues in cancer survivorship research and practice. EJC Suppl. 2014;12(1):54–64.CrossRefPubMedPubMedCentral
39.
Irwin ML, varez-Reeves M, Cadmus L, Mierzejewski E, Mayne ST, Yu H, et al. Exercise improves body fat, lean mass, and bone mass in breast cancer survivors. Obesity (Silver Spring). 2009;17(8):1534–41.CrossRef
40.
Bennett JA, Lyons KS, Winters-Stone K, Nail LM, Scherer J. Motivational interviewing to increase physical activity in long-term cancer survivors: a randomized controlled trial. Nurs Res. 2007;56(1):18–27.CrossRefPubMed
41.
Michie S, Abraham C, Whittington C, McAteer J, Gupta S. Effective techniques in healthy eating and physical activity interventions: a meta-regression. Health Psychol. 2009;28(6):690–701.CrossRefPubMed
42.
Sterne JA, White IR, Carlin JB, Spratt M, Royston P, Kenward MG, et al. Multiple imputation for missing data in epidemiological and clinical research: potential and pitfalls. BMJ. 2009;338:b2393.CrossRefPubMedPubMedCentral
43.
Squires DA. Explaining high health care spending in the United States: an international comparison of supply, utilization, prices, and quality. International Program in Health Policy and Innovation, The Commonwealth Fund, USA 2012(10):1558–6847.
Metadata
Title
Long-term effectiveness and cost-effectiveness of high versus low-to-moderate intensity resistance and endurance exercise interventions among cancer survivors
Authors
C. S. Kampshoff
J. M. van Dongen
W. van Mechelen
G. Schep
A. Vreugdenhil
J. W. R. Twisk
J. E. Bosmans
J. Brug
M. J. M. Chinapaw
Laurien M. Buffart
Publication date
01-06-2018
Publisher
Springer US
Published in
Journal of Cancer Survivorship / Issue 3/2018
Print ISSN: 1932-2259
Electronic ISSN: 1932-2267
DOI
https://doi.org/10.1007/s11764-018-0681-0

Other articles of this Issue 3/2018

Journal of Cancer Survivorship 3/2018 Go to the issue

OriginalPaper

Feasibility and preliminary efficacy of an exercise telephone counseling intervention for hematologic cancer survivors: a phase II randomized controlled trial

OriginalPaper

Predictors of vasomotor symptoms among breast cancer survivors

OriginalPaper

Consumer credit as a novel marker for economic burden and health after cancer in a diverse population of breast cancer survivors in the USA

OriginalPaper

Healthcare system barriers to long-term follow-up for adult survivors of childhood cancer in British Columbia, Canada: a qualitative study

OriginalPaper

Cardiovascular disease incidence in adolescent and young adult cancer survivors: a retrospective cohort study

OriginalPaper

Usability and acceptance evaluation of ACESO: a Web-based breast cancer survivorship tool
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
Image Credits