The Effect of Exercise and Nutritional Interventions on Body Composition in Patients with Advanced or Metastatic Cancer: A Systematic Review
Abstract
:1. Introduction
2. Materials and Methods
2.1. Search Strategy
2.2. Study Eligibility
2.3. Study Selection
2.4. Data Extraction
2.5. Methodological Assessment
3. Results
3.1. Study Characteristics
3.2. Intervention Characteristics
3.3. Adherence and Adverse Events
3.4. Outcome Measures
3.4.1. Lean Mass-Related Outcomes
3.4.2. Fat Mass-Related Outcomes
3.5. Risk of Bias Assessment
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Study Details | Population | Experimental Groups | Intervention | Body Composition Outcomes | Pre vs. Post Training Mean ± SD or MD ± SD/(95%CI) |
---|---|---|---|---|---|
Exercise only | |||||
Cormie et al. [69] Australia RCT | Population: Prostate cancer with bone metastases (n = 20) Stage: Metastatic: 100% | EX (n allocated = 10; n completed outcome = 8): Supervised resistance training, home-based aerobic training. CON (n allocated = 10; n completed outcome = 7): Self-directed exercise | 12-week intervention Exercise component (FITT): F: RT = 2 days/week; AT = NR. I: RT = 8–12 RM; AT = moderate intensity. Time: RT = 60 min, 8–12 reps, 2–4 sets; AT = 150 min/week. Type: Supervised machine weight resistance training that did not target areas of bone metastases, self-directed home-based aerobic exercise. Adherence: attended 93% of supervised exercise sessions. | Lean mass (kg) (DXA) | Within-group differences: EX: PRE: 57.2 ± 7.8 vs. POST: 57.8 ± 8.0 CON: PRE: 53.2 ± 9.7 vs. POST: 52.5 ± 8.0 Between-group differences: EX vs. CON: MD: 1.7 (0.2 to 3.2) ¥↑ |
Appendicular lean mass (kg) (DXA) | Within-group differences: EX: PRE: 24.3 ± 3.7 vs. POST: 24.5 ± 3.7 CON: PRE: 21.4 ± 3.9 vs. POST: 20.9 ± 3.3 Between-group differences: EX vs. CON: MD: 1.0 (0.4 to 1.6) ¥↑ | ||||
Fat mass (kg) (DXA) | Within-group differences: EX: PRE: 27.7 ± 5.6 vs. POST: 27.8 ± 6.0 CON: PRE: 27.2 ± 5.7 vs. POST: 27.5 ± 6.5 Between-group differences: EX vs. CON: MD: −0.3 (−1.4 to 0.9) | ||||
Trunk fat mass (kg) (DXA) | Within-group differences: EX: PRE: 14.7 ± 3.4 vs. POST: 14.6 ± 3.7 CON: PRE: 15.0 ± 3.4 vs. POST: 15.0 ± 3.8 Between-group differences: EX vs. CON: MD: 0.0 (−0.6 to 0.6) | ||||
Visceral fat mass (kg) (DXA) | Within-group differences: EX: PRE: 0.89 ± 0.20 vs. POST: 0.89 ± 0.23 CON: PRE: 0.96 ± 0.19 vs. POST: 0.96 ± 0.19 Between-group differences: EX vs. CON: MD: 0.01 (−55.3 to 58.6) | ||||
Body fat percent (%) (DXA) | Within-group differences: EX: PRE: 31.7 ± 4.9 vs. POST: 31.5 ± 5.1 CON: PRE: 32.7 ± 2.2 vs. POST: 33.0 ± 3.3 Between-group differences: EX vs. CON: MD: −0.4 (−1.9 to 1.2) | ||||
Uth et al. [67] Denmark RCT | Population: Advanced or locally advanced prostate cancer (n = 57) Stage: ≥T3: 70.2% | EX (n allocated = 29, n completed outcome = 26): Supervised football training CON (n allocated = 28, n completed outcome = 23): Usual care control. | 12-week intervention Exercise component (FITT): F: 2–3 days/week I: Not prescribed but a mean HR of 84.6 ± 3.9% of individual max HR was achieved. Time: 45 min Type: Football drills and game. Adherence: attended 76.5 ± 24.2% of supervised exercise sessions. | Lean mass (kg) (DXA) | Within-group differences: EX: MD: 0.5 (0.1 to 0.9) ¥↑ CON: MD: −0.2 (−0.6 to 0.2) Between-group differences: EX vs. CON: MD: 0.7 (0.1 to 1.2) ¥↑ |
Fat mass (kg (DXA) | Within-group differences: EX: MD: −0.6 (−1.4 to 0.1) CON: MD: 0.0 (−0.5 to 0.5) Between-group differences: EX vs. CON: MD: −0.6 (−1.5 to 0.2) | ||||
Body fat percent (%) (DXA) | Within-group differences: EX: MD: −0.7 (−1.3 to 0.0) CON: MD: 0.1 (−0.4 to 0.5) Between-group differences: EX vs. CON: MD: −0.7 (−1.5 to 0.2) | ||||
Galvao et al. [73] Australia RCT | Population: Prostate cancer with bone metastases(n = 57) Stage: Metastatic: 100% | EX (n allocated = 28, n completed outcome = 23): Supervised aerobic and resistance exercise. CON (n allocated = 29, n completed outcome = 26): Usual care control. | 12-week intervention Exercise component (FITT): F: 3 days/week I: AT = 60–85% HRmax; RT = 10–12 RM Time: 60 min sessions; AT = 20–30 min; RT = 10–12 reps, 3 sets. Type: Exercises did not target bone metastases sites. AT = choice or walking, cycling, rowing; RT = machine based. Adherence: attended 89% of supervised exercise sessions. | Lean mass (kg) (DXA) | Within-group differences: EX: PRE: 56.6 ± 8.1 vs. POST: 56.2 ± 8.0 CON: PRE: 55.6 ± 7.8 vs. POST: 55.4 ± 7.5 Between-group differences: EX vs. CON: MD: −0.3 (−1.3 to 0.7) |
Fat mass (kg) (DXA) | Within-group differences: EX: PRE: 28.7 ± 8.1 vs. POST: 29.0 ± 7.8 CON: PRE: 28.3 ± 6.9 vs. POST: 29.0 ± 6.4 Between-group differences: EX vs. CON: MD: −0.2 (−1.2 to 0.7) | ||||
Villumsen et al. [74] Denmark RCT | Population: Locally advanced or advanced stage prostate cancer (n = 46) Stage: Bone metastases: 34.8% Lymph node metastases: 6.5% | EX (n allocated = 23, n completed outcome = 21): Home-based exergaming CON (n allocated = 23, n completed outcome = 20): Usual care control inclusive of physical activity advice. | 12-week intervention Exercise component (FITT): F: 3 days/week I: NR Time: 60 min Type: Exergaming using both aerobic and strength exercises, free weights. Adherence: Completed on average 153.5 min/week from a prescribed 180 min/week. | Lean mass (%) (BIA) | Within-group differences: EX: NR CON: NR Between-group differences: EX vs. CON: MD: 0.91 (−0.2 to 2.0) |
Fat mass (% (BIA) | Within-group differences: EX: NR CON: NR Between-group differences: EX vs. CON: MD: −0.9 (−2.0 to 0.2) | ||||
Stuecher et al. [75] Germany RCT | Population: Stage III or IV gastrointestinal tract cancers(n = 44) Stage: Metastatic: NR | EX (n allocated = 22, n completed outcome = 13): Self-directed walking. CON (n allocated = 22, n completed outcome = 15): Usual care control. | 12-week intervention Exercise component (FITT): F: 3–5 days/week I: 11–13 RPE Time: 150 min/week Type: Home-based walking. Adherence: 81.3% completed the home-based program as prescribed. | Lean mass (%) (BIA) | Within-group differences: EX: MD: 3.4 ± 4.6 CON: MD: 0.64 ± 3.4 Between-group differences: EX vs. CON: MD: NR, p = 0.02. ¥↑ |
Phase angle (°) (BIA) | Within-group differences: EX: MD: 0.13 ± 0.91 CON: MD: −0.01 ± 0.69 Between-group differences: EX vs. CON: MD: NR, p = 0.2 | ||||
Bjerre et al. [78] Denmark RCT | Population: Prostate cancer with bone metastases (n = 41) Stage: Metastatic: 100% | EX (n allocated = 22, n completed outcome = 21): Community-based football intervention CON (n allocated = 19, n completed outcome = 15): Usual care | 6-month intervention Exercise component (FITT): F: 2 days/week I: NR Time: 60 min Type: Supervised group-based football training involving bodyweight training, football skills and football match play. Adherence: attended 63% of supervised group sessions (at week-12); attended 54% of supervised group sessions (at 6-months). | Lean mass (kg) (DXA) | Within-group differences: EX: MD: −0.3 (−1.1 to 0.5) CON: MD: −0.4 (−1.3 to 0.6) Between-group differences: EX vs. CON: MD: −0.2 (−1.4 to 0.9) |
Fat mass (kg) (DXA) | Within-group differences: EX: MD: −0.4 (−1.3 to 0.6) CON: MD: −0.2 (−1.4 to 1.0) Between-group differences: EX vs. CON: MD: 0.4 (−1.1 to 1.8) | ||||
Combined exercise and nutrition | |||||
Xu et al. [70] Taiwan RCT | Population: Locally advanced tumors of the esophagus (n = 56) Stage: Stage 1: 3.6% Stage 2: 7.1% Stage 3: 82.1% | EX + NU (n allocated = 28, n completed outcome = 28): Supervised walking and nutrition counselling. CON (n allocated = 28, n completed outcome = 28): Usual care control. | 4–5-week intervention Exercise component (FITT): F: 3 days/week I: 60% age predicted maximum HR Time: 25 min Type: Walking Nutrition component: Weekly nutrition counselling. Adherence: EX: Completed 8.4 ± 3.6 of supervised walking sessions.NU: attended 100% of nutrition sessions. | Lean mass (kg) (BIA) | Within-group differences: EX + NU: MD: −0.7 ± 1.9 CON: MD: −2.0 ± 3.0 Between-group differences: EX + NU vs. CON: MD: 1.3 (−0.05 to 2.66) |
Kapoor et al. [72] India RCT | Population: Females with advanced cancer (n = 63) Stage: NR | EX + NU (n allocated = 30, n completed outcome = 17): Multimodal (Nutrition counselling, oral nutrition supplement, physical activity recommendation) CON (n allocated = 33, n completed outcome = 15): Nutrition counselling and physical activity recommendation | 6-month intervention Exercise component (FITT): F: NR I: Not prescribed but reported: EX + NU: PRE: 33.6 ± 3.9 METs vs. POST 31.9 ± 2.7 METs (p = 0.274); CON: PRE: 30.7 ± 2.7 METs vs. POST 28.0 ± 2.5 METs (p = 0.004). Time: NR. Type: Low levels of PA, e.g., walking and participation in household activities. Nutrition component: Bi-weekly nutrition counselling visits. 100 g/day of IAtta oral nutrition supplement (mixture of roasted bengal gram flour, roasted barley flour, roasted soybean flour, flaxseed powered, dried amaranthus spinosus powder). Adherence: EX: NR. NU: NR. EX + NU: 51% completed the intervention as prescribed. | Body fat percent (%) (skinfolds) | Within-group differences: EX + NU: PRE: 20.5 ± 5.2 vs. POST: 23.7 ± NR ¥↑ CON: PRE: 25.4 ± 6.5 vs. POST: 24.5 ± NR ¥↓ Between-group differences: EX + NU vs. CON: MD: NR; p = 0.001 ¥↑ |
Uster et al. [68] Switzerland RCT | Population: Metastatic or locally advanced tumors of gastrointestinal and lung tracts (n = 58) Stage: Stage III: 2% Stage IV: 98% | EX + NU (n allocated = 29, n completed outcome = 24): Multimodal (Supervised group-based resistance and balance training, nutrition counseling) CON (n allocated = 29, n completed outcome = 20): Usual care control. | 3-month intervention Exercise component (FITT): F: 2 days/week I: RT= 60–80% of 1-RM; Balance = NR. Time: 60 min, RT = 10 reps, 2 sets, Balance= 1–2 min per move. Type: RT = resistance machines; balance mat. Nutrition component: Minimum of 3 nutritional counselling during intervention encouraging patients to consume 1.2 g protein/kg body weight/day, with emphasis on consuming protein after exercise sessions. Adherence: EX: attended 67% of supervised exercise sessions. NU: 89.7% completed the minimum nutritional counseling sessions. EX + NU: 100% consumed at least 9–10 g of protein after each exercise session. | Phase angle (°) (BIA) | Within-group differences: EX + NU: NR. CON: NR. Between-group differences: EX + NU vs. CON: MD: NR. |
Zhao et al. [82] United States of America Non-RCT | Population: Stage III-IV Head and neck squamous cell carcinoma (n = 20) Stage: Stage III: 22% Stage IV: 78% | EX + NU (n = 11): Multimodal (Supervised and unsupervised aerobic and resistance training, nutrition counselling) CON (n = 7): Standard of care inclusive of nutritional counselling. | 14-week intervention (7 weeks supervised, 7 weeks unsupervised) Exercise component (FITT): F: Supervised period = 3 days/week; unsupervised period = 5 days/week I: 11–13 RPE Time: 60 min sessions; AT = 30 min; RT = 8–12 reps, 3 sets. Type: AT = walking; RT = free weights Nutrition component: Baseline nutrition counselling. Adherence: EX: attended 72% of supervised exercise sessions. NU: NR. | Lean mass (%) (DXA) | Within-group differences: EX + NU: MD: 7 weeks: 0.2 ± 0.5 vs. 14 weeks: 4.7 ± 1.5 CON: MD: 7 weeks: 1.0 ± 0.7 vs. 14 weeks: 4.0 ± 0.9 Between-group differences: EX + NU vs. CON: NR; p > 0.05. |
Schink et al. [83] Germany Non-RCT | Population: Advanced solid tumours (n = 131) Stage: Stage III: 26% Stage IV: 74% | EX + NU (n allocated = 96; n completed outcome = 58): Multimodal (supervised whole-body electromyostimulation, nutrition counselling) CON (n allocated = 35; n completed outcome = 27): Usual care control with nutrition counselling. | 12-week intervention Exercise component (FITT): F: 2 days/week I: 85 Hz, 350 μs inducing a 6 s stimulation and 4 s rest. Time: 12–20 min, 6 reps per min. Type: whole-body electromyostimulation with additional light exercises. Nutrition component: Nutrition counselling encouraging >1 g/kg day of protein and minimum energy intake of 25 kcal/kg/day. Adherence: EX: attended 86.6 ± 10.8% of supervised sessions. NU: EX + NU = 67.4% and CON = 69% consumed the protein intake recommendation or more. EX + NU =74.2% and 75.8 consumed the kcal intake recommendations. | Skeletal muscle mass (kg) (BIA) | Within-group differences: EX + NU: NRCON: NRBetween-group differences: EX + NU vs.CON: MD: 0.53 (0.05 to 0.98) ¥ ↑ |
Fat mass (%) (BIA) | Within-group differences: EX + NU: NR CON: NRBetween-group differences: EX + NU vs. CON: MD: 0.51 (−0.46 to 1.47) | ||||
Phase angle (°) (BIA) | Within-group differences: EX + NU: NR CON: NR Between-group differences: EX + NU vs. CON: MD: 0.07 (−0.06 to 0.19) | ||||
Schink et al. [84] Germany Non-RCT | Population: Advanced solid tumours (n = 80) Stage: Stage III: 24.4% Stage IV: 75.6% | EX + NU (n allocated = 58; n completed outcome = 26): Multimodal (supervised whole-body electromyostimulation, nutrition counselling) CON (n allocated = 22; n completed outcome = 15): Usual care control with nutrition counselling. | 12-week intervention Exercise component (FITT): F: 2 days/week I: 85 Hz, 350 μs inducing a 6 s stimulation and 4 s rest. Time: 12–20 min, 6 reps per min. Type: whole-body electromyostimulation with additional light exercises. Nutrition component: Nutrition counselling encouraging >1 g/kg day and minimum energy intake of 25 kcal/kg/day. Adherence: EX: attended 88.9 ± 8.7% of supervised sessions. NU: NR | Skeletal muscle mass (kg) (BIA) | Within-group differences: EX + NU: NR CON: NR Between-group differences: EX + NU vs. CON: MD: 0.99 (0.09 to 1.90) ¥↑ |
van der Werf et al. [76] Netherlands RCT | Population: Metastatic colon cancer (n = 107) Stage: Metastatic: 100% | NU + PA: (n allocated = 52; n completed outcome T1 = 50; N completed outcome T2 = 39): Nutrition counselling and PA CON (n allocated = 55; n completed outcome T1 = 52; n completed outcome T2 = 33): Usual care inclusive of regular care dietician referral. | T0-T1 = mean 9 ± 3 weeks; T0-T2 = mean 19 ± 3 weeks Exercise component (FITT): F: 5 days/week I: moderate intensity Time: ≥30 min Type: self-directed PA. Nutrition component: Nutrition counselling with the goal of 1.2 g protein/kg body weight/day and at least ≥25 g protein per meal. Adherence: PA: T1 = 24%; T2 = 16% achieved PA recommendations. NU: T1 = 61%; T2 = 40% achieved protein intake recommendations. T1 = 61%; T2 = 49% achieved energy intake recommendations. | Skeletal muscle area (cm2) (CT) | Within-group differences: NU + PA: NR CON: NR Between-group differences: NU + PA vs. CON: MD: T0-T1: 0.3 (−3.5 to 4.0) vs. T1-T2: 0.3 (−3.4 to 4.0) |
Muscle density (Hounsfield units) (CT) | Within-group differences: NU + PA: NR CON: NR Between-group differences: NU + PA vs. CON: MD: T0-T1: 0.2 (−1.8 to 2.2) vs. T1-T2: −0.1 (−2.2 to 2.0) | ||||
Storck et al. [77] Switzerland RCT | Population: Metastatic or locally advanced cancers of the lungs, gastrointestinal tract, breast, ovarian, prostate, renal cell, bladder (n = 52) Stage: Metastatic: NR | EX + NU (n allocated = 27; n completed outcome = 23):Multimodal (supervised and self-directed aerobic and resistance exercise, nutrition counselling). CON (n allocated = 25; n completed outcome =18): Usual care inclusive of regular care nutrition counselling and physiotherapy. | 12-week intervention Exercise component (FITT): F: 2 days/week supervised, 1 day/week home-based. I: AT = 3–5 RPE (10 borg); RT = NR. Time: 60–90 min; AT = NR; RT = 10–15 reps, 3 sets. Type: AT= bike or treadmill; RT = circuit, resistance bands. Nutrition component: Nutrition counselling at baseline, 6 weeks, 12 weeks, and as required between times. 15–30 g/day of whey protein. Adherence: EX: attended 70.7% of supervised sessions and completed 95% of home sessions. NU: attended 106.7% nutrition counselling sessions. 71.2% consumed the protein supplements. | Phase angle (°) (BIA) | Within-group differences: EX + NU: MD: 0.08 ± NR CON: MD: −0.04 ± NR Between-group differences: EX + NU vs. CON: MD: NR (−0.39 to 0.16) |
Lean mass (kg) (BIA) | Within-group differences: EX + NU: MD: 0.89 ± NRCON: MD: 0.46 ± NR Between-group differences: EX vs. CON: MD:NR (−2.04 to 1.18) | ||||
Body cell mass (kg) (BIA) | Within-group differences: EX + NU: MD: 0.62 ± NR CON: MD: 0.33 ± NR Between-group differences: EX + NU vs. CON: MD:NR (−1.45 to 0.87) | ||||
Fat mass (kg) (BIA) | Within-group differences: EX + NU: MD: 0.17 ± NR CON: MD: −0.38 ± NR Between-group differences: EX + NU vs. CON: MD:NR (−2.08 to 0.97) | ||||
Exercise with or without nutrition, plus an additional component | |||||
Solheim et al. [71] United Kingdom and Norway RCT | Population: Stage III/IV NSCLC or inoperable pancreatic cancer (n = 46) Stage: Pancreas stage III = 20% Pancreas stage IV = 25% NSCLC stage III = 10% NSCLC stage IV = 47.5% | EX + NU + O (n allocated = 25; n completed outcome = 23): Multimodal (self-directed exercise, nutrition counselling, oral nutrition supplement, anti-inflammatory drug). CON (n allocated = 21; n completed outcome = 18): Standard of care | 6-week intervention Exercise component (FITT): F: AT = 2 days/week; RT = 3 days/week. I: NR Time: AT = 30 min; RT = 20 min Type: AT = patient choice; AT = body weight and free weights. Nutrition component: Baseline nutrition counselling session. 220 mL of an oral nutrition supplement equating to 2 g/day of eicosapentaenoic acid. Other component: 300 mg/day of Celecoxib, an anti-inflammatory. Adherence: EX: attended 60% of exercise sessions. NU: 48% consumed the supplement O: 76% took the prescribed celecoxib. | Lean mass (cm2) (CT) | Within-group differences: EX + NU + O: MD: −2.82 ± 9.41 CON: MD: −4.97 ± 7.80 Between-group differences: EX + NU + O vs. CON: MD: NR |
Balstad et al. [85] United Kingdom and Norway Secondary analysis of Solheim et al., 2017. | See Solheim et al. [71] | EX + NU + O (n allocated = 23; n completed outcome = 22):Multimodal (self-directed exercise, nutrition counselling, oral nutrition supplement, anti-inflammatory drug). CON (n allocated = 23; n completed outcome = 18): Standard of care | See Solheim et al. [71] | Visceral adipose tissue (cm2) (CT) | Within-group differences: EX + NU + O: PRE: 108.4 ± 67.6 vs. POST: 108.8 ± 66.1 CON: PRE: 99.9 ± 65.2 vs. POST: 94.9 ± 55.9 Between-group differences: EX + NU + O vs. CON: ES: 0.22 |
Subcutaneous adipose tissue (cm2) (CT) | Within-group differences: EX + NU + O: PRE: 182.3 ± 114.5 vs. POST: 176.4 ± 108.5 CON: PRE: 160.6 ± 70.7 vs. POST: 149.4 ± 64.5 Between-group differences: EX + NU + O vs. CON: ES: 0.15 | ||||
Ratio VAT:SAT | Within-group differences: EX + NU + O: PRE: 0.7 ± 0.6 vs. POST: 0.7 ± 0.5 CON: PRE: 0.7 ± 0.5 vs. POST: 0.7 ± 0.4 Between-group differences: EX + NU + O vs. CON: ES: 0.25 | ||||
Total adipose area (cm2) (CT) | Within-group differences: EX + NU + O: PRE: 290.7 ± 154.0 vs. POST: 285.2 ± 149.5 CON: PRE: 260.5 ± 99.9 vs. POST: 244.3 ± 93.7 Between-group differences: EX + NU + O vs. CON: ES: 0.21 | ||||
Total adipose index (cm2/m2) (CT) | Within-group differences: EX + NU + O: PRE: 99.5 ± 52.7 vs. POST: 97.4 ± 51.2 CON: PRE: 93.3 ± 36.5 vs. POST: 87.4 ± 34.2 Between-group differences: EX + NU + O vs. CON: ES: 0.21 | ||||
Skeletal muscle mass index (cm2/m2) (CT) | Within-group differences: EX + NU + O: PRE: 45.9 ± 8.9 vs. POST: 45.0 ± 9.2 CON: PRE: 45.7 ± 8.6 vs. POST: 43.9 ± 9.4 ¥↓ Between-group differences: EX + NU + O vs. CON: ES: 0.26 | ||||
Sheean et al. [80] United States of America RCT | Population: Metastatic breast cancer (n = 35) Stage: Metastatic: 100% | EX + NU + O (n allocated = 17; n complete outcome = 17): Multimodal (Supervised aerobic and resistance exercise, nutrition counseling) CON (n allocated = 18; n complete outcome = 18): Usual care waitlist control given monthly reminder of upcoming intervention. | 12-week intervention Exercise component (FITT): F: 4 days/week I: moderate intensity Time: 150 min/week Type: AT = patient choice; RT = resistance bands. Nutrition component: Weekly phone calls, encouraging consumption of whole grains and 5+ fruits and vegetables daily. Other component: Rooted in social cognitive theory. Adherence: EX: attended 93% for supervised sessions NU + O: 84% for telephone sessions. | Appendicular skeletal muscle index (kg/m2) (DXA) | Within-group differences: EX + NU + O: MD: − 0.1 ± 0.4 CON: MD: 0.0 ± 0.2 Between-group differences: EX + un + O vs. CON: MD: − 0.0 ± 0.3 |
Lean mass (kg) (DXA) | Within-group differences: EX + NU + O: MD: − 0.5 ± 1.6 CON: MD: − 0.3 ± 1.4 Between-group differences: EX + NU + O vs. CON: MD: − 0.4 ± 1.5 | ||||
Fat mass (kg) (DXA) | Within-group differences: EX + NU + O: MD: 0.3 ± 1.7 CON: MD: 0.3 ± 2.0 Between-group differences: EX + NU + O vs. CON: MD: 0.3 ± 1.8 | ||||
Body fat percent (%) (DXA) | Within-group differences: EX + NU + O: MD: 0.5 ± 1.3 CON: MD: 0.3 ± 1.2 Between-group differences: EX + NU + O vs. CON: MD: 0.4 ± 1.2 | ||||
Visceral fat mass (g) (DXA) | Within-group differences: EX + NU + O: MD: − 99 ± 181 ¥↓ CON: MD: − 81 ± 162 ¥↓ Between-group differences: EX + NU + O vs. CON: MD: − 89 ± 168 ¥↓ | ||||
Mikkelsen et al. [79] Denmark RCT | Population: Pancreatic cancer, biliary tract cancer, small cell lung cancer (n = 84) Stage: Locally advanced: 14.3% Metastatic: 85.7% | EX + NU + O (n allocated = 43; n complete outcome = 29): Multimodal intervention (exercise + protein + PA+ counselling) CON (n allocated = 41; n completed outcome = 34): Usual care. | 12-week intervention Exercise components (FITT): F: 2 days/week I: 10–15 RM Time: 60 min (Volume: 10–15 reps, 2–3 sets) Type: Supervised group-based resistance training. Individualized home-based walking program controlled with a pedometer. Nutrition component: Post-exercise protein supplementation intake (12–18 g) 2 days/week. Other components: Nurse-led support and counselling (holistic assessment of function) Adherence: EX: attended 69% of supervised exercise sessions and 75% adherence to the walking program. NU: NR | Lean mass (kg) (DXA) | Within-group differences: EX + NU + O: PRE: 47.3 ± 8.1 vs. POST: 48.7 ± 9.1¥↑ CON: PRE: 47 ± 9.2 vs. POST: 46.4 ± 9.1 Between-group differences: EX + NU + O vs. CON: MD: 0.9 ± 0.4 ¥↑ |
Fat mass (kg) (DXA) | Within-group differences: EX + NU + O: PRE: 20.8 ± 8.1 vs. POST: 21.6 ± 7.6 CON: PRE: 22.4 ± 9.4 vs. POST: 22.7 ± 10 Between-group differences: EX + NU + O vs. CON: MD: 0.2 ± 0.6 | ||||
Lean mass (kg) (BIA) | Within-group differences: EX + NU + O: PRE:44.1 ± 8.5 vs. POST: 44.4 ± 9.6 CON: PRE: 42.9 ± 10.5 vs. POST: 41.9 ± 8.8 Between-group differences: EX + NU + O vs. CON: MD: −0.9 ± 1.3 | ||||
Fat mass (kg) (BIA) | Within-group differences: EX + NU + O: PRE:17.2 ± 8.8 vs. POST: 17.4 ± 8.5 CON: PRE: 18.5 ± 10.2 vs. POST: 18.9 ± 11.1 Between-group differences: EX + NU + O vs. CON: MD: 1.0 kg ± 1.0 | ||||
Kim et al. [48] Australia RCT | Population: Prostate cancer (n = 40) Stage: Metastatic: 100% | EX + O (n allocated = 20; n complete outcome =13): Supervised aerobic and resistance training with psychological support CON (n allocated = 20; n complete outcome = 12): self-directed exercise | 6-month intervention Exercise component (FITT): F: 3 days/week I: RT: 6–12 RM, HITT: RPE 8 AT: RPE 6 Time: RT: 2–5 sets, 6 exercises. HITT 3–6 bouts of 30–60 s. AT: 10–40 min. Progressive increase in time and volume. Type: Supervised RT and HITT 2 days per week and continuous cycling AT 1 day per week. Other component Psychological support Adherence: EX + O: attended 82.5 ± 13.0% of supervised exercise sessions. | Lean mass (kg) (DXA) | Within-group differences: EX + O: PRE: 53.1 ± 10.4 vs. POST: 50.6 (95%CI: 49.4 to 51.9) CON: PRE: 49.1 ± 8.2 vs. POST 50.7 (95%CI 49.4 to 51.9) Between-group differences: EX + O vs. CON: MD: NR |
Lean mass (%) (DXA) | Within-group differences: EX + O: PRE: 57.0 ± 3.9 vs. POST: 58.4 (57.1 to 59.6) CON: PRE: 59.8 ± 4.0 vs. POST: 57.7 (56.4 to 59) Between-group differences: EX + O vs. CON: MD: NR | ||||
Lean mass index (kg/m2) (DXA) | Within-group differences: EX + O: PRE: 17.6 ± 1.9 vs. POST: 17.2 (16.8 to 17.4) CON: PRE: 16.7 ± 2.1 vs. POST: 17.0 (16.6 to 17.4) Between-group differences: EX + O vs. CON: MD: NR | ||||
Fat mass (kg) (DXA) | Within-group differences: EX + O: PRE: 33.4 ± 10.5 vs. POST: 29.8 (27.9 to 31.8) CON: PRE: 26.9 ± 6.7 vs. POST: 32.1 (30.0 to 34.1) Between-group differences: EX + O vs. CON: MD: NR | ||||
Body fat percent (%) (DXA) | Within-group differences: EX + O: PRE: 37.1 ± 4.4 vs. POST: 35.9 (34.4 to 37.5) CON: PRE: 34.4 ± 4.7 vs. POST: 36.7 (35.1 to 38.2) Between-group differences: EX + O vs. CON: MD: NR | ||||
Allen et al. [81] United Kingdom RCT | Population: Locally advanced esophagogastric cancer patients (n = 54) Stage: T1 = 1(2) T2 = 12 (22) T3 = 38 (70) T4 = 3 (6) N0 = 18 (33) N1 = 17 (31) N2 = 16 (30) N3 = 3 (6) | EX + NU + On allocated = 26; n complete outcome = 24: Prehabilitation Multimodal intervention (exercise + nutrition + psychological support) CON (n allocated = 28; n complete outcome = 28): Usual care with encouragement to get fitter during treatment. | 15-week intervention Exercise component (FITT): F: Supervised in-clinic 2 days/week + Home-based 3 days/week I: AT: 40–60 HRR or 11–14 RPE and RT: 12–14 RPE Time: 60 min (Volume: 12 reps, 2 sets) Type: Prehabilitation supervised in clinic and unsupervised home-based AT and RT and flexibility. Nutrition component: Needs-based nutritional intervention with frequent, tailored, dietetic input from dieticians. Other component Psychological support: 6 face-to-face sessions with discussion of health status, strengths, recognition, resilience, or goal setting. Adherence: EX: attended 76 ± 14% of supervised exercise sessions and 65 ± 27% of home-based.NU + O: NR | Skeletal muscle index (cm2/m2) (CT) | Within-group differences: EX + NU + O: MD: −11.6 (95%CI –14.2 to –9.0) CON: MD: −15.6 (95%CI –18.7 to –15.4) Between-group differences: EX + NU + O vs. CON: MD: NR¥↑ |
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Barnes, O.; Wilson, R.L.; Gonzalo-Encabo, P.; Kang, D.-W.; Christopher, C.N.; Bentley, T.; Dieli-Conwright, C.M. The Effect of Exercise and Nutritional Interventions on Body Composition in Patients with Advanced or Metastatic Cancer: A Systematic Review. Nutrients 2022, 14, 2110. https://doi.org/10.3390/nu14102110
Barnes O, Wilson RL, Gonzalo-Encabo P, Kang D-W, Christopher CN, Bentley T, Dieli-Conwright CM. The Effect of Exercise and Nutritional Interventions on Body Composition in Patients with Advanced or Metastatic Cancer: A Systematic Review. Nutrients. 2022; 14(10):2110. https://doi.org/10.3390/nu14102110
Chicago/Turabian StyleBarnes, Oscar, Rebekah L. Wilson, Paola Gonzalo-Encabo, Dong-Woo Kang, Cami N. Christopher, Thomas Bentley, and Christina M. Dieli-Conwright. 2022. "The Effect of Exercise and Nutritional Interventions on Body Composition in Patients with Advanced or Metastatic Cancer: A Systematic Review" Nutrients 14, no. 10: 2110. https://doi.org/10.3390/nu14102110