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1. Encontro 01
Ivan Ricardo Zimmermann
22/10/2013

2. Exercise interventions on healthrelated quality of life for
cancer survivors
Mishra SI, Scherer RW, Geigle
PM, Berlanstein DR, Topaloglu O, Gotay
CC, Snyder C.
Cochrane Database of Systematic
Reviews, Issue 8, 2012 (CD007566).

3. Background
• As treatments for cancers improve, the number
of cancer survivors is growing rapidly.
• These survivors experience many disease and
treatment-related adverse outcomes and poorer
health-related quality of life (HRQoL).
• Exercise interventions might alleviate these
adverse outcomes.

4. Objectives
• To evaluate the effectiveness of exercise on
overall HRQoL outcomes and specific HRQoL
domains (e.g. physical, psychological, etc)
• A secondary objective examined the
effectiveness of exercise on HRQoL outcomes
stratified (e.g. intensity of exercise, sex, etc)

5. Methods
• Participants: Cancer survivors diagnosed at 18 years or
older. (Studies in people who were terminally ill or where
most participants were undergoing active cancer treatment
were not eligible.)
• Intervention: Any physical activity causing an increase in
energy expenditure, and involving a planned or structured
movement of the body performed in a systematic manner (in
terms of frequency, intensity, and duration designed to
maintain or enhance health-related outcomes. (Dance was
excluded.)

6. Methods
• Comparison: No exercise, another intervention, or usual
care.
• Outcomes: Health-related quality of life, disease or
treatment-related outcomes, adverse effects.
• Studies: Randomised trials and controlled clinical trials.

7. Methods
•
•
•
•
•
CENTRAL,
MEDLINE,
EMBASE,
CINAHL,
LILACS
•
•
•
•
•
PsycINFO,
PEDRO,
SIGLE,
SportDiscus,
OTSeeker,
• Sociological
Abstracts
• Registers of
trials.
• Citations were checked through Web of Science and
Scopus, PubMed’s related article feature, and several
websites. References in reports of included trials and
other reviews were checked. No language restrictions.

8. Methods
• Random-effects model when trials reported
continuous data for health related quality of life:
– The mean difference (MD) and a, having used
the same method or scale;
– The standardized mean difference (SMD) if
different measurements were used for the
same domain.
• Trial data combined using Review Manager
(RevMan 5.1)

10. Results
• Searches were completed in October 2011, with
40 trials (3694 participants) identified as
appropriate for inclusion in the current review
(38 were RCTs).
• Exercise intervention included strength
training, resistance
training, walking, cycling, yoga, Qigong, or Tai
Chi. Frequency and varied across studies.

12. 1 It was not possible to blind study participants or people administering treatment.
2 Statistical heterogeneity was moderate to high.
3 The small total population sample size represents a small effect.

13. Results
• No evidence of effect was found for HRQoL
domains such as cognitive function, physical
functioning, general health perspective, and
spirituality
• There were positive trends and impact of
exercise intervention for depression and body
image.

14. Conclusions
• Exercise may have beneficial effects on HRQoL
including cancer specific concerns (e.g. breast
cancer), emotional well-being, sexuality, sleep
disturbance, etc, at varying follow-up periods.
• The results must be interpreted cautiously due
to the heterogeneity of exercise programs tested
and measures used to assess HRQoL, and the
risk of bias in many trials.

15. Conclusions
• Further research is required to determine
essential attributes of exercise
(mode, intensity, frequency, duration, timing) by
cancer type and cancer treatment for optimal
effects on HRQoL and its domains.

16. Pontos críticos
• Quão aplicável é a definição de “exercícios”
adotada?
• Qual o impacto da ausência de cegamento nos
estudos?
• As evidências são aplicáveis a exercícios em
geral?
• Os resultados não se aplicam aos indivíduos
excluídos por questões práticas?

17. Referências
• Mishra SI, Scherer RW, Geigle PM, Berlanstein DR, Topaloglu
O, Gotay CC, Snyder C. Exercise interventions on health-related
quality of life for cancer survivors. Cochrane Database of
Systematic Reviews 2012, Issue 8. Art. No.: CD007566. DOI:
10.1002/14651858.CD007566.pub2.
• Cochrane Journal Club: http://www.cochranejournalclub.com/

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