Quality of life for men with metastatic castrate-resistant prostate cancer participating in an aerobic and resistance exercise pilot intervention

Feasibility, safety, and adherence of home-based exercise interventions in people diagnosed with cancer: a systematic review

PURPOSE

This systematic review aims to evaluate the feasibility, safety, and adherence of home-based exercise interventions in people diagnosed with cancer. The primary research question is: Are home-based exercise interventions safe and feasible for people diagnosed with cancer?

METHODS

A comprehensive search of databases including PubMed, EMBASE, and Cochrane Library was conducted in January 2025, focusing on randomized controlled trials (RCTs) that involved home-based exercise interventions people diagnosed with cancer. Studies were included if they reported on safety, feasibility, and health-related outcomes. The Physiotherapy Evidence Database (PEDro) scale was used to assess study quality and risk of bias. Adverse events were categorized by severity, and feasibility which was determined based on recruitment, withdrawal, and adherence rates.

RESULTS

From 127 eligible studies involving 10,562 participants, the review found that home-based exercise interventions are generally safe, with less than 3.2% of participants experiencing exercise-related adverse events, most of which were minor. Feasibility was supported by an average recruitment rate of 50.1%, which was calculated as the proportion of eligible participants who consented to participate across the included studies. Additionally, the review found a withdrawal rate of 13.7%, and an adherence rate of 76.2%. However, significant variability in these rates were observed across the studies, highlighting the challenges in maintaining participant engagement.

CONCLUSIONS

Home-based exercise interventions are feasible and safe for people diagnosed with cancer, with minor adverse events being the most common. However, there is a need for standardized protocols in reporting adverse events and better strategies to improve recruitment and adherence.

IMPLICATIONS FOR CANCER SURVIVORS

These findings support the integration of home-based exercise into standard cancer care, offering a practical and safe option for enhancing the health and well-being of cancer survivors. However, the successful implementation of these programs may require additional support from exercise professionals within primary care or community settings to ensure appropriate guidance and adherence. Personalized exercise programs, developed by qualified exercise professionals such as physiotherapists or clinical exercise physiologists, and improved reporting standards are essential to optimizing these interventions.

Exercise Interventions for Depression, Anxiety, and Quality of Life in Older Adults With Cancer: A Systematic Review and Meta-Analysis

Importance

Cancer and its treatment negatively impact the mental health of older adults. The potential of exercise interventions as a complementary treatment to alleviate the psychological impacts of cancer is promising, but there are gaps in the current literature.

Objective

To determine if exercise interventions are associated with improvements in psychological outcomes among older adults with cancer.

Data Sources

PubMed, Embase, PsycINFO, and Cochrane databases were searched from database inception to November 5, 2024. Search terms used were geriatrics, cancer, depression, anxiety, quality of life, and exercise interventions.

Study Selection

English-language randomized clinical trials (RCTs) that analyzed the association of various exercise interventions with at least 1 of 3 psychological outcomes (depression, anxiety, or health-related quality-of-life [HRQOL]) were included. The control groups were given usual care. Studies were included if the mean age of participants was older than 60 years and had participants with a diagnosis of any cancer regardless of comorbidities.

Data Extraction and Synthesis

Studies were screened, and data were extracted by 2 independent authors. Random-effects meta-analyses and meta-regressions were used for analysis. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was followed.

Main Outcomes and Measures

The primary outcomes were depression, anxiety, and HRQOL. Standardized mean difference (SMD) was used to quantify the association of exercise interventions with outcomes.

Results

A total of 27 RCTs with 1929 participants were included. Meta-analyses observed an association of exercise with a significant reduction in levels of depression (SMD = -0.53; 95% CI, -0.79 to -0.28) and anxiety (SMD = -0.39; 95% CI, -0.66 to -0.12) and improvements in overall HRQOL (SMD = 0.63; 95% CI, 0.10 to 1.17). Subgroup analyses revealed that mind-body exercise interventions were significantly associated with improved depression (SMD = -0.89; 95% CI, -1.51 to -0.27) and anxiety levels (SMD = -0.77; 95% CI, -1.54 to -0.01) compared with conventional exercise interventions.

Conclusion

In this systematic review and meta-analysis of 27 RCTs, exercise interventions were found to be associated with significantly reduced levels of depression and anxiety and significantly improved HRQOL in older adults with cancer. These findings suggest that health care professionals and policymakers should focus more on implementing exercise interventions to improve mental health outcomes in this vulnerable population.

Effects of exercise on sleep quality in general population: Meta-analysis and systematic review

PURPOSE

Sleep is the foundation of human physiological health and psychological health, as well as one of the basic needs for human survival. Sleep quality problems are prevalent in the population, and poor sleep quality is often closely related to the occurrence of many diseases, which seriously affects the quality of life and may even result in a shortened lifespan, so that improving sleep health has become a real problem that needs to be solved urgently. Exercise, as an important non-pharmacological tool, has been widely used for sleep quality enhancement, while the efficacy of exercise on subjective and objective sleep with respect to individual sleep quality remains controversial. Therefore, the aim of this meta-analysis was to compare the effects of exercise on subjective sleep quality and objective sleep efficiency in a non-athlete population, and to further rank the effectiveness of exercise types to provide appropriate means of exercise to improve sleep.

METHODS

This study was evaluated by literature search in five databases, PubMed, Embase, Web of Science, Cochrane, and EBSCO, and paired meta-analysis and network meta-analysis were performed using Review Manager 5.3 and stata16.0.

RESULTS

A total of 7494 studies were retrieved, and 81 eligible randomized controlled trials involving 6193 subjects were finally included. The primary outcome metrics included subjective sleep quality (PSQI), and the secondary outcome was objective sleep efficiency (SE), of which 65 reported PSQI and 23 reported SE. The results of paired meta-analysis showed that exercise significantly decreased PSQI [MD = -1.77, (95 % CI = -2.28,-1.25),P < 0.05] and increased SE [MD = 4.81, (95 % CI = 2.89,6.73),P < 0.05]. The results of the network meta-analysis showed that body and mind exercise [MD = -2.28, (95 % CI = -3.19,-1.36),P < 0.05, SUCRA = 85.6] may be the best exercise to improve PSQI, and aerobic exercise [MD = 5.02, (95 % CI = 2.52,7.52),P < 0.05, SUCRA = 75.1] is most likely to be the best type of exercise to improve SE. In regression analyses, there was a moderating effect of exercise cycle (β = -0.25 [0.40, 0.46], SE = 0.10 [P = 0.015, R2 = 0.24]) and age (β = -0.20 [-0.04, -0.01, SE = -2.06 [P = 0.039,R2 = 0.16]) as moderators of objective sleep efficiency.

CONCLUSION

Exercise is effective in improving both subjective and objective sleep quality. Body and mind exercise, aerobic exercise, and aerobic combined with resistance exercise may be the preferred way to improve sleep, and the longer the exercise cycle, the more obvious the improvement in sleep effect, the improvement effect will gradually decrease with age.

The Effect of Resistance and/or Aerobic Training on Quality of Life, Fitness, and Body Composition in Prostate Cancer Patients-A Systematic Review and Meta-Analysis

Background: Prostate cancer (PC) and its treatment are often associated with side effects such as fatigue, muscle loss, and diminished quality of life (QoL). Physical exercise, particularly resistance training (RT) and aerobic training (AT), has been suggested as a strategy to mitigate these effects. However, the comparative efficacy of RT, AT, and combined RT/AT on QoL, body composition, physical fitness, and laboratory markers in PC patients is still insufficiently understood. Methods: Randomized controlled trials (RCTs) investigating structured RT, AT, or combined RT/AT programs in PC patients undergoing various treatments were included. The primary outcome was QoL, assessed using EORTC QLQ-C30 and EORTC QLQ-PR25 questionnaires. Secondary outcomes included body composition, fitness, and laboratory parameters. The studies were sourced from PubMed, Embase, and CENTRAL through May 2024. The effect sizes were pooled using random-effects models, and the risk of bias was systematically assessed following the GRADE approach. Results: A total of 30 RCTs, encompassing 2216 PC patients, were analyzed. Combined RT/AT significantly improved QoL subdomains, including global health, and cognitive and sexual function, while reducing fatigue and urinary symptoms. RT alone improved body composition by increasing lean body mass and reducing body fat percentage. Both RT and combined RT/AT enhanced strength (chest and leg press) and VO2peak. No significant changes were observed in laboratory markers, such as PSA or lipid levels. The effects of isolated AT remain unclear due to limited data. Conclusions: RT and combined RT/AT significantly improve QoL, fitness, and body composition in PC patients, with no detectable effect on PSA or lipid levels. Further research is needed to elucidate the specific effects of AT and to investigate long-term outcomes.

Sleep and health improvement programme (SHIP) for patients with prostate cancer and caregivers

Objective

The objective of this study is to determine whether a sleep and health improvement programme (SHIP) to promote healthy sleep, eating and physical activity would be feasible, acceptable and have a positive impact on lifestyle behaviours for prostate cancer survivors and caregivers.

Methods

We recruited 50 participants for a single group 3-month pre-post pilot study. The SHIP intervention included (1) website about sleep, nutrition and physical activity (≥1 view/week), (2) two email newsletters with goal-setting exercises and resources and (3) midpoint health coach call. The primary outcome was changes in validated sleep scales; secondary outcomes included changes in diet, physical activity and concentration from baseline to 3 months.

Results

Of 50 participants enrolled, median age was 65, 30% were Black and 8% were Hispanic. Thirty-four patients and 7 family caregivers completed the pilot study (82%). Following the intervention, we observed a statistically significant improvement in the Sleep Hygiene Index (pre: 15, post: 13, p < 0.01), and a trend toward lower Insomnia Severity Index (pre: 12, post: 9, p = 0.07). There were no statistically significant improvements in sleep quality or physical activity, but there were improvements in healthy eating (e.g., increase in cruciferous vegetables and reduction in dairy) and in fatigue-related problems and concentration. Exit interview feedback was positive.

Conclusions

A web-based sleep and healthy lifestyle programme for patients with prostate cancer and their caregivers is feasible and acceptable. A randomized controlled trial is planned to test whether a refined SHIP improves sleep and lifestyle in patients with prostate cancer and caregivers.

Effects of resistance training on sleep quality and disorders among individuals diagnosed with cancer: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Sleep disorders are often complained by cancer patients and can last years after the end of therapies, leading to different negative consequences. Non-pharmacological strategies such as exercise interventions may be considered to counteract this phenomenon. The literature supports the beneficial effects of aerobic training (AT), while evidence on resistance training (RT) is scarce. Accordingly, our systematic review aims to investigate the potential novel effect of RT on sleep outcomes in cancer survivors.

METHODS

The literature search was conducted on MEDLINE (Pubmed), Web of Science, Scopus, and Cochrane Central Register of Controlled Trials databases, including only randomized controlled trials (RCTs). The screening procedure was conducted using the web-based software COVIDENCE. Sleep outcomes assessed through self-reported questionnaires or objective sleep measurements were extracted from RCTs recruiting cancer survivors of any age and gender, on or off treatment. The risk of bias (RoB) for each study was assessed using the Cochrane RoB 2 tool for RCTs. Meta-analytic syntheses were performed on sleep quality and insomnia.

RESULTS

A total of 21 studies were included in the review. Considering the mean percentage differences of all studies combined, promising positive results were found after combined aerobic and resistance exercise program (COMB) for sleep quality (-19%) and sleep disturbance (-17.3%). The meta-analysis results showed significant improvement for both sleep quality and insomnia (d = 0.28, SE: 0.11, Z = 2.51, p < 0.01, 95% CI: 0.07-0.49 and d = 0.43, SE: 0.20, Z = 2.18, p = 0.029, 95% CI: 0.07-0.49, respectively).

CONCLUSION

RT interventions of 60 minutes per session, performed 2-3 times a week for 12 weeks, with exercise intensity ranging from 60% to 80% of one-repetition maximum can be administered to cancer survivors, aiming to improve sleep outcomes.

Updated systematic review of the effects of exercise on understudied health outcomes in cancer survivors

INTRODUCTION

The American College of Sports Medicine provided guidelines for exercise prescriptions in cancer survivors for specific cancer- and treatment-related health outcomes. However, there was insufficient evidence to generate exercise prescriptions for 10 health outcomes of cancer treatment. We sought to update the state of evidence.

METHODS

We conducted a systematic review of these 10 understudied health outcomes (bone health, sleep, cardiovascular function, chemotherapy-induced peripheral neuropathy (CIPN), cognitive function, falls and balance, nausea, pain, sexual function, and treatment tolerance) and provided an update of evidence.

RESULTS

While the evidence base for each outcome has increased, there remains insufficient evidence to generate exercise prescriptions. Common limitations observed across outcomes included: variability in type and quality of outcome measurement tools, variability in definitions of the health outcomes, a lack of phase III trials, and a majority of trials investigating breast or prostate cancer survivors only.

CONCLUSION

We identified progress in the field of exercise oncology for several understudied cancer- and treatment-related health outcomes. However, we were not able to generate exercise prescriptions due to continued insufficient evidence base. More work is needed to prescribe exercise as medicine for these understudied health outcomes, and our review highlights several strategies to aid in research acceleration within these areas of exercise oncology.

Symptomatic benefit of momelotinib in patients with myelofibrosis: Results from the SIMPLIFY phase III studies

BACKGROUND

Myelofibrosis (MF)-associated constitutional symptoms can severely impact health-related quality of life. Clinical trials in MF traditionally measure symptom response to treatment as a landmark endpoint of total symptom score (TSS) reduction ≥50% from baseline. However, this dichotomous assessment provides a limited view of clinically relevant symptomatic changes. Herein we evaluated longitudinal change from baseline in TSS over the continuous 24-week period and individual symptom scores to obtain a more comprehensive understanding of symptom benefits experienced by patients with MF receiving therapy.

METHODS

Longitudinal symptom change was evaluated using mixed-effect model repeated measure (MMRM) methodology with individual item-level analyses to complement the interpretation of the landmark symptom results in the completed phase III SIMPLIFY studies of momelotinib in MF. MMRM compared mean change in TSS from baseline with Week 24 using data from all patient visits. Generalized estimating equations were used to estimate item-level odds ratios using multiple predictive imputations for missing data.

RESULTS

Momelotinib and ruxolitinib groups reported similar overall symptom improvements, with a TSS difference of <1.5 points between groups for each post-baseline visit in SIMPLIFY-1. In SIMPLIFY-2, the improvement in TSS observed in momelotinib-treated patients was consistent with that observed in SIMPLIFY-1, whereas progressive TSS deterioration was observed with control. Item-level scores were heterogeneous in both studies. A similar and greater proportion of momelotinib-treated patients were categorized as "improved" or "stable" compared with control in SIMPLIFY-1 and SIMPLIFY-2, respectively. Odds ratios for between-group comparison ranged from 0.75 to 1.21 in SIMPLIFY-1, demonstrating similarity in likelihood of symptom improvement. In SIMPLIFY-2, the likelihood of symptom improvement in each item was higher in the momelotinib arm.

CONCLUSIONS

These findings suggest that momelotinib provides clinically relevant symptom benefits in the JAK inhibitor-naïve and JAK inhibitor-exposed settings.