TABLE 1.
Descriptive characteristics of included studies.
| Population characteristics at baseline | Outcomes | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Reference | Country | Design | Age, years | Sample size [n (% male)] | BMI, kg/m2 | Height, cm/m | Weight, kg | Cancer-type | Treatment phase/Type | Method | Baseline bone | Follow-up | |
| Hartman et al. (2009) | Netherlands | Prospective randomised study | Exercise group: Mean (range) 5.3 (1.3–15.6)Control group: Mean (range) 6.2 (1.7–17.1) | Exercise group: 20 (56%)Control group:21 (62%) | Exercise group: SDS-0.33Control group: SDS-0.38 | Exercise group: SDS-0.11Control group: SDS-0.10 | Exercise group: SDS-0.40Control group: SDS-0.09 | Exercise group: 25 Acute lymphoblastic leukemiaControl group: 26 Acute lymphoblastic leukemia | During treatment/Chemotherapy | X-ray absorptiometry (DXA; Lunar DPX-L, Madison, WI) | Exercise group: SDS WB aBMD (g/cm2): −0.10LS aBMD (g/cm2): −0.42LS BMAD (g/cm2): 0.14Control group: SDS WB aBMD (g/cm2): −0.18LS aBMD (g/cm2): −0.96LS BMAD (g/cm2): −0.48 | Exercise group: SDS WB ΔaBMD (g/cm2): 0.42LS ΔaBMD (g/cm2): 0.10LS ΔBMAD (g/cm2): 0.12Control group: SDS WB ΔaBMD (g/cm2): 0.35LS ΔaBMD (g/cm2): 0.14LS ΔBMAD (g/cm2): −0.04 | |
| Müller et al. (2014) | Germany | Non-randomised interventional study |
Exercise group:
Mean ± SD 15.2 ± 2.0 Control group: Mean ± SD 12.2 ± 2.6 |
Exercise group:
10 (40%) Control group: 11 (45%) |
Exercise group:
Mean ± SD 19.9 ± 2.9 Control group: Mean ± SD 18.2 ± 3.9 |
Exercise group:
Mean ± SD 1.71 ± 0.10 Control group: Mean ± SD 1.54 ± 0.08 |
Exercise group:
Mean ± SD 57.9 ± 7.2 Control group: Mean ± SD 44.0 ± 12.6 |
Exercise group: 7 osteosarcomas and 3 Ewing sarcoma Control group: 7 osteosarcomas and 4 Ewing sarcoma |
During treatment/Surgery and/or radiotherapy | X-ray absorptiometry (DXA), Lunar Prodigy system (enCore 2006; Software version 10.51.006, GE Healthcare) |
Exercise group:
Mean (SEM) LS (L2-L4) vBMD (g/cm3): 0.348, (0.020) LS (L2-L4) aBMD (g/cm2): 1.074 (0.054) LS (L2-L4) BMC (g): 42.06 (2.58) FN vBMD (g/cm3): 0.418 (0.024) FN aBMD (g/cm2): 1.103 (0.043) FN BMC (g): 4.85 (0.27) Control group: Mean (SEM) LS (L2-L4) vBMD (g/cm3): 0.322 (0.019) LS (L2-L4) aBMD (g/cm2): 0.961 (0.050) LS (L2-L4) BMC (g): 35.47 (2.43) FN vBMD (g/cm3): 0.381 (0.023) FN aBMD (g/cm2): 0.898 (0.040) FN BMC (g): 4.06 (0.25) |
Exercise group: Mean (SEM)
LS (L2-L4) vBMD (g/cm3): 0.347, (0.018) LS (L2-L4) aBMD (g/cm2): 1.068 (0.055) LS (L2-L4) BMC (g): 41.23 (2.76) FN vBMD (g/cm3): 0.406 (0.027) FN aBMD (g/cm2): 0.998 (0.052) FN BMC (g): 4.72 (0.30) Control group: Mean (SEM) LS (L2-L4) vBMD (g/cm3): 0.294 (0.017) LS (L2-L4) aBMD (g/cm2): 0.875 (0.051) LS (L2-L4) BMC (g): 32.97 (2.60) FN vBMD (g/cm3): 0.332 (0.027) FN aBMD (g/cm2): 0.791 (0.052) FN BMC (g): 3.63 (0.30) |
|
| Cox et al. (2018) | United States and Canada | RCT | NR |
Exercise group: 35 ( 64.2%) Control group: 40 (66.7%) |
NR | NR | NR |
Exercise group: 53 Acute lymphoblastic leukemia Control group: 55 Acute lymphoblastic leukemia |
During treatment/Chemotherapy | Dual-energy X-ray absorptiometry (DEXA) using the GE Lunar Prodigy (Atlanta and Toronto) or the Hologic (SJCRH and MDA) |
Exercise group:
LS (L1-L4): Z-score (SEM) −0.21 (±1.27) Control group: LS (L1-L4) Z-score: Z-score (SEM) −0.62 (±1.14) |
Exercise group:
LS (L1-L4) Z-score: Z-score (SEM) −0.55 (±0.86) Control group: LS (L1-L4) Z-score: Z-score (SEM) −0.78 (±1.11) |
|
| Waked and Albenasy (2018) | Saudi Arabia | RCT |
Exercise group:
Mean ± SD 9.26 ± 2.39 Control group: Mean ± SD 9.91 ± 2.09 |
Exercise group:
23 (65.2%) Control group: 23 (78.3%) |
Exercise group:
Mean ± SD 18.15 ± 1.79 Control group: Mean ± SD 19.12 ± 1.56 |
Exercise group:
Mean ± SD 124.13 ± 11.95 Control group: Mean ± SD 129.30 ± 10.8 |
Exercise group:
Mean ± SD 28.52 ± 7.39 Control group: Mean ± SD 32.26 ± 6.57 |
Exercise group: 23 Acute lymphoblastic leukemia Control group: 23 Acute lymphoblastic leukemia |
During treatment/Chemotherapy | Dual Energy X-ray Absorptiometry (DEXA) (DXA, Lunar DPXL/PED, Madison, Wisconsin, United States). |
Exercise group:
Mean (SD) WB aBMD (g/cm2): 0.811 ± 0.072 LS (L2-L4) aBMD (g/cm2): 0.727 ± 0.059 Control group: Mean (SD) WB aBMD (g/cm2): 0.814 ± 0.071 LS (L2-L4) aBMD (g/cm2): 0.712 ± 0.050 |
Exercise group:
Mean (SD) 6 months WB aBMD (g/cm2): 0.842 ± 0.076 LS (L2-L4) aBMD (g/cm2): 0.778 ± 0.035 12 months WB aBMD (g/cm2): 0.869 ± 0.069 LS (L2-L4) aBMD (g/cm2): 0.808 ± 0.058 Control group: Mean (SD) 6 months WB aBMD (g/cm2): 0.805 ± 0.056 LS (L2-L4) aBMD (g/cm2): 0.716 ± 0.040 12 months WB aBMD (g/cm2): 0.797 ± 0.055 LS (L2-L4) aBMD (g/cm2): 0.724 ± 0.032 |
|
| Dubnov-Raz et al. (2015) | Israel | Interventional trial |
Exercise group:
Mean (range) 11.1 (7.8–13.8) Control group: Mean (range) 11.8 (9.0–12.8) |
Exercise group: 10 (40%) Control group: 11 (50%) |
Exercise group:
Mean (range) 19.6 (17.6–3.9) Control group: Mean (range) 18.7 (17.1–21.2) |
Exercise group:
Mean (range) 144 (130–152) Control group: Mean (range) 148 (127–158) |
Exercise group:
Mean (range) (33.0–52.8) Control group: Mean (range) 40.6 (29.1–54.9) |
Exercise group: 5 Acute lymphoblastic leukemia, 1 Burkitt lymphoma, 1 acute myeloid leukemia, 1 acute promyelocytic leukemia, 1 juvenile myelomonocytic leukemia and 1 neuroblastoma Control group: 3 Acute lymphoblastic leukemia, 2 Burkitt lymphoma, 2 Hodgkin lymphoma, 1 medulloblastoma, 1 rhabdomyosarcoma, 1 Wilms’ tumor, 1 severe aplastic anemia and 1 Wiskott–Aldrich syndrome |
After treatment/Chemotherapy and/or steroids and/or bone marrow transplantation | Dual energy X-ray absorptiometry with Lunar DPX software version 3.6 (Lunar Prodigy; General Electric Healthcare, Madison, Wisconsin, United States) |
Exercise group: Median (IQR)
B aBMD (g/cm2): 0.95 (0.87–1.01) WB BMC: (g): 1435 (1117–2051) LS (L1-L4) aBMD (g/cm2): 0.84 (0.78–0.92) FN aBMD (g/cm2): 0.85 (0.75–0.89) Control group: Median (IQR) WB aBMD (g/cm2): 0.90 (0.87–0.99) WB BMC (g): 1293 (1124–2069) LS (L1-L4) aBMD (g/cm2): 0.75 (0.63–0.82) FN aBMD (g/cm2): 0.82 (0.70–0.97) |
Exercise group:
Median (IQR) WB aBMD (g/cm2): 0.97 (0.86–1.03) WB BMC (g): 1631 (1076–1993) LS (L1-L4) aBMD (g/cm2): 0.88 (0.79–0.97) FN aBMD (g/cm2): 0.89 (0.82–0.95) Control group: Median (IQR) WB aBMD (g/cm2): 0.91 (0.90–1.03) WB BMC (g): 1445 (1222–2139) LS (L1-L4) aBMD (g/cm2): 0.79 (0.69–0.85) FN aBMD (g/cm2): 0.86 (0.72–0.97) |
|
| Braam et al. (2018) | Netherlands | RCT |
Exercise group:
Mean ± SD 13.4 ± 3.1 Control group: Mean ± SD 13.1 ± 3.1 |
Exercise group: 26 (53%) Control group: 33 (55%) |
NR |
Exercise group:
Mean ± SD 158.9 ± 16.5 Control group: Mean ± SD 154.5 ± 17.2 |
Exercise group:
Mean ± SD 51.6 ± 16.0 Control group: Mean ± SD 49.2 ± 16.9 |
Exercise group: 8 Acute lymphoblastic leukemia, 12 acute myeloid leukemia or Hodgkin lymphoma or non-Hodgkin lymphoma or chronic myeloid leukemia or Burkitt, 1 central nervous system/brain tumor and 9 solid tumors Control group: 12 Acute lymphoblastic leukemia, 13 acute myeloid leukemia or Hodgkin lymphoma or non-Hodgkin lymphoma or chronic myeloid leukemia or Burkitt, 6 centrals nervous system/brain tumor and 7 solid tumors |
After treatment/Chemotherapy and/or radiotherapy | Dual-energy-X-ray absorptiometry (DXA)-scanner. (Hologic DXA scanner with the same software) + Lunar |
Exercise group:
Mean (SD) LS (L1-L4) aBMD (g/cm2): 0.78 (±0.21) Control group: Mean (SD) LS (L1-L4) aBMD (g/cm2): 0.75 (±0.18) |
Exercise group:
Mean (SD) Post Short-term LS (L1-L4) aBMD (g/cm2): 0.78 (±0.20) Post Long-term LS (L1-L4) aBMD (g/cm2): 0.83 (±0.23) Control group: Mean (SD) Post Short-term LS (L1-L4) aBMD (g/cm2): 0.76 (±0.20) Post Long-term LS (L1-L4) aBMD (g/cm2): 0.78 (±0.21) |
|
| Mogil et al. (2016) | United States | Prospective, double-blind, placebo-controlled trial |
Exercise group:
Mean ± SD 13.6 ± 3.7 Control group: Mean ± SD 13.6 ± 2.9 |
Exercise group:
22 (56.2%) Control group: 26 (51.5%) |
NR | NR | NR | NR | After treatment/Unspecified | X-ray absorptiometry (DEXA, 4500 QDR-A/Discovery fan beam; Hologic | NR |
Exercise group:
Mean change (SD) WB BMC/height, total, %: 1.71 (9.01) WB BMD/height, total, %: 6.56 (7.64) LS BMC/height, total, %: 3.70 (21.20) LS BMD/height, total, %: 4.91 (10.34) LS vBMD, %: 5.64 (10.83) Control group: Mean change (SD) WB BMC/height, total, %: 3.99 (8.97) WB BMD/height, total, %: 3.45 (7.60) LS BMC/height, total, %: 2.54 (21.06) LS BMD/height, total, %: 5.01 (10.29) LS vBMD, %: 5.30 (11.06) |
|
| Elnaggar and Mohamed (2021) | Saudi Arabia | Prospective, single-blinded quasi-experimental study |
Exercise group:
Mean ± SD 13.33 ± 3.13 Control group: Mean ± SD 12.87 ± 2.56 |
Exercise group: 15 (73.3%) Control group: 15 (53.3%) |
Exercise group:
Mean ± SD 22.53 ± 1.40 Control group: Mean ± SD 21.89 ± 1.57 |
Exercise group:
Mean ± SD 145 ± 14 Control group: Mean ± SD 149 ± 0.13 |
Exercise group:
Mean ± SD 48.20 ± 10.86 Control group: Mean ± SD 49.80 ± 11.54 |
Exercise group: 15 Acute lymphoblastic leukemia Control group: 15 Acute lymphoblastic leukemia |
After treatment/Unspecified | Lunar DPX-L pediatric software and dual-energy x-ray absorptiometry (DEXA) device (GE-Lunar) |
Exercise group:
Mean (SD) LS (L 2 through L 5 segment) aBMD (g/cm2): 0.64 ± 0.10 LS (L 2 through L 5 segment) vBMD (g/cm3): 0.32 ± 0.04 LS BMC (L 2 through L 5 segment) (g): 33.91 ± 7.12 FN aBMD (g/cm2): 0.59 ± 0.06 FN vBMD (g/cm3): 0.31 ± 0.04 FN BMC (g): 32.35 ± 6.69 Control group: Mean (SD) LS (L 2 through L 5 segment) aBMD (g/cm2): 0.61 ± 0.06 LS (L 2 through L 5 segment) vBMD (g/cm3): 0.30 ± 0.03 LS (L 2 through L 5 segment) BMC (g/cm): 30.63 ± 5.92 FC aBMD (g/cm2): 0.62 ± 0.05 FN vBMD (g/cm3): 0.30 ± 0.04 FN BMC (g): 32.88 ± 6.16 |
Exercise group:
Mean (SD) LS (L 2 through L 5 segment) aBMD (g/cm2): 0.70 ± 0.06 LS (L 2 through L 5 segment) vBMD (g/cm3): 0.36 ± 0.03 LS (L 2 through L 5 segment) BMC (g): 37.46 ± 4.59 FN aBMD (g/cm2): 0.67 ± 0.07 FN vBMD (g/cm3): 0.34 ± 0.03 FN BMC (g): 37.76 ± 5.65 Control group: Mean (SD) LS (L 2 through L 5 segment) aBMD (g/cm2): 0.64 ± 0.07 LS (L 2 through L 5 segment) vBMD (g/cm3): 0.32 ± 0.03 LS (L 2 through L 5 segment) BMC (g): 33.29 ± 4.14 FC aBMD (g/cm2): 0.63 ± 0.05 FN vBMD (g/cm3): 0.31 ± 0.04 FN BMC (g): 34.45 ± 5.02 |
|
Abbreviations: RCT, randomised controlled trial; WB, whole body; LS, lumbar spine; FN, femoral neck; aBMD, areal bone mineral density; vBMD, volumetric bone mineral density; BMAD, bone mineral apparent density; BMC, bone mineral content; SDS, standard deviation scores; NR, not reported.