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. 2019 Jan 31;2019(1):CD009075. doi: 10.1002/14651858.CD009075.pub3

Knols 2011.

Methods Randomisation
  • 2 arms: 12‐weeks outpatient aerobic and strength exercises versus usual care


Recruitment period
  • January 2005 to May 2008


Median follow‐up time
  • 12 weeks


Sample size calculation
  • Reported, sample size 64 participants per arm

Participants Eligibility criteria
  • Adults (≥ 18 years of age)

  • 3 weeks up to 6 months after autologous or allogeneic stem cell transplantation

  • Without graft versus host disease > grade I or requiring treatment

  • Written informed consent


Participants (N = 131)
  • Intervention group (N = 64)

  • Control group (N = 67)


Mean age
  • Intervention group: 46.7 (18 to 75) years

  • Control group: 46.6 (20 to 67) years


Stage/type of disease
  • Intervention group: 5 Hodgkin lymphoma, 11 NHL, 17 multiple myeloma, 19 AML, 5 CLL, 7 other; 27 allogeneic stem cell transplantation, 37 autologous stem cell transplantation

  • Control group: 9 Hodgkin lymphoma, 14 NHL, 20 multiple myeloma, 12 AML, 9 CLL, 2 ALL, 1 other; 24 allogeneic stem cell transplantation, 43 autologous stem cell transplantation


Country
  • Switzerland

Interventions Exercise group
  • All participants started with a 10‐minutes warming up on an ergometer cycle or walking treadmill

  • Aerobic performance for at least 20 minutes (from 50% to 60% of maximum heart rate (220 ‐ participant's age) to 70% to 80%)

  • Progressive resistance training including squats, step‐ups and ‐downs, barbell rotation, upright rowing. Could be extended to chest press, triceps extension, biceps curl and calf raises.


Control group
  • Usual care, without any structured or supervised training and without encouragement to do physical exercise

Outcomes Reported and analysed in this review
  • Physical function

  • Fatigue

  • Physical performance

  • Anthopometric measures

Notes Financially supported by Zürcher Krebsliga ("Zurich cancer league") and Eidgenössische Sportkommission (Federal Authorities of the Swiss Confederation, Federal Department of Defence, Civil Protection and Sport)
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Low risk Quote: "minimization procedure was used to achieve an optimal balance between groups for the factors age, sex and type of transplantation"
Allocation concealment (selection bias) Low risk Quote: "opaque envelopes"
Blinding of participants and personnel (performance bias) 
 All outcomes High risk Blinding in this context is not feasible
Blinding of outcome assessor (primary endpoint; mortality) Low risk Outcome not reported. The review authors judge that the outcome mortality in this unblinded trial is unlikely to be influenced by lack of blinding
Blinding of outcome assessor (patient‐reported outcomes) High risk Blinding in this context is not feasible
Blinding of outcome assessor (physical performance, AEs, SAEs) Unclear risk Not reported
Incomplete outcome data (attrition bias) 
 All outcomes Low risk "was carried out on intention to treat analysis"
Selective reporting (reporting bias) Unclear risk Protocol not available
Other bias Low risk Financially supported by Zürcher Krebsliga ("Zurich cancer league") and Eidgenössische Sportkommission (Federal Authorities of the Swiss Confederation, Federal Department of Defence, Civil Protection and Sport). Any bias due to this support is not expected