Summary of findings 1. Summary of findings.
| Exercise intervention compared with usual care on HRQoL and HRQoL domains for cancer survivors | ||||||
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Patient or population: Cancer survivors who have completed active cancer treatment Settings: Varied Intervention: Exercise interventions (varied) Comparison: Usual care | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Comparison group | Exercise intervention group | |||||
| Overall quality of life change score ‐ up to 12 weeks' follow‐up | The standardized mean change from baseline to up to 12 weeks' follow‐up in overall quality of life ranged across control groups from ‐0.59 to 0.56 standard deviation units | The standardized mean change from baseline to up to 12 weeks' follow‐up in overall quality of life in the exercise groups was 0.48 standard deviation units higher (0.16 to 0.81 standard deviation units higher) | 826 (11 studies) | ⊕⊕⊝⊝ low1,2 | (SMD 0.48; 95% CI 0.16 to 0.81) A standard deviation units is equivalent to about a 14.5‐point change using the FACT‐G HRQoL form or a 18.5‐point change using the QLQ‐C30 HRQoL form |
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| Overall quality of life change score ‐ 6 months' follow‐up | The standardized mean change from baseline to 6 months' follow‐up in overall quality of life ranged across control groups from ‐0.32 to 0.15 standard deviation units | The standardized mean change from baseline to 6 months' follow‐up in overall quality of life in the exercise groups was 0.46 standard deviation units higher (0.09 to 0.84 standard deviation units higher) | 115 (2 studies) | ⊕⊕⊕⊝ moderate1,3 | (SMD 0.46; 95% CI 0.09 to 0.84) | |
| Overall anxiety change ‐ Up to 12 weeks' follow‐up | The standardized mean change from baseline to up to 12 weeks' follow‐up in overall anxiety ranged across control groups from ‐0.25 to 0.04 standard deviation units | The standardized mean change from baseline to up to 12 weeks' follow‐up in overall anxiety in the exercise groups was ‐0.26 standard deviation units lower (‐0.44 to ‐0.07 standard deviation units lower) | 455 (4 studies) | ⊕⊕⊝⊝ low1,4,5 | (SMD ‐0.26; 95% CI ‐0.44 to ‐0.07) A standard deviation unit is equivalent to about a 3.4‐point change using the HADS scale or about a 11.5‐point change using the STAI scale |
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| Overall emotional well‐being/mental health change ‐ up to 12 weeks' follow‐up | The standardized mean change from baseline to up to 12 weeks' follow‐up in overall emotional well‐being/mental health ranged across control groups from ‐0.48 to 0.46 standard deviation units | The standardized mean change from baseline to up to 12 weeks' follow‐up in overall emotional well‐being/mental health in the exercise groups was 0.33 standard deviation units higher (0.05 to 0.61 standard deviation units higher) | 632 (8 studies) | ⊕⊕⊝⊝ low1,2,4,5 | (SMD 0.33; 95% CI 0.05 to 0.61) A standard deviation unit is equivalent to about a 24‐point change on the QLQ‐C30 emotional function sub‐scale or about a 5‐point change on the FACT‐emotion sub‐scale |
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| Overall fatigue change ‐ Up to 12 weeks' follow‐up | The standardized mean change from baseline to up to 12 weeks' follow‐up in overall fatigue ranged across control groups from ‐0.29 to 0.44 standard deviation units | The standardized mean change from baseline to up to 12 weeks' follow‐up in overall fatigue in the exercise groups was ‐0.82 standard deviation units lower (‐1.50 to ‐0.14 standard deviation units lower) | 745 (10 studies) | ⊕⊕⊕⊝ moderate1 | (SMD ‐0.82; 95% CI ‐1.50 to ‐0.14) A standard deviation unit is equivalent to about a 21‐point change on the QLQ‐C30 fatigue subscale or about a 11‐point change on the FACT‐F sub‐scale |
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| Overall fatigue change ‐ More than 12 weeks less than 6 months' follow‐up | The standardized mean change from baseline to between 12 weeks and 6 month follow‐up in overall fatigue ranged across control groups from ‐0.27 to 0.74 standard deviation units | The standardized mean change from baseline to between 12 weeks and 6 month follow‐up in overall fatigue in the exercise groups was ‐0.42 standard deviation units lower (‐0.83 to ‐0.02 standard deviation units lower) | 246 (3 studies) | ⊕⊕⊝⊝ low1,2,3 | (SMD ‐0.42; 95% CI ‐0.83 to ‐0.02) | |
| Overall pain follow‐up values ‐ up to 12 weeks' follow‐up | The standardized mean follow‐up values in overall pain for up to 12 weeks' follow‐up ranged across control groups from 0.94 to 9.67 standard deviation units | The standardized mean follow‐up values in overall pain for up to 12 weeks' follow‐up in the exercise groups was ‐0.29 standard deviation units lower (‐0.55 to ‐0.04 standard deviation units lower) | 289 (4 studies) | ⊕⊕⊕⊝ moderate1,3 | (SMD ‐0.29; 95% CI ‐0.55 to ‐0.04) A standard deviation unit is equivalent to about a 28‐point change on the QLQ‐C30 pain sub‐scale |
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| Overall sexuality change ‐ 6 months' follow‐up | The standardized mean change from baseline to 6 months' follow‐up in overall sexuality change ranged across control groups from ‐0.01 to 0.04 standard deviation units | The standardized mean change from baseline to 6 months' follow‐up in overall sexuality change in the exercise groups was 0.40 standard deviation units higher (0.11 to 0.68 standard deviation units higher) | 193 (2 studies) | ⊕⊕⊕⊝ moderate1,3 | (SMD 0.40; 95% CI 0.11 to 0.68) | |
| Overall sleep disturbance follow‐up values ‐ up to 12 weeks' follow‐up | The standardized mean change from baseline to up to 12 weeks' follow‐up in overall sleep disturbance ranged across control groups from 1.02 to 9.71 standard deviation units | The standardized mean change from baseline to up to 12 weeks' follow‐up in overall sleep disturbance in the exercise groups was ‐0.46 standard deviation units lower (‐0.72 to ‐0.20 standard deviation units lower) | 438 (8 studies) | ⊕⊕⊕⊝ moderate1 | (SMD ‐0.46; 95% CI ‐0.72 to ‐0.20) A standard deviation unit is equivalent to about a 6‐point change on the PSQI |
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| Overall social functioning change ‐ up to 12 weeks' follow‐up | The standardized mean change from baseline to up to 12 weeks' follow‐up in overall social functioning ranged across control groups from ‐0.44 to 0.11 standard deviation units | The standardized mean change from baseline to up to 12 weeks' follow‐up in overall social functioning in the exercise groups was 0.45 standard deviation units higher (0.02 to 0.87 standard deviation units higher) | 386 (5 studies) | ⊕⊝⊝⊝ very low1,2,3,4,5 | (SMD 0.45; 95% CI 0.02 to 0.87) A standard deviation unit is equivalent to about a 25‐point change on the QLQ‐C30 social functioning subscale or about a 6‐point change on the FACT‐Social subscale |
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| Overall social functioning change ‐ 6 months' follow‐up | The standardized mean change from baseline to 6 month follow‐up in overall social functioning ranged across control groups from ‐0.59 to ‐0.31 standard deviation units | The standardized mean change from baseline to 6 month follow‐up in overall social functioning in the exercise groups was 0.49 standard deviation units higher (0.11 to 0.87 standard deviation units higher) | 110 (2 studies) | ⊕⊕⊕⊝ moderate1,3 | (SMD 0.49; 95% CI 0.11 to 0.87) | |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; EORTC QLQ‐C30: European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core Module; FACT‐emotion: Functional Assessment of Cancer Therapy ‐ emotion; FACT‐F: Functional Assessment of Cancer Therapy ‐ Fatigue; FACT‐G: Functional Assessment of Cancer Therapy ‐ General; FACT‐Social: Functional Assessment of Cancer Therapy ‐ Social; HADS: Hospital Anxiety and Depression Scale; HRQoL: health‐related quality of life; PSQI: Pittsburgh Sleep Quality Index; SMD: standardized mean difference; STAI: State‐Trait Anxiety Index. | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
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.
4 Random sequence generation was unclear in half or more of the trials.
5 Allocation concealment was unclear in half or more the trials.