Table 1.
Summary characteristics and results of each study.
| Study Details | Population | Experimental Groups | Intervention | Body Composition Outcomes | Pre vs. Post Training Mean ± SD or MD ± SD/(95%CI) |
|---|---|---|---|---|---|
| Exercise only | |||||
| Cormie et al. [69] Australia RCT |
Population: Prostate cancer with bone metastases (n = 20) Stage: Metastatic: 100% |
EX (n allocated = 10; n completed outcome = 8): Supervised resistance training, home-based aerobic training. CON (n allocated = 10; n completed outcome = 7): Self-directed exercise |
12-week intervention Exercise component (FITT): F: RT = 2 days/week; AT = NR. I: RT = 8–12 RM; AT = moderate intensity. Time: RT = 60 min, 8–12 reps, 2–4 sets; AT = 150 min/week. Type: Supervised machine weight resistance training that did not target areas of bone metastases, self-directed home-based aerobic exercise. Adherence: attended 93% of supervised exercise sessions. |
Lean mass (kg) (DXA) |
Within-group differences: EX: PRE: 57.2 ± 7.8 vs. POST: 57.8 ± 8.0 CON: PRE: 53.2 ± 9.7 vs. POST: 52.5 ± 8.0 Between-group differences: EX vs. CON: MD: 1.7 (0.2 to 3.2) ¥↑ |
| Appendicular lean mass (kg) (DXA) |
Within-group differences: EX: PRE: 24.3 ± 3.7 vs. POST: 24.5 ± 3.7 CON: PRE: 21.4 ± 3.9 vs. POST: 20.9 ± 3.3 Between-group differences: EX vs. CON: MD: 1.0 (0.4 to 1.6) ¥↑ |
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| Fat mass (kg) (DXA) |
Within-group differences: EX: PRE: 27.7 ± 5.6 vs. POST: 27.8 ± 6.0 CON: PRE: 27.2 ± 5.7 vs. POST: 27.5 ± 6.5 Between-group differences: EX vs. CON: MD: −0.3 (−1.4 to 0.9) |
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| Trunk fat mass (kg) (DXA) |
Within-group differences: EX: PRE: 14.7 ± 3.4 vs. POST: 14.6 ± 3.7 CON: PRE: 15.0 ± 3.4 vs. POST: 15.0 ± 3.8 Between-group differences: EX vs. CON: MD: 0.0 (−0.6 to 0.6) |
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| Visceral fat mass (kg) (DXA) |
Within-group differences: EX: PRE: 0.89 ± 0.20 vs. POST: 0.89 ± 0.23 CON: PRE: 0.96 ± 0.19 vs. POST: 0.96 ± 0.19 Between-group differences: EX vs. CON: MD: 0.01 (−55.3 to 58.6) |
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| Body fat percent (%) (DXA) |
Within-group differences: EX: PRE: 31.7 ± 4.9 vs. POST: 31.5 ± 5.1 CON: PRE: 32.7 ± 2.2 vs. POST: 33.0 ± 3.3 Between-group differences: EX vs. CON: MD: −0.4 (−1.9 to 1.2) |
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| Uth et al. [67] Denmark RCT |
Population: Advanced or locally advanced prostate cancer (n = 57) Stage: ≥T3: 70.2% |
EX (n allocated = 29, n completed outcome = 26): Supervised football training CON (n allocated = 28, n completed outcome = 23): Usual care control. |
12-week intervention Exercise component (FITT): F: 2–3 days/week I: Not prescribed but a mean HR of 84.6 ± 3.9% of individual max HR was achieved. Time: 45 min Type: Football drills and game. Adherence: attended 76.5 ± 24.2% of supervised exercise sessions. |
Lean mass (kg) (DXA) |
Within-group differences: EX: MD: 0.5 (0.1 to 0.9) ¥↑ CON: MD: −0.2 (−0.6 to 0.2) Between-group differences: EX vs. CON: MD: 0.7 (0.1 to 1.2) ¥↑ |
| Fat mass (kg (DXA) |
Within-group differences: EX: MD: −0.6 (−1.4 to 0.1) CON: MD: 0.0 (−0.5 to 0.5) Between-group differences: EX vs. CON: MD: −0.6 (−1.5 to 0.2) |
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| Body fat percent (%) (DXA) |
Within-group differences: EX: MD: −0.7 (−1.3 to 0.0) CON: MD: 0.1 (−0.4 to 0.5) Between-group differences: EX vs. CON: MD: −0.7 (−1.5 to 0.2) |
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| Galvao et al. [73] Australia RCT |
Population: Prostate cancer with bone metastases(n = 57) Stage: Metastatic: 100% |
EX (n allocated = 28, n completed outcome = 23): Supervised aerobic and resistance exercise. CON (n allocated = 29, n completed outcome = 26): Usual care control. |
12-week intervention Exercise component (FITT): F: 3 days/week I: AT = 60–85% HRmax; RT = 10–12 RM Time: 60 min sessions; AT = 20–30 min; RT = 10–12 reps, 3 sets. Type: Exercises did not target bone metastases sites. AT = choice or walking, cycling, rowing; RT = machine based. Adherence: attended 89% of supervised exercise sessions. |
Lean mass (kg) (DXA) |
Within-group differences: EX: PRE: 56.6 ± 8.1 vs. POST: 56.2 ± 8.0 CON: PRE: 55.6 ± 7.8 vs. POST: 55.4 ± 7.5 Between-group differences: EX vs. CON: MD: −0.3 (−1.3 to 0.7) |
| Fat mass (kg) (DXA) |
Within-group differences: EX: PRE: 28.7 ± 8.1 vs. POST: 29.0 ± 7.8 CON: PRE: 28.3 ± 6.9 vs. POST: 29.0 ± 6.4 Between-group differences: EX vs. CON: MD: −0.2 (−1.2 to 0.7) |
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| Villumsen et al. [74] Denmark RCT |
Population: Locally advanced or advanced stage prostate cancer (n = 46) Stage: Bone metastases: 34.8% Lymph node metastases: 6.5% |
EX (n allocated = 23, n completed outcome = 21): Home-based exergaming CON (n allocated = 23, n completed outcome = 20): Usual care control inclusive of physical activity advice. |
12-week intervention Exercise component (FITT): F: 3 days/week I: NR Time: 60 min Type: Exergaming using both aerobic and strength exercises, free weights. Adherence: Completed on average 153.5 min/week from a prescribed 180 min/week. |
Lean mass (%) (BIA) |
Within-group differences: EX: NR CON: NR Between-group differences: EX vs. CON: MD: 0.91 (−0.2 to 2.0) |
| Fat mass (% (BIA) |
Within-group differences: EX: NR CON: NR Between-group differences: EX vs. CON: MD: −0.9 (−2.0 to 0.2) |
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| Stuecher et al. [75] Germany RCT |
Population: Stage III or IV gastrointestinal tract cancers(n = 44) Stage: Metastatic: NR |
EX (n allocated = 22, n completed outcome = 13): Self-directed walking. CON (n allocated = 22, n completed outcome = 15): Usual care control. |
12-week intervention Exercise component (FITT): F: 3–5 days/week I: 11–13 RPE Time: 150 min/week Type: Home-based walking. Adherence: 81.3% completed the home-based program as prescribed. |
Lean mass (%) (BIA) |
Within-group differences: EX: MD: 3.4 ± 4.6 CON: MD: 0.64 ± 3.4 Between-group differences: EX vs. CON: MD: NR, p = 0.02. ¥↑ |
| Phase angle (°) (BIA) |
Within-group differences: EX: MD: 0.13 ± 0.91 CON: MD: −0.01 ± 0.69 Between-group differences: EX vs. CON: MD: NR, p = 0.2 |
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| Bjerre et al. [78] Denmark RCT |
Population: Prostate cancer with bone metastases (n = 41) Stage: Metastatic: 100% |
EX (n allocated = 22, n completed outcome = 21): Community-based football intervention CON (n allocated = 19, n completed outcome = 15): Usual care |
6-month intervention Exercise component (FITT): F: 2 days/week I: NR Time: 60 min Type: Supervised group-based football training involving bodyweight training, football skills and football match play. Adherence: attended 63% of supervised group sessions (at week-12); attended 54% of supervised group sessions (at 6-months). |
Lean mass (kg) (DXA) |
Within-group differences: EX: MD: −0.3 (−1.1 to 0.5) CON: MD: −0.4 (−1.3 to 0.6) Between-group differences: EX vs. CON: MD: −0.2 (−1.4 to 0.9) |
| Fat mass (kg) (DXA) |
Within-group differences: EX: MD: −0.4 (−1.3 to 0.6) CON: MD: −0.2 (−1.4 to 1.0) Between-group differences: EX vs. CON: MD: 0.4 (−1.1 to 1.8) |
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| Combined exercise and nutrition | |||||
| Xu et al. [70] Taiwan RCT |
Population: Locally advanced tumors of the esophagus (n = 56) Stage: Stage 1: 3.6% Stage 2: 7.1% Stage 3: 82.1% |
EX + NU (n allocated = 28, n completed outcome = 28): Supervised walking and nutrition counselling. CON (n allocated = 28, n completed outcome = 28): Usual care control. |
4–5-week intervention Exercise component (FITT): F: 3 days/week I: 60% age predicted maximum HR Time: 25 min Type: Walking Nutrition component: Weekly nutrition counselling. Adherence: EX: Completed 8.4 ± 3.6 of supervised walking sessions.NU: attended 100% of nutrition sessions. |
Lean mass (kg) (BIA) |
Within-group differences: EX + NU: MD: −0.7 ± 1.9 CON: MD: −2.0 ± 3.0 Between-group differences: EX + NU vs. CON: MD: 1.3 (−0.05 to 2.66) |
| Kapoor et al. [72] India RCT |
Population: Females with advanced cancer (n = 63) Stage: NR |
EX + NU (n allocated = 30, n completed outcome = 17): Multimodal (Nutrition counselling, oral nutrition supplement, physical activity recommendation) CON (n allocated = 33, n completed outcome = 15): Nutrition counselling and physical activity recommendation |
6-month intervention Exercise component (FITT): F: NR I: Not prescribed but reported: EX + NU: PRE: 33.6 ± 3.9 METs vs. POST 31.9 ± 2.7 METs (p = 0.274); CON: PRE: 30.7 ± 2.7 METs vs. POST 28.0 ± 2.5 METs (p = 0.004). Time: NR. Type: Low levels of PA, e.g., walking and participation in household activities. Nutrition component: Bi-weekly nutrition counselling visits. 100 g/day of IAtta oral nutrition supplement (mixture of roasted bengal gram flour, roasted barley flour, roasted soybean flour, flaxseed powered, dried amaranthus spinosus powder). Adherence: EX: NR. NU: NR. EX + NU: 51% completed the intervention as prescribed. |
Body fat percent (%) (skinfolds) |
Within-group differences: EX + NU: PRE: 20.5 ± 5.2 vs. POST: 23.7 ± NR ¥↑ CON: PRE: 25.4 ± 6.5 vs. POST: 24.5 ± NR ¥↓ Between-group differences: EX + NU vs. CON: MD: NR; p = 0.001 ¥↑ |
| Uster et al. [68] Switzerland RCT |
Population: Metastatic or locally advanced tumors of gastrointestinal and lung tracts (n = 58) Stage: Stage III: 2% Stage IV: 98% |
EX + NU (n allocated = 29, n completed outcome = 24): Multimodal (Supervised group-based resistance and balance training, nutrition counseling) CON (n allocated = 29, n completed outcome = 20): Usual care control. |
3-month intervention Exercise component (FITT): F: 2 days/week I: RT= 60–80% of 1-RM; Balance = NR. Time: 60 min, RT = 10 reps, 2 sets, Balance= 1–2 min per move. Type: RT = resistance machines; balance mat. Nutrition component: Minimum of 3 nutritional counselling during intervention encouraging patients to consume 1.2 g protein/kg body weight/day, with emphasis on consuming protein after exercise sessions. Adherence: EX: attended 67% of supervised exercise sessions. NU: 89.7% completed the minimum nutritional counseling sessions. EX + NU: 100% consumed at least 9–10 g of protein after each exercise session. |
Phase angle (°) (BIA) |
Within-group differences: EX + NU: NR. CON: NR. Between-group differences: EX + NU vs. CON: MD: NR. |
| Zhao et al. [82] United States of America Non-RCT |
Population: Stage III-IV Head and neck squamous cell carcinoma (n = 20) Stage: Stage III: 22% Stage IV: 78% |
EX + NU (n = 11): Multimodal (Supervised and unsupervised aerobic and resistance training, nutrition counselling) CON (n = 7): Standard of care inclusive of nutritional counselling. |
14-week intervention (7 weeks supervised, 7 weeks unsupervised) Exercise component (FITT): F: Supervised period = 3 days/week; unsupervised period = 5 days/week I: 11–13 RPE Time: 60 min sessions; AT = 30 min; RT = 8–12 reps, 3 sets. Type: AT = walking; RT = free weights Nutrition component: Baseline nutrition counselling. Adherence: EX: attended 72% of supervised exercise sessions. NU: NR. |
Lean mass (%) (DXA) |
Within-group differences: EX + NU: MD: 7 weeks: 0.2 ± 0.5 vs. 14 weeks: 4.7 ± 1.5 CON: MD: 7 weeks: 1.0 ± 0.7 vs. 14 weeks: 4.0 ± 0.9 Between-group differences: EX + NU vs. CON: NR; p > 0.05. |
| Schink et al. [83] Germany Non-RCT |
Population: Advanced solid tumours (n = 131) Stage: Stage III: 26% Stage IV: 74% |
EX + NU (n allocated = 96; n completed outcome = 58): Multimodal (supervised whole-body electromyostimulation, nutrition counselling) CON (n allocated = 35; n completed outcome = 27): Usual care control with nutrition counselling. |
12-week intervention Exercise component (FITT): F: 2 days/week I: 85 Hz, 350 μs inducing a 6 s stimulation and 4 s rest. Time: 12–20 min, 6 reps per min. Type: whole-body electromyostimulation with additional light exercises. Nutrition component: Nutrition counselling encouraging >1 g/kg day of protein and minimum energy intake of 25 kcal/kg/day. Adherence: EX: attended 86.6 ± 10.8% of supervised sessions. NU: EX + NU = 67.4% and CON = 69% consumed the protein intake recommendation or more. EX + NU =74.2% and 75.8 consumed the kcal intake recommendations. |
Skeletal muscle mass (kg) (BIA) |
Within-group differences: EX + NU: NRCON: NRBetween-group differences: EX + NU vs.CON: MD: 0.53 (0.05 to 0.98) ¥ ↑ |
| Fat mass (%) (BIA) |
Within-group differences: EX + NU: NR CON: NRBetween-group differences: EX + NU vs. CON: MD: 0.51 (−0.46 to 1.47) |
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| Phase angle (°) (BIA) |
Within-group differences: EX + NU: NR CON: NR Between-group differences: EX + NU vs. CON: MD: 0.07 (−0.06 to 0.19) |
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| Schink et al. [84] Germany Non-RCT |
Population: Advanced solid tumours (n = 80) Stage: Stage III: 24.4% Stage IV: 75.6% |
EX + NU (n allocated = 58; n completed outcome = 26): Multimodal (supervised whole-body electromyostimulation, nutrition counselling) CON (n allocated = 22; n completed outcome = 15): Usual care control with nutrition counselling. |
12-week intervention Exercise component (FITT): F: 2 days/week I: 85 Hz, 350 μs inducing a 6 s stimulation and 4 s rest. Time: 12–20 min, 6 reps per min. Type: whole-body electromyostimulation with additional light exercises. Nutrition component: Nutrition counselling encouraging >1 g/kg day and minimum energy intake of 25 kcal/kg/day. Adherence: EX: attended 88.9 ± 8.7% of supervised sessions. NU: NR |
Skeletal muscle mass (kg) (BIA) |
Within-group differences: EX + NU: NR CON: NR Between-group differences: EX + NU vs. CON: MD: 0.99 (0.09 to 1.90) ¥↑ |
| van der Werf et al. [76] Netherlands RCT |
Population: Metastatic colon cancer (n = 107) Stage: Metastatic: 100% |
NU + PA: (n allocated = 52; n completed outcome T1 = 50; N completed outcome T2 = 39): Nutrition counselling and PA CON (n allocated = 55; n completed outcome T1 = 52; n completed outcome T2 = 33): Usual care inclusive of regular care dietician referral. |
T0-T1 = mean 9 ± 3 weeks; T0-T2 = mean 19 ± 3 weeks Exercise component (FITT): F: 5 days/week I: moderate intensity Time: ≥30 min Type: self-directed PA. Nutrition component: Nutrition counselling with the goal of 1.2 g protein/kg body weight/day and at least ≥25 g protein per meal. Adherence: PA: T1 = 24%; T2 = 16% achieved PA recommendations. NU: T1 = 61%; T2 = 40% achieved protein intake recommendations. T1 = 61%; T2 = 49% achieved energy intake recommendations. |
Skeletal muscle area (cm2) (CT) |
Within-group differences: NU + PA: NR CON: NR Between-group differences: NU + PA vs. CON: MD: T0-T1: 0.3 (−3.5 to 4.0) vs. T1-T2: 0.3 (−3.4 to 4.0) |
| Muscle density (Hounsfield units) (CT) |
Within-group differences: NU + PA: NR CON: NR Between-group differences: NU + PA vs. CON: MD: T0-T1: 0.2 (−1.8 to 2.2) vs. T1-T2: −0.1 (−2.2 to 2.0) |
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| Storck et al. [77] Switzerland RCT |
Population: Metastatic or locally advanced cancers of the lungs, gastrointestinal tract, breast, ovarian, prostate, renal cell, bladder (n = 52) Stage: Metastatic: NR |
EX + NU (n allocated = 27; n completed outcome = 23):Multimodal (supervised and self-directed aerobic and resistance exercise, nutrition counselling). CON (n allocated = 25; n completed outcome =18): Usual care inclusive of regular care nutrition counselling and physiotherapy. |
12-week intervention Exercise component (FITT): F: 2 days/week supervised, 1 day/week home-based. I: AT = 3–5 RPE (10 borg); RT = NR. Time: 60–90 min; AT = NR; RT = 10–15 reps, 3 sets. Type: AT= bike or treadmill; RT = circuit, resistance bands. Nutrition component: Nutrition counselling at baseline, 6 weeks, 12 weeks, and as required between times. 15–30 g/day of whey protein. Adherence: EX: attended 70.7% of supervised sessions and completed 95% of home sessions. NU: attended 106.7% nutrition counselling sessions. 71.2% consumed the protein supplements. |
Phase angle (°) (BIA) |
Within-group differences: EX + NU: MD: 0.08 ± NR CON: MD: −0.04 ± NR Between-group differences: EX + NU vs. CON: MD: NR (−0.39 to 0.16) |
| Lean mass (kg) (BIA) |
Within-group differences: EX + NU: MD: 0.89 ± NRCON: MD: 0.46 ± NR Between-group differences: EX vs. CON: MD:NR (−2.04 to 1.18) |
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| Body cell mass (kg) (BIA) |
Within-group differences: EX + NU: MD: 0.62 ± NR CON: MD: 0.33 ± NR Between-group differences: EX + NU vs. CON: MD:NR (−1.45 to 0.87) |
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| Fat mass (kg) (BIA) |
Within-group differences: EX + NU: MD: 0.17 ± NR CON: MD: −0.38 ± NR Between-group differences: EX + NU vs. CON: MD:NR (−2.08 to 0.97) |
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| Exercise with or without nutrition, plus an additional component | |||||
| Solheim et al. [71] United Kingdom and Norway RCT |
Population: Stage III/IV NSCLC or inoperable pancreatic cancer (n = 46) Stage: Pancreas stage III = 20% Pancreas stage IV = 25% NSCLC stage III = 10% NSCLC stage IV = 47.5% |
EX + NU + O (n allocated = 25; n completed outcome = 23): Multimodal (self-directed exercise, nutrition counselling, oral nutrition supplement, anti-inflammatory drug). CON (n allocated = 21; n completed outcome = 18): Standard of care |
6-week intervention Exercise component (FITT): F: AT = 2 days/week; RT = 3 days/week. I: NR Time: AT = 30 min; RT = 20 min Type: AT = patient choice; AT = body weight and free weights. Nutrition component: Baseline nutrition counselling session. 220 mL of an oral nutrition supplement equating to 2 g/day of eicosapentaenoic acid. Other component: 300 mg/day of Celecoxib, an anti-inflammatory. Adherence: EX: attended 60% of exercise sessions. NU: 48% consumed the supplement O: 76% took the prescribed celecoxib. |
Lean mass (cm2) (CT) |
Within-group differences: EX + NU + O: MD: −2.82 ± 9.41 CON: MD: −4.97 ± 7.80 Between-group differences: EX + NU + O vs. CON: MD: NR |
| Balstad et al. [85] United Kingdom and Norway Secondary analysis of Solheim et al., 2017. |
See Solheim et al. [71] |
EX + NU + O (n allocated = 23; n completed outcome = 22):Multimodal (self-directed exercise, nutrition counselling, oral nutrition supplement, anti-inflammatory drug). CON (n allocated = 23; n completed outcome = 18): Standard of care |
See Solheim et al. [71] | Visceral adipose tissue (cm2) (CT) |
Within-group differences: EX + NU + O: PRE: 108.4 ± 67.6 vs. POST: 108.8 ± 66.1 CON: PRE: 99.9 ± 65.2 vs. POST: 94.9 ± 55.9 Between-group differences: EX + NU + O vs. CON: ES: 0.22 |
| Subcutaneous adipose tissue (cm2) (CT) |
Within-group differences: EX + NU + O: PRE: 182.3 ± 114.5 vs. POST: 176.4 ± 108.5 CON: PRE: 160.6 ± 70.7 vs. POST: 149.4 ± 64.5 Between-group differences: EX + NU + O vs. CON: ES: 0.15 |
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| Ratio VAT:SAT |
Within-group differences: EX + NU + O: PRE: 0.7 ± 0.6 vs. POST: 0.7 ± 0.5 CON: PRE: 0.7 ± 0.5 vs. POST: 0.7 ± 0.4 Between-group differences: EX + NU + O vs. CON: ES: 0.25 |
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| Total adipose area (cm2) (CT) |
Within-group differences: EX + NU + O: PRE: 290.7 ± 154.0 vs. POST: 285.2 ± 149.5 CON: PRE: 260.5 ± 99.9 vs. POST: 244.3 ± 93.7 Between-group differences: EX + NU + O vs. CON: ES: 0.21 |
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| Total adipose index (cm2/m2) (CT) |
Within-group differences: EX + NU + O: PRE: 99.5 ± 52.7 vs. POST: 97.4 ± 51.2 CON: PRE: 93.3 ± 36.5 vs. POST: 87.4 ± 34.2 Between-group differences: EX + NU + O vs. CON: ES: 0.21 |
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| Skeletal muscle mass index (cm2/m2) (CT) |
Within-group differences: EX + NU + O: PRE: 45.9 ± 8.9 vs. POST: 45.0 ± 9.2 CON: PRE: 45.7 ± 8.6 vs. POST: 43.9 ± 9.4 ¥↓ Between-group differences: EX + NU + O vs. CON: ES: 0.26 |
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| Sheean et al. [80] United States of America RCT |
Population: Metastatic breast cancer (n = 35) Stage: Metastatic: 100% |
EX + NU + O (n allocated = 17; n complete outcome = 17): Multimodal (Supervised aerobic and resistance exercise, nutrition counseling) CON (n allocated = 18; n complete outcome = 18): Usual care waitlist control given monthly reminder of upcoming intervention. |
12-week intervention Exercise component (FITT): F: 4 days/week I: moderate intensity Time: 150 min/week Type: AT = patient choice; RT = resistance bands. Nutrition component: Weekly phone calls, encouraging consumption of whole grains and 5+ fruits and vegetables daily. Other component: Rooted in social cognitive theory. Adherence: EX: attended 93% for supervised sessions NU + O: 84% for telephone sessions. |
Appendicular skeletal muscle index (kg/m2) (DXA) |
Within-group differences: EX + NU + O: MD: − 0.1 ± 0.4 CON: MD: 0.0 ± 0.2 Between-group differences: EX + un + O vs. CON: MD: − 0.0 ± 0.3 |
| Lean mass (kg) (DXA) |
Within-group differences: EX + NU + O: MD: − 0.5 ± 1.6 CON: MD: − 0.3 ± 1.4 Between-group differences: EX + NU + O vs. CON: MD: − 0.4 ± 1.5 |
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| Fat mass (kg) (DXA) |
Within-group differences: EX + NU + O: MD: 0.3 ± 1.7 CON: MD: 0.3 ± 2.0 Between-group differences: EX + NU + O vs. CON: MD: 0.3 ± 1.8 |
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| Body fat percent (%) (DXA) |
Within-group differences: EX + NU + O: MD: 0.5 ± 1.3 CON: MD: 0.3 ± 1.2 Between-group differences: EX + NU + O vs. CON: MD: 0.4 ± 1.2 |
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| Visceral fat mass (g) (DXA) |
Within-group differences: EX + NU + O: MD: − 99 ± 181 ¥↓ CON: MD: − 81 ± 162 ¥↓ Between-group differences: EX + NU + O vs. CON: MD: − 89 ± 168 ¥↓ |
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| Mikkelsen et al. [79] Denmark RCT |
Population: Pancreatic cancer, biliary tract cancer, small cell lung cancer (n = 84) Stage: Locally advanced: 14.3% Metastatic: 85.7% |
EX + NU + O (n allocated = 43; n complete outcome = 29): Multimodal intervention (exercise + protein + PA+ counselling) CON (n allocated = 41; n completed outcome = 34): Usual care. |
12-week intervention Exercise components (FITT): F: 2 days/week I: 10–15 RM Time: 60 min (Volume: 10–15 reps, 2–3 sets) Type: Supervised group-based resistance training. Individualized home-based walking program controlled with a pedometer. Nutrition component: Post-exercise protein supplementation intake (12–18 g) 2 days/week. Other components: Nurse-led support and counselling (holistic assessment of function) Adherence: EX: attended 69% of supervised exercise sessions and 75% adherence to the walking program. NU: NR |
Lean mass (kg) (DXA) |
Within-group differences: EX + NU + O: PRE: 47.3 ± 8.1 vs. POST: 48.7 ± 9.1¥↑ CON: PRE: 47 ± 9.2 vs. POST: 46.4 ± 9.1 Between-group differences: EX + NU + O vs. CON: MD: 0.9 ± 0.4 ¥↑ |
| Fat mass (kg) (DXA) |
Within-group differences: EX + NU + O: PRE: 20.8 ± 8.1 vs. POST: 21.6 ± 7.6 CON: PRE: 22.4 ± 9.4 vs. POST: 22.7 ± 10 Between-group differences: EX + NU + O vs. CON: MD: 0.2 ± 0.6 |
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| Lean mass (kg) (BIA) |
Within-group differences: EX + NU + O: PRE:44.1 ± 8.5 vs. POST: 44.4 ± 9.6 CON: PRE: 42.9 ± 10.5 vs. POST: 41.9 ± 8.8 Between-group differences: EX + NU + O vs. CON: MD: −0.9 ± 1.3 |
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| Fat mass (kg) (BIA) |
Within-group differences: EX + NU + O: PRE:17.2 ± 8.8 vs. POST: 17.4 ± 8.5 CON: PRE: 18.5 ± 10.2 vs. POST: 18.9 ± 11.1 Between-group differences: EX + NU + O vs. CON: MD: 1.0 kg ± 1.0 |
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| Kim et al. [48] Australia RCT |
Population: Prostate cancer (n = 40) Stage: Metastatic: 100% |
EX + O (n allocated = 20; n complete outcome =13): Supervised aerobic and resistance training with psychological support CON (n allocated = 20; n complete outcome = 12): self-directed exercise |
6-month intervention Exercise component (FITT): F: 3 days/week I: RT: 6–12 RM, HITT: RPE 8 AT: RPE 6 Time: RT: 2–5 sets, 6 exercises. HITT 3–6 bouts of 30–60 s. AT: 10–40 min. Progressive increase in time and volume. Type: Supervised RT and HITT 2 days per week and continuous cycling AT 1 day per week. Other component Psychological support Adherence: EX + O: attended 82.5 ± 13.0% of supervised exercise sessions. |
Lean mass (kg) (DXA) |
Within-group differences: EX + O: PRE: 53.1 ± 10.4 vs. POST: 50.6 (95%CI: 49.4 to 51.9) CON: PRE: 49.1 ± 8.2 vs. POST 50.7 (95%CI 49.4 to 51.9) Between-group differences: EX + O vs. CON: MD: NR |
| Lean mass (%) (DXA) |
Within-group differences: EX + O: PRE: 57.0 ± 3.9 vs. POST: 58.4 (57.1 to 59.6) CON: PRE: 59.8 ± 4.0 vs. POST: 57.7 (56.4 to 59) Between-group differences: EX + O vs. CON: MD: NR |
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| Lean mass index (kg/m2) (DXA) |
Within-group differences: EX + O: PRE: 17.6 ± 1.9 vs. POST: 17.2 (16.8 to 17.4) CON: PRE: 16.7 ± 2.1 vs. POST: 17.0 (16.6 to 17.4) Between-group differences: EX + O vs. CON: MD: NR |
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| Fat mass (kg) (DXA) |
Within-group differences: EX + O: PRE: 33.4 ± 10.5 vs. POST: 29.8 (27.9 to 31.8) CON: PRE: 26.9 ± 6.7 vs. POST: 32.1 (30.0 to 34.1) Between-group differences: EX + O vs. CON: MD: NR |
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| Body fat percent (%) (DXA) |
Within-group differences: EX + O: PRE: 37.1 ± 4.4 vs. POST: 35.9 (34.4 to 37.5) CON: PRE: 34.4 ± 4.7 vs. POST: 36.7 (35.1 to 38.2) Between-group differences: EX + O vs. CON: MD: NR |
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| Allen et al. [81] United Kingdom RCT |
Population: Locally advanced esophagogastric cancer patients (n = 54) Stage: T1 = 1(2) T2 = 12 (22) T3 = 38 (70) T4 = 3 (6) N0 = 18 (33) N1 = 17 (31) N2 = 16 (30) N3 = 3 (6) |
EX + NU + On allocated = 26; n complete outcome = 24: Prehabilitation Multimodal intervention (exercise + nutrition + psychological support) CON (n allocated = 28; n complete outcome = 28): Usual care with encouragement to get fitter during treatment. |
15-week intervention Exercise component (FITT): F: Supervised in-clinic 2 days/week + Home-based 3 days/week I: AT: 40–60 HRR or 11–14 RPE and RT: 12–14 RPE Time: 60 min (Volume: 12 reps, 2 sets) Type: Prehabilitation supervised in clinic and unsupervised home-based AT and RT and flexibility. Nutrition component: Needs-based nutritional intervention with frequent, tailored, dietetic input from dieticians. Other component Psychological support: 6 face-to-face sessions with discussion of health status, strengths, recognition, resilience, or goal setting. Adherence: EX: attended 76 ± 14% of supervised exercise sessions and 65 ± 27% of home-based.NU + O: NR |
Skeletal muscle index (cm2/m2) (CT) |
Within-group differences: EX + NU + O: MD: −11.6 (95%CI –14.2 to –9.0) CON: MD: −15.6 (95%CI –18.7 to –15.4) Between-group differences: EX + NU + O vs. CON: MD: NR¥↑ |
¥: statistically significant change. ↑: increase. ↓: decrease. Abbreviations (in order of appearance): RCT, randomized clinical trial; n, sample of participants; EX, exercise intervention group; CON, control group; FITT, exercise frequency, intensity, time, and type; RT, resistance training; AT, aerobic training; NR, not reported; RM, repetition maximum; Min, minutes; Reps, repetitions; Kg, kilogram; DXA, Dual-energy X-ray absorptiometry; SD, standard deviation; 95%CI, 95% confidence interval; PRE, pre-intervention; POST, post-intervention; MD, mean difference; HR, heart rate; BIA, bioelectrical impedance analysis; RPE, rating of perceived exertion; NU, nutrition; EX + NU, exercise and nutrition intervention group; METs, metabolic equivalent of task; PA, physical activity; G, gram; G/KG, grams consumed per kilograms of body weight; Non-RCT, non-randomized controlled trial; Hz, hertz; μs, microsecond; S, seconds; kcal/kg/day, kilocalories consumed per kilograms of body weight per day; T, time point; Cm, centimeters; CT, computed tomography; NU + PA, nutrition and physical activity intervention group; NSCLC, non-small cell lung cancer; mL, milliliters; O, other component; EX + NU + O, exercise/physical activity and nutrition intervention group, as well as other component; ES, effect size; VAT:SAT, ratio of visceral adipose tissue to subcutaneous adipose tissue; M, meter; HITT, high intensity interval training; HRR, heart rate reserve.