| # |
Author, year, location (Type) |
Participants |
Measurement Outcomes |
Results |
| 1 |
Lonbro et al., 2013 [13]
Denmark
(Non randomized controlled study) |
N=90 (66 HNSCC; 24 healthy)
Mean age: 56±8y HNSCC; 59±9y Healthy
Gender ratio: 12F:54M HNSCC; 7F:17M Healthy
Race: NR
Cancer type: HNSCC
Cancer stage: NR
Treatment: Radiation or chemo-radiation |
Lean body mass (DXA)
Muscle strength (isokinetic dynamometry)
Functional performance (10m walk, sit to stand 30s, stair climb, 30s max arm curl)
Level of leisure time physical activity (Saltin & Grimby Questionnaire) |
- Baseline LBM 10% lower in HNSCC compared to healthy (5.6±1.5kg); p<0.0001; 95%CI -8.6; -2.7); at 12 weeks significant difference is absent
- Baseline muscle strength 15% lower in HNSCC and significant difference in isometric muscle strength (p<0.0001); at 12 weeks significant difference is absent
- Baseline functional performance was 18% lower in HNSCC; at 12 weeks significant difference is absent
- 83% of HNSCC participated in at least light PA for a minimum of 4 hours per week
- 95% of healthy individuals participated in at least light PA for a minimum of 4 hours per week
Other:
- Significant association between LBM and all measures of maximal strength R2= 0.59-0.67 (p<0.0001); KE strength 4.8-5.5Nm/kg LBM, KF strength 2.0-2.2 Nm/kg LBM
- Significant association between total body weight and muscle strength R2= 0.50 – 0.57 (p<0.0001)
- Association between maximal isometric KE strength and 30s arm curl R2=0.44 (p<0.0001), 10m max gait speed R2=0.31 (p<0.0001), 30s chair rise R2=0.34 (p<0.0001), not significant with stair climb R2= 0.21 (p=0.007)
- No association between functional performance tests and physical function of EORTC QLQ-C30
|
| 2 |
Lonbro et al., 2013 [14]
Denmark
(RCT) |
N=30 (16 PROCR; 14 PLA)
Median age: 56y PROCR; 59y PLA
Gender ratio: 7F:23M
Race: NR
Cancer type: HNSCC (pharynx, larynx, pharynx and larynx, nasopharynx, oral cavity, unknown primary)
Cancer stage: I-II: 1, III-IV: 29
Treatment: Radiation or chemo-radiation |
Feasibility (Recruitment rate, retention, adherence and adverse events)
Body Composition/Lean body mass (DXA)
Muscle strength (isokinetic dynamometry)
Functional performance (10m walk, sit to stand 30s, stair climb, 30s max arm curl) |
- Recruitment rate 28% (30 of 109); Retention rate 70% (21 of 30); Adherence to PRT 97% (29 out of 30 sessions over mean of 13 weeks); No adverse events
- LBM increased significantly by 5.0±3.8% (50.5±9.3 to 53.1± 10.8kg) in PROCR group (p<0.0001) and 2.8±2.5% (50.4±8.4 to 51.7±8.3kg) in PLA group (p=0.07); LBM increase in HPV positive patients was 1.8 kg larger than HPV negative (p=0.06; 95% CI -0.04; 3.7)
- Both groups increased muscle strength significantly pre to post exercise program but no difference between groups
- Both groups increased functional performance significantly pre to post exercise program but no difference between groups
Other:
- No difference between group in BW, LBM or BM
- BW increase non-significant in PROCR and unchanged in PLA
- FM decreased non-significant in PROCR and PLA
|
| 3 |
Lonbro et al., 2013 [12]
Denmark
(RCT) |
N=41 (20 EE 21 DE)
Mean age: 55±7y EE; 58±7y DE
Gender ratio: 7F:23M
Race: NR
Cancer type: HNSCC (pharynx, larynx, , oral cavity, unknown primary)
Cancer stage: I-II: 8, III-IV: 33
Treatment: Radiation or chemo-radiation |
Lean body mass (DXA)
Muscle strength (isokinetic dynamometry)
Functional performance (10m walk, sit to stand 30s, stair climb, 30s max arm curl)
Quality of life (EORTC QLQ-C30) |
- EE increased LBM by 4.3% (2.3kg; p<0.001; 95% CI 0.5; 2.5) DE increased LBM by 4.2% (2.4kg; p<0.001; 95% CI 1.1) after PRT
- EE Isometric KE increased by 20% (33Nm; p<0.001; 95%CI16; 50) DE increased 21% (34Nm; p<0.001; 95% CI 17; 50) after PRT. Similar results observed for isokinetic KF; larger increase in isometric KF and isokinetic KE in DE
- DE improved functional tests: arm curl and chair raise
- EE improved overall QOL and “cognitive function” after PRT than DE self chosen activity; DE improved “physical function” more after PRT than EE self chosen activity
Other:
- Recruitment 22%; retention rate 83%; adherence to PRT 95% for both groups; no adverse events reported.
- Stratification factors (HPV/p16 positive, presence of feeding tube, treatment induced weight loss) not significantly related to LBM increase
|
| 4 |
Samuel et al., 2013 [19]
India
(RCT) |
N=48 (24 Ex, 24 UC)
Mean age: 52.5±8.27y ex; 51.7±10y UC
Gender ratio: 6F:42M
Race: NR
Cancer type: HNC
Cancer stage: NR
Treatment: concurrent chemo-radiation |
Functional capacity (6MWT)
Quality of life (SF36) |
- 6MWD increased 42m in exercise group and decreased 96m in UC (p<0.05); statistically significant different 6MWD from baseline with and between groups with moderate effect size (d=0.46) for between group
- Physical component score decreased to 32.7(18%) in UC while exercise group stayed the same
- Mental component score increased to 40.9 (11.73%) in exercise group, while decreased to 23 (75.21%) in UC
Other:
- Adherence was not monitored
- No adverse events
|
| 5 |
Eades et al., 2013 [20]
Canada
(Retrospective Cohort) |
N=31 enrolled, data on 27 reported
Mean age: 54.9±9.2
Gender ratio: 5F:22M
Race: NR
Cancer type: HNC (nasal cavity, oral cavity, pharynx, larynx)
Cancer stage: I-II: 6, III-IV: 21
Treatment: surgery, radiation, chemotherapy or combo |
Functional status (6MWT)
Quality of life (ESAS)
Nutritional (BW and presence of PEG)
Symptoms severity (ESAS)
Interference with function (MD Anderson symptom inventory)
Distress level (thermometer) |
- Improved 6MWD 59m (95% CI 27-91) after program (effect size, d=0.8)
- Improved QOL change mean 1.8 (effect size, d=0.8)
- 11 gained >1kg, 10 maintained, 6 lost >1kg BW
- Baseline most severe symptoms: weakness, anorexia, pain, and depression. End of program strong decrease in pain and weakness (effect size: d=0.8-0.9), moderate decrease in shortness of breath, anorexia, insomnia and depression (effect size: 0.6-0.7) and non significant decrease in nausea, vomiting, constipation and sleepiness (effect size d=0.1-0.4)
- No clinically meaningful reduction in symptom interference (d=0.2-0.4)
- Patients reported moderate decrease in distress (d=0.7). Percentage exceeding clinical important distress fell from 73% to 42% (p=0.008).
|
| 6 |
Rogers et al., 2013 [18]
USA
(RCT) |
N=15 (7 Ex; 8 UC)
Mean age: 60.5±12.5y
Gender ratio: 3F:12M
Race: 15 white
Cancer type: HNC (nasopharyngeal, salivary gland, scalp, oral cavity, tongue, oropharyngeal, larynx, unknown primary)
Cancer stage: I-II: 7, III-IV: 8
Treatment: radiation or chemo-radiation |
Feasibility (recruitment, completion, adverse events, adherence) paid $25 for completed assessment
Lean body mass (BIA)
Muscle strength (leg and hand dynamometer)
Physical functioning (tandem balance, 8 foot walk time, 5 rise and sit)
QOL (FACT-H&N, FACT G)
Fatigue (FACT-fatigue subscale) |
- Recruitment rate 45% (15 of 33); Retention rate 100% at 6 weeks and 87% at 12 weeks; Adherence 83% (70 of 84) first 6 weeks, 53% (32 of 60) at home; 3 unrelated adverse events
- Small to medium effect size increase in 6 week LBM (d=0.35)
- Small to medium effect size increase for hand grip at 6 (d=0.22) and 12 weeks (d=0.34) Small decreases in back/leg extensor strength at 6 (-0.21) and 12 weeks (d=-0.19)
- Small to medium effect size increase in chair rise 6 (d=-0.63) and 12 weeks (d=-0.60); minimal increases in physical functioning (d=0.15-0.19)
- Medium and small effect size increase for overall QOL 6 (d=0.52) and 12 weeks (d=0.39), physical well being 6 (d=0.44) and 12 weeks (d=0.36), emotional well being 12 weeks (d=0.45), functional well being 6 (d=0.41) and 12 weeks (d=0.33)
- Small to medium effect size, significant increase in fatigue control in 6 week (d=-0.64)
- Small decrease in HNC specific symptoms at 6 weeks (d=-0.23) and 12 weeks (d=-0.25). Little increase in social well being
|
| 7 |
Aghili et al., 2007 [21]
Iran
(Prospective non-randomized parallel group design) |
N=30
Mean age: NR
Gender ratio: NR
Race: NR
Cancer type: Breast and HNC
Cancer stage: NR
Treatment: radiation |
Fatigue (BFI) |
- Baseline moderate fatigue 56% (exercise) and 43% (UC) (no significant difference, p=0.632)
- 4th week exercise 44% mild fatigue UC 57% severe fatigue (significant difference reported, p=0.011)
- 2-4th week median severity unchanged in exercise group, increased in UC (p=0.039)
- Median fatigue for 24h period first week - exercise 56% and UC 43% had equal moderate fatigue (p=0.647)
- Median fatigue 24h period at 4 week exercise 38% mild and UC 57% severe (p=0.001)
- 2-4th week median 24h period severity unchanged in exercise group increase in UC (p=0.013)
|
| 8 |
Crevenna et al., 2003 [22]
Austria
(Prospective Cohort) |
N=6 laryngectomy patients
Mean age: 57±10
Gender ratio: All male |
Feasibility (acceptance, compliance, safety in a group, impact on goals of therapy)
Endurance capacity (cycle ergometer and 6MWT)
Quality of Life (SF36)
Postural control (SMART Equitest system) |
- Adherence rate 88% (127 of 144)
- Improved endurance capacity (p<0.028); longer 6MWD (p<0.028)
- Improved QOL sub scales: “physical functioning” (p<0.027), “vitality” (p<0.027) “role-physical” (p<0.027) and social functioning (p<0.043) other subscales improved not significantly
- Improved postural stability
- Decreased perception of fatigue (p<0.028)
- Expectoration improved (p<0.043)
- Improved perceived neck and shoulder mobility (p<0.027)
- Improved perception of flexibility (p<0.027)
- Improved perception of postural control (p<0.028)
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