low grade lymphoma | Role of aerobic physical exercise for adults with malignant hemic

Role of aerobic physical exercise for adults with malignant hemic
Issue of the review



We examined existing data on the effect of aerobic physical exercise associated with standard care versus standard care alone in adults with malignant hemic. We found nine randomized controlled trials.

Context

Malignant hemopathy is a tumor of the myeloid or lymphatic cells. Lymphomas, Leukemias, Myeloma and myelodysplastic and myeloproliferative syndromes are all malignant hemic. These diseases account for nearly 10% of the new cancer cases diagnosed in the United States and are characterized by highly variable and divergent clinical developments and prognosis. Various treatments are available for patients with malignant hemic, from vigilant forbearance to chemotherapy with one or more agents (combination of medications), through radiation therapy and immunotherapy, to Autologous stem cell transplantation (the recipient is also the donor) or allogeneic (donor and recipient are two different people). In addition, the best supportive care is provided in order to improve their comfort and prevent, control or treat complications and side effects. Although people with malignant hemic have to endure long phases of therapy and immobility that reduce their physical performance, they are often advised to spare themselves and avoid efforts. This recommendation is partly related to the decrease in the number of red blood cells and platelets that affect many of these patients. The inability to carry out the activities of daily life limits them, diminishes their quality of life and can influence their medical treatment.

Characteristics of the studies

We searched several medical literature databases and included nine randomized controlled trials involving 818 people, comparing a physical exercise to improve oxygen metabolism Associated with standard care with standard treatment alone. The majority of subjects suffered from acute leukemia, multiple myeloma or lymphoma. In five trials, participants received their own stem cells or a donor-derived stem cell transplant. Aerobic exercise interventions consisted of various variable duration and intensity walking programs. The evidence is up to date on January 2014.

Main results

None of the included trials were interested in overall survival, although three studies reported the number of participants who died during the study or during the first 100 days. There is no evidence of a difference in this evaluation criterion between the physically active group and the control group.

The quality of life was measured in four trials. We excluded an essay from this analysis because of the differences between the groups at the beginning of the study. The other three trials showed quality of life improvements in the physically active group. Four trials evaluated physical functioning, depression, and anxiety, and combined them in a meta-analysis. There is an advantage for the physically active group for physical functioning and depression, but no clear evidence of a difference between active subjects and witnesses for anxiety. Seven trials assessed fatigue, with an advantage for subjects exercising.

Eight studies assessed the level of physical performance (e.g. aerobic capacity, cardiovascular condition); In seven of these trials, we found a statistically significant trend or improvement for the exercise group. 

Three trials measured serious adverse events and one trial reported adverse events (side effects), but the results of these trials were inconclusive.

Quality of evidence

The quality of the evidence included is moderate for deaths, physical functioning and fatigue, low for overall quality of life, depression, anxiety, adverse events and serious adverse events, and very low for Physical performance. The main limitations were the absence of blindness for the participants, the doctors and the evaluators of the results, as well as the low number of participants in the included studies, which means that we could not exclude the possibility that The intervention had little or no effect at all.

Authors ' Conclusions: There is no evidence of differences in mortality between exercise groups and control groups. The physical exercise added to the standard treatment can improve the quality of life, especially physical functioning, depression and fatigue. There is currently inconclusive evidence of anxiety, physical performance, serious adverse events and adverse events.

We need further testing with more participants and longer follow-up periods to assess the effects of physical exercise interventions for people with malignant hemic. In addition, we need trials whose primary endpoint would be global survival, to determine whether the proposed benefits result in a survival benefit. To improve the comparability of study data, it would be useful to develop and implement basic sets of measurement devices.

Background: Although people with malignant hemic must endure long phases of therapy and immobility, which are notoriously reducing their physical performance, they are still often advised to spare themselves and avoid Efforts. This recommendation is partly related to severe anemia and thrombocytopenia that affect many of these patients. The inability to carry out the activities of daily life limits them, diminishes their quality of life and can influence their medical treatment.

Objectives: To assess the efficacy, safety and feasibility of aerobic exercise for adults suffering from malignant hemic.

Documentary Research strategy: We conducted research in the Cochrane Controlled trials (CENTRAL) registry (The Cochrane Library, 2014, number 1) and MEDLINE (1950 to January 2014), as well as in conference proceedings to identify Randomized controlled trials (RCTs).

Selection criteria: We have included rcts comparing an intervention with aerobic physical exercises to improve oxygen metabolism and associated with standard care with standard treatment alone for adults suffering of hemic malignant. We have also included studies evaluating aerobic exercise in addition to strength training. We have excluded studies studying the effect of training programs by yoga, Tai chi chuan, Qi Gong or similar types of exercises. We have also excluded studies exploring the influence of force training not associated with aerobic exercises. In addition, we have excluded studies evaluating evaluation criteria without clinical impact.

Data collection and Analysis: Two authors of the journal independently analyzed the results of the research, extracted the data and evaluated the quality of the tests. We used relative risks (RR) for adverse events and survival at 100 days, standardized average differences in quality of life, fatigue and physical performance, and average differences in measurements Anthropometric.

Main results: Our research strategies identified 1 518 potentially relevant references. Of these, we selected nine RCTs for 818 participants. The potential risk of bias in these trials is not clear because of the poor quality of the report.

The majority of participants suffered from acute lymphoblastic leukemia, acute myeloid leukemia, malignant lymphoma or multiple myeloma; Six trials randomized patients received a stem cell transplant. Most of the aerobic exercise interventions consisted of various variable duration and intensity walking programs.

Our main criterion for overall survival was not analyzed in any of the included trials, but three trials reported the number of participants who died during the study or in the first 100 days. There is no evidence of a difference between the exercise participants and the control group (RR 0.93; 95% CI from 0.59 to 1.47; P = 0.75; 3 trials, 269 participants, moderate quality evidence).

Four trials analyzed the influence of exercise intervention on quality of life. If a trial with a serious imbalance is not taken into account at the beginning of the study, physical exercise improves the quality of life (DMS 0.26; 95% CI from 0.03 to 0.49; P = 0.03; 3 trials, 291 participants, low quality data). This positive effect of the exercise was also found in the physical operating subscales (DMS 0.33; 95% CI from 0.13 to 0.52; P = 0.0009; Four trials, 422 participants, evidence of moderate quality) and depression (DMS 0.25; 95% CI-0.00 to 0.50; P = 0.05; 3 trials, 249 participants, low quality evidence). There is, however, no evidence of a difference between the addition of exercises and the standard treatment for the anxiety subscale (DMS-0.18; 95% CI-0.64 to 0.28; P = 0.45; 3 trials, 249 participants, low quality evidence). Seven trials (692 participants) assessed fatigue. There is evidence of moderate quality that exercise improves fatigue (DMS 0.24; 95% CI from 0.08 to 0.40; P = 0.003).

Eight studies evaluated different aspects of physical performance (e.g. aerobic capacity, cardiovascular condition), but we were unable to group them into a meta-analysis. Seven trials show a statistically significant trend or effect in favour of the exercise group (very low quality evidence).

Three trials (266 participants) examined serious adverse events (e.g., bleeding, fever, pneumonia, deep venous thrombosis or infection), and one trial (122 participants) adverse events. There is no evidence of a difference between groups for serious adverse events (RR 1.44; 95% CI from 0.96 to 2.18; P = 0.06) or adverse events (RR 7.23; 95% CI from 0.38 to 137.05; P = 0.19); These two results are based on low-quality data.