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Purpose This individual participant data meta-analysis (IPD-MA) assesses exercise effects on self-reported cognitive functioning (CF) and investigates whether effects differ by patient-, intervention-, and exercise-related characteristics. Methods IPD from 16 exercise RCTs, including 1987 patients across multiple types of non-metastatic cancer, was pooled. A one-stage IPD-MA using linear mixed-effect models was performed to assess exercise effects on self-reported CF (z-score) and to identify whether the effect was moderated by sociodemographic, clinical, intervention- and exercise-related characteristics, or fatigue, depression, anxiety, and self-reported CF levels at start of the intervention (i.e., baseline). Models were adjusted for baseline CF and included a random intercept at study level to account for clustering of patients within studies. A sensitivity analysis was performed in patients who reported cognitive problems at baseline. Results Minimal significant beneficial exercise effects on self-reported CF (β=−0.09 [−0.16; −0.02]) were observed, with slightly larger effects when the intervention was delivered post-treatment (n=745, β=−0.13 [−0.24; −0.02]), and no significant effect during cancer treatment (n=1,162, β=−0.08 [−0.18; 0.02]). Larger effects were observed in interventions of 12 weeks or shorter (β=−0.14 [−0.25; −0.04]) or 24 weeks or longer (β=−0.18 [−0.32; −0.02]), whereas no effects were observed in interventions of 12–24 weeks (β=0.01 [−0.13; 0.15]). Exercise interventions were most beneficial when provided to patients without anxiety symptoms (β=−0.10 [−0.19; −0.02]) or after completion of treatment in patients with cognitive problems (β=−0.19 [−0.31; −0.06]). No other significant moderators were identified. Conclusions This cross-cancer IPD meta-analysis observed small beneficial exercise effects on self-reported CF when the intervention was delivered post-treatment, especially in patients who reported cognitive problems at baseline. Implications for Cancer Survivors This study provides some evidence to support the prescription of exercise to improve cognitive functioning. Sufficiently powered trials are warranted to make more definitive recommendations and include these in the exercise guidelines for cancer survivors.

Objectives: Exercise interventions during and after treatment for pediatric cancer are associated with beneficial physical, psychological, and social effects. However, valid data about adverse events (AEs) of such interventions have rarely been evaluated. This retrospective study evaluates AEs that occurred during supervised oncological exercise programs for pediatric cancer patients and survivors. Methods: This Germany-wide study used a self-administered online survey focusing on general program characteristics and AEs retrospectively for 2019. The questionnaire included (a) basic data on the offered exercise program, (b) AEs with consequences (Grade 2–5) that occurred in 2019 during an exercise intervention, (c) number of Grade 1 AEs, (d) safety procedures as part of the exercise programs, and (e) possibility to give feedback and describe experience with AEs in free text. Results: Out of 26 eligible exercise programs, response rate of program leaders was 92.3% ( n = 24). Representatives working for Universities ( n = 6), rehabilitation clinics ( n = 3), acute cancer clinics ( n = 12), and activity camps ( n = 3) participated. In total, 35,110 exercise interventions with varying duration were recorded for 2019. Six AEs with consequences (Grade 2–3) occurred during exercise interventions after cancer treatment resulting in an incidence of 17 per 100,000 exercise interventions (0.017%). No life-threatening consequences or death were reported and no serious AE occurred during acute cancer treatment. Grade 1 AE occurred with a frequency of 983, corresponding to an incidence of 2,800 per 100,000 interventions (2.8%). Most frequent Grade 1 AE were muscle soreness, circulatory problems, and abdominal pain. The most frequent preventive safety procedures at the institutions were regular breaks, consultations with the medical treatment team, and material selection with low injury potential. Conclusions: Supervised exercise interventions for pediatric cancer patients and survivors seem to be safe and AEs with consequences comparatively rare when compared to general childhood population data. Occurrence of grade 1 AEs was common, however, causality was probably not evident between AEs and the exercise intervention. Future research should standardize assessment of AEs in clinical practice and research, and prospectively register and evaluate AEs that occur in the context of exercise interventions in pediatric cancer patients and survivors.

Objectives: Exercise interventions during and after treatment for pediatric cancer are associated with beneficial physical, psychological, and social effects. However, valid data about adverse events (AEs) of such interventions have rarely been evaluated. This retrospective study evaluates AEs that occurred during supervised oncological exercise programs for pediatric cancer patients and survivors. Methods: This Germany-wide study used a self-administered online survey focusing on general program characteristics and AEs retrospectively for 2019. The questionnaire included (a) basic data on the offered exercise program, (b) AEs with consequences (Grade 2–5) that occurred in 2019 during an exercise intervention, (c) number of Grade 1 AEs, (d) safety procedures as part of the exercise programs, and (e) possibility to give feedback and describe experience with AEs in free text. Results: Out of 26 eligible exercise programs, response rate of program leaders was 92.3% (n = 24). Representatives working for Universities (n = 6), rehabilitation clinics (n = 3), acute cancer clinics (n = 12), and activity camps (n = 3) participated. In total, 35,110 exercise interventions with varying duration were recorded for 2019. Six AEs with consequences (Grade 2–3) occurred during exercise interventions after cancer treatment resulting in an incidence of 17 per 100,000 exercise interventions (0.017%). No life-threatening consequences or death were reported and no serious AE occurred during acute cancer treatment. Grade 1 AE occurred with a frequency of 983, corresponding to an incidence of 2,800 per 100,000 interventions (2.8%). Most frequent Grade 1 AE were muscle soreness, circulatory problems, and abdominal pain. The most frequent preventive safety procedures at the institutions were regular breaks, consultations with the medical treatment team, and material selection with low injury potential. Conclusions: Supervised exercise interventions for pediatric cancer patients and survivors seem to be safe and AEs with consequences comparatively rare when compared to general childhood population data. Occurrence of grade 1 AEs was common, however, causality was probably not evident between AEs and the exercise intervention. Future research should standardize assessment of AEs in clinical practice and research, and prospectively register and evaluate AEs that occur in the context of exercise interventions in pediatric cancer patients and survivors. OA Förderung 2021

Hintergrund: Hunderte Studien zeigen, dass Sport und Bewegung einen signifikant positiven Effekt auf den Therapieverlauf von Krebspatienten haben. Eine spezifisch durchgeführte Sport- und Bewegungstherapie kann die vielfältigen Nebenwirkungen einer Krebstherapie deutlich reduzieren [ref:1].[zum vollständigen Text gelangen Sie über die oben angegebene URL], 19. Deutscher Kongress für Versorgungsforschung (DKVF)

Background: More than 700 randomized, controlled trials (RCTs) have shown significant positive effects of exercise interventions for cancer patients and survivors. Further, in the 2019 guidelines the American College of Sports Medicine (ACSM) recommended to triage and referral oncological patients, [for full text, please go to the a.m. URL], 19. Deutscher Kongress für Versorgungsforschung (DKVF)

Studiengang: Master of Education; Sport-/Ernährungswissenschaften (HU-Berlin)Art der Arbeit: MasterarbeitBetreuer: Prof. Dr. Mirko Wegner, PD Dr. Joachim WiskemannArbeitstitel: Evaluation des „OnkoAktiv-Netzwerkes“ aus Patientenperspektive – Ein Beitrag zum aktuellen Diskurs[zum vollständigen Text gelangen Sie über die oben angegebene URL], 18. Deutscher Kongress für Versorgungsforschung (DKVF)

© 2017 Springer Science+Business Media, LLC, part of Springer Nature Purpose: Exercise has been shown to reduce fatigue during cancer treatment. Hypothesized mechanisms include inflammatory pathways. Therefore, we investigated effects of exercise on markers of inflammation in breast cancer patients during adjuvant chemotherapy. Methods: We pooled data from two randomized controlled exercise intervention trials with breast cancer patients during adjuvant chemotherapy (n = 130), which had previously shown beneficial effects of exercise on fatigue. Exercise comprised a 12-week resistance training (BEATE study) or an 18-week combined resistance and aerobic training (PACT study). Serum IL-6, IL-1ra, and the IL-6/IL-1ra ratio were quantified at baseline, mid-intervention, post-intervention, and 6–9 months post-baseline. Results: Mixed effect models showed significant increases in IL-6 and IL-6/IL-1ra ratio during chemotherapy and decreases afterwards. Differences between exercise and control group were not significant at any time point. Changes in total cancer-related fatigue were significantly correlated with changes in IL-6/IL-1ra ratio (partial correlation r = 0.23) and IL-6 (r = 0.21), and changes in physical cancer-related fatigue with changes in IL-6/IL-1ra ratio (r = 0.21). Conclusions: Changes in fatigue were slightly correlated with changes in inflammatory markers, and there was a strong inflammatory response to adjuvant chemotherapy. The supervised exercise training did not counteract this increase in inflammation, suggesting that beneficial effects of exercise on fatigue during adjuvant chemotherapy for breast cancer are not essentially mediated by IL-6, IL-1ra, or the IL-6/IL-1ra ratio.

Background Metastatic bone disease is a common and severe complication in patients with advanced cancer. Radiotherapy (RT) has long been established as an effective local treatment for metastatic bone disorder. This study assesses the effects of RT combined with muscle-training exercises in patients with unstable bone metastases of the spinal column from solid tumors. The primary goal of this study is to evaluate the feasibility of muscle-training exercises concomitant to RT. Secondly, quality of life, fatigue, overall and bone survival, and local control will be assessed. Methods/Design This study is a single-center, prospective, randomized, controlled, explorative intervention study with a parallel-group design to determine multidimensional effects of a course of exercises concomitant to RT on patients who have unstable metastases of the vertebral column, first under therapeutic instruction and subsequently performed by the patients themselves independently for strengthening the paravertebral muscles. On the days of radiation treatment the patients will be given four different types of exercises to ensure even isometric muscle training of all the spinal muscles. In the control group progressive muscle relaxation will be carried out parallel to RT. The patients will be randomized into two groups: differentiated muscle training or progressive muscle relaxation with 30 patients in each group. Discussion Despite the clinical experience that RT is an effective treatment for bone metastases, there is insufficient evidence for a positive effect of the combination with muscle-training exercises in patients with unstable bone metastases. Our previous DISPO-1 trial showed that adding muscle-training exercises to RT is feasible, whereas this was not proven in patients with an unstable spinal column. Although associated with several methodological and practical challenges, this randomized controlled trial is needed. Trial registration ClinicalTrials.gov, identifier: NCT02847754. Registered on 27 July 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1903-x) contains supplementary material, which is available to authorized users.

SPIRIT 2013 Checklist: recommended items to address in a clinical trial protocol and related documents. (DOC 121 kb)

Background: Physical activity (PA) can support cancer patients during medical treatment by reducing side-effects and increasing quality of life. However, PA levels mostly decline after diagnosis. Which factors can explain if patients are able to remain or even increase their PA level? Self-efficacy is an important cognitive factor that has been linked to cancer patients' PA across many studies. In contrast, affective factors such as PA enjoyment have rarely been examined. We compare the influence of self-efficacy and PA enjoyment on cancer patients' PA levels after completion of an exercise or stress-management intervention. Methods: Outpatient cancer patients [N = 72; 54% female; M = 56 years, SD = 12.34; most with breast or colon cancer (34%, 15%)] were enrolled in the MOTIVACTION study, a 4-week intervention (1 h counseling followed by weekly phone calls), with pre-test (T1), post-test (T2), and a 10-week follow-up (T3). Participants were randomized to either an exercise intervention (emphasizing self-regulatory strategies for behavior change) or to a stress management intervention (coping and relaxation techniques). Sixty-seven patients remained in the study and completed the SQUASH assessment of PA, a measure of maintenance self-efficacy (7 items, Cronbach's α = 0.88) and PA enjoyment (2 items, Cronbach's α = 0.89). Regression analyses were calculated with PA level (at T2 and T3) as dependent variable and relative weight analyses were conducted. The study was registered at clinicalTrials.gov (unique identifier:NCT01576107; URL: https://clinicaltrials.gov/ct2/show/NCT01576107?term=motivaction&rank=1). Results: Baseline self-efficacy and change in PA enjoyment significantly predicted cancer patients' PA level at T2 adjusting for baseline PA and type of intervention. Relative weight (RW) analysis revealed that PA enjoyment (baseline and change together) explained 34.3% of the dependent variable, self-efficacy (baseline and change) explained 38.4%. At follow-up, self-efficacy was still a significant predictor of PA (RW = 74.6%), whereas PA enjoyment was no longer a relevant factor (RW = 5.2%). Conclusion: The affective factor PA enjoyment was equally important as self-efficacy for predicting cancer patient' PA level directly after completion of the intervention. Reasons for the reduced relevance at follow-up and a broader range of affective factors should be analyzed in future studies on cancer patients' PA level.

Die allogene hämatopoetische Stammzelltransplantation (allo-HSCT) stellt eines der komplexesten und risikoreichsten medizinischen Behandlungsverfahren der heutigen Zeit dar. Gleichzeitig bietet sie jedoch Patienten mit austherapierten oder hämatologischen Krebserkrankungen mit ungünstigen Risikokonstellationen die letzte Chance auf vollständige Genesung und somit Heilung. Vor, während und nach allo-HSCT unterliegen die betroffenen Patienten mitunter starken biopsychosozialen Beeinträchtigungen, welche durch die Grunderkrankung an sich als auch durch die medizinische Therapie verursacht werden. Sport-/Bewegungstherapeutische Maßnahmen haben das Potential im Rahmen der Transplantation einen wichtigen Beitrag zur Behandlung zahlreicher therapie- und krankheitsbedingten Nebenwirkungen (bspw. Fatiguesymptomatik) zu leisten. Aus diesem Grund wurde in der vorliegenden Dissertation, im Rahmen einer randomisierten und kontrollierten Studie, die Durchführbarkeit und differenzielle Wirksamkeit eines bewegungstherapeutischen Interventionsprogramms (körperliches Kraft- und Ausdauertraining) untersucht, welches als behandlungsphasenübergreifendes Konzept entwickelt wurde und die Patienten im Sinne der integrativen Versorgung vor, während und nach allogener Stammzelltransplantation betreute. Insgesamt konnten 112 Patienten in die Studie eingeschlossen werden, von denen 106 Patienten der allogenen Stammzelltransplantation zugeführt wurden. Das theoriegeleitet konzipierte Trainingsprogramm war in jeder Studienphase praktikabel und erzielte zum Teil Adherence-Werte über 90%. Die interventionsinduzierten Effekte waren dabei multidimensional. So konnte eine hohe Wirksamkeit im Bezug auf die körperliche Leistungsfähigkeit der trainierenden Patienten während und nach der Transplantation gezeigt werden. Die im Gruppenvergleich gefundenen mittleren bis großen Effektstärken sprechen eindeutig für den Bedarf eines gezielten körperlichen Trainings im Kontext der allogenen HSCT, als auch für die Wirksamkeit der durchgeführten Intervention. Im gleichen Zeitraum ließen sich zudem eine signifikant positive Beeinflussung der Lebensqualität und erstmalig eine relevante Einflussnahme auf die Fatiguesymptomatik (häufigste nicht-letale, jedoch stark einschränkende Komplikation nach allo-HSCT) darlegen. Weitere Befunde zur positiven Beeinflussung des subjektiven Stressempfindens sowie zu emotionalen/kognitiven Komponenten erweitern das erfreuliche Therapieoutcome. Auf körperlicher Ebene zeigte sich zudem während des stationären Studienabschnittes eine signifikant geringere Häufigkeit an hypertonen Phasen für die Experimentalgruppe und ein besserer Karnofsky-Index zum Ende der Intervention. Keine statistisch signifikante Beeinflussung konnte hingegen für immuno- oder hämatologische Parameter festgestellt werden, wobei positive Tendenzen zu Gunsten der körperlich Trainierenden mit Blick auf die stationäre Substitutionsbedürftigkeit, die Hämoglobin- und Thrombozytenwerte sowie die BMI-Entwicklung nach stationärer Entlassung deskriptiv sichtbar waren. Zahlreiche Effekte wiesen darüber hinaus eine adäquate Nachhaltigkeit bis zum Ende des Beobachtungszeitraumes 6 Monate nach stationärer Entlassung auf. Zusammenfassend beurteilt ist der Nutzen des untersuchten bewegungstherapeutischen Interventionskonzeptes im Rahmen der allogenen hämatopoetischen Stammzelltransplantation als hoch einzuschätzen, da zahlreiche Nebenwirkungen und Komplikationen der Behandlung abgemildert oder verhindert werden konnten. Somit ist, unter Beachtung spezieller Kontraindikationen, ein entsprechendes körperliches Training für jeden betroffenen allo-HSCT Patienten zu empfehlen.