Advertisement

Supportive Care in Cancer

, Volume 25, Issue 12, pp 3655–3664 | Cite as

Resistance training as supportive measure in advanced cancer patients undergoing TKI therapy—a controlled feasibility trial

  • F. Rosenberger
  • J. Wiskemann
  • S. Vallet
  • G. M. Haag
  • E. Schembri
  • D. Jäger
  • C. Grüllich
Original Article

Abstract

Purpose

While there is growing evidence for positive effects of progressive resistance training in curatively treated cancer patients, data on advanced cancer patients are scarce. This pilot study aimed at investigating for the first time feasibility and effects of progressive resistance training in advanced cancer patients undergoing tyrosine kinase inhibitor (TKI) therapy.

Methods

Patients starting a TKI-based anti-tumor therapy were assigned to a resistance training group (RT, 12 weeks of progressive machine-based resistance training 2×/week) or a control group (CON, treatment as usual) until 10 patients had finished in each group (RT 80% males, 90% renal cell carcinoma, 65 ± 11 years, CON 80% males, 70% renal cell carcinoma, 61 ± 6 years). Primary endpoint was feasibility. Furthermore, fatigue (MFI), quality of life (QoL, EORTC QLQC30), and muscle strength were assessed. Testing occurred at baseline and after 12 weeks.

Results

Training was feasible in 9 out of 10 participants and no serious adverse events occurred. It had beneficial effects on muscle strength (maximum voluntary isometric contraction of the quadriceps: RT +11 ± 9 Nm, CON −13 ± 25 Nm, p = 0.005), but not on fatigue (general fatigue score RT +0.3 ± 4.1, CON -1.5 ± 3.0, p = 0.223) or QoL (global QoL score RT −5.6 ± 16.1, CON −2.0 ± 18.2, p = 0.617).

Conclusions

Progressive machine-based resistance training appears feasible in the majority of advanced cancer patients undergoing TKI therapy. However, its positive effects on muscle strength do not seem to be associated with positive effects on fatigue or quality of life. Future studies should therefore compare whether home-based training is more beneficial for patient-reported outcomes.

Trial registration

NCT01645150

Keywords

Exercise Advanced cancer Tyrosine kinase inhibitor Physical fitness Fatigue Quality of life 

Notes

Acknowledgements

We thank Professor Karen Steindorf, Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany, for the helpful discussions on study design and conduct and the continuous support with important resources including the diagnostic lab facilities.

Compliance with ethical standards

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

References

  1. 1.
    Schmitz KH, Courneya KS, Matthews C, Demark-Wahnefried W, Galvao DA, Pinto BM, Irwin ML, Wolin KY, Segal RJ, Lucia A, Schneider CM, von Gruenigen VE, Schwartz AL (2010) American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc 42(7):1409–1426. doi: 10.1249/MSS.0b013e3181e0c112 CrossRefPubMedGoogle Scholar
  2. 2.
    Mishra SI, Scherer RW, Snyder C, Geigle PM, Berlanstein DR, Topaloglu O (2012) Exercise interventions on health-related quality of life for people with cancer during active treatment. Cochrane Database Syst Rev 8:CD008465. doi: 10.1002/14651858.CD008465.pub2 Google Scholar
  3. 3.
    Strasser B, Steindorf K, Wiskemann J, Ulrich CM (2013) Impact of resistance training in cancer survivors: a meta-analysis. Med Sci Sports Exerc 45(11):2080–2090. doi: 10.1249/MSS.0b013e31829a3b63 CrossRefPubMedGoogle Scholar
  4. 4.
    Cramp F, Byron-Daniel J (2012) Exercise for the management of cancer-related fatigue in adults. Cochrane Database Syst Rev 11:Cd006145. doi: 10.1002/14651858.CD006145.pub3
  5. 5.
    Jones LW, Courneya KS, Mackey JR, Muss HB, Pituskin EN, Scott JM, Hornsby WE, Coan AD, Herndon JE, Douglas PS, Haykowsky M (2012) Cardiopulmonary function and age-related decline across the breast cancer survivorship continuum. J Clin Oncol 30(20):2530–2537. doi: 10.1200/JCO.2011.39.9014 CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Wiskemann J, Kleindienst N, Kuehl R, Dreger P, Schwerdtfeger R, Bohus M (2015) Effects of physical exercise on survival after allogeneic stem cell transplantation. Int J Cancer 137(11):2749–2756. doi: 10.1002/ijc.29633 CrossRefPubMedGoogle Scholar
  7. 7.
    Meyerhardt JA, Giovannucci EL, Holmes MD, Chan AT, Chan JA, Colditz GA, Fuchs CS (2006) Physical activity and survival after colorectal cancer diagnosis. J Clin Oncol 24(22):3527–3534. doi: 10.1200/JCO.2006.06.0855 CrossRefPubMedGoogle Scholar
  8. 8.
    Hayes SC, Spence RR, Galvao DA, Newton RU (2009) Australian Association for Exercise and Sport Science position stand: optimising cancer outcomes through exercise. J Sci Med Sport 12(4):428–434. doi: 10.1016/j.jsams.2009.03.002 CrossRefPubMedGoogle Scholar
  9. 9.
    Rock CL, Doyle C, Demark-Wahnefried W, Meyerhardt J, Courneya KS, Schwartz AL, Bandera EV, Hamilton KK, Grant B, McCullough M, Byers T, Gansler T (2012) Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin 62(4):243–274. doi: 10.3322/caac.21142 CrossRefPubMedGoogle Scholar
  10. 10.
    Lowe SS (2011) Physical activity and palliative cancer care. Recent Results Cancer Res 186:349–365. doi: 10.1007/978-3-642-04231-7_15 CrossRefPubMedGoogle Scholar
  11. 11.
    Titz C, Hummler S, Thomas M, Wiskemann J (2016) Physical exercise in advanced cancer patients undergoing palliative treatment. Expert Rev Qual Life Cancer Care 1(6):432–442. doi: 10.1080/23809000.2016.1251292
  12. 12.
    Galvao DA, Taaffe DR, Spry N, Joseph D, Newton RU (2010) Combined resistance and aerobic exercise program reverses muscle loss in men undergoing androgen suppression therapy for prostate cancer without bone metastases: a randomized controlled trial. J Clin Oncol 28(2):340–347. doi: 10.1200/JCO.2009.23.2488 CrossRefPubMedGoogle Scholar
  13. 13.
    Hojjat-Farsangi M (2014) Small-molecule inhibitors of the receptor tyrosine kinases: promising tools for targeted cancer therapies. Int J Mol Sci 15(8):13768–13801. doi: 10.3390/ijms150813768 CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Santoni M, Conti A, Massari F, Arnaldi G, Iacovelli R, Rizzo M, De Giorgi U, Trementino L, Procopio G, Tortora G, Cascinu S (2015) Treatment-related fatigue with sorafenib, sunitinib and pazopanib in patients with advanced solid tumors: an up-to-date review and meta-analysis of clinical trials. Int J Cancer 136(1):1–10. doi: 10.1002/ijc.28715 CrossRefPubMedGoogle Scholar
  15. 15.
    Houk BE, Bello CL, Poland B, Rosen LS, Demetri GD, Motzer RJ (2010) Relationship between exposure to sunitinib and efficacy and tolerability endpoints in patients with cancer: results of a pharmacokinetic/pharmacodynamic meta-analysis. Cancer Chemother Pharmacol 66(2):357–371. doi: 10.1007/s00280-009-1170-y CrossRefPubMedGoogle Scholar
  16. 16.
    Cohen MH, Cortazar P, Justice R, Pazdur R (2010) Approval summary: imatinib mesylate in the adjuvant treatment of malignant gastrointestinal stromal tumors. Oncologist 15(3):300–307. doi: 10.1634/theoncologist.2009-0120 CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Smets EM, Garssen B, Bonke B, De Haes JC (1995) The multidimensional fatigue inventory (MFI) psychometric qualities of an instrument to assess fatigue. J Psychosom Res 39(3):315–325CrossRefPubMedGoogle Scholar
  18. 18.
    Bartsch HH, Weis J, Moser MT (2003) Cancer-related fatigue in patients attending oncological rehabilitation programs: prevalence, patterns and predictors. Onkologe 26(1):51–57Google Scholar
  19. 19.
    Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, de Haes JC et al (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85(5):365–376CrossRefPubMedGoogle Scholar
  20. 20.
    Hautzinger M, Bailer M, Hofmeister D, Keller F (2012) Allgemeine Depressionsskala (ADS), 2nd edn. Hogrefe, GöttingenGoogle Scholar
  21. 21.
    Schroevers MJ, Sanderman R, van Sonderen E, Ranchor AV (2000) The evaluation of the Center for Epidemiologic Studies Depression (CES-D) scale: depressed and positive affect in cancer patients and healthy reference subjects. Qual Life Res 9:1015–1029CrossRefPubMedGoogle Scholar
  22. 22.
    Jones LW, Eves ND, Haykowsky M, Joy AA, Douglas PS (2008) Cardiorespiratory exercise testing in clinical oncology research: systematic review and practice recommendations. Lancet Oncol 9(8):757–765. doi: 10.1016/S1470-2045(08)70195-5
  23. 23.
    Beaver W, Wasserman K, Whipp B (1986) A new method for detecting anaerobic threshold by gas exchange. J Appl Physiol 60(6):2020–2027PubMedGoogle Scholar
  24. 24.
    Borg GA (1982) Psychophysical bases of perceived exertion. Med Sci Sports Exerc 14(5):377–381CrossRefPubMedGoogle Scholar
  25. 25.
    Vickers AJ, Altman DG (2001) Statistics notes: analysing controlled trials with baseline and follow-up measurements. BMJ 323(7321):1123–1124CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Newman AB, Kupelian V, Visser M, Simonsick EM, Goodpaster BH, Kritchevsky SB, Tylavsky FA, Rubin SM, Harris TB (2006) Strength, but not muscle mass, is associated with mortality in the health, aging and body composition study cohort. J Gerontol A Biol Sci Med Sci 61(1):72–77CrossRefPubMedGoogle Scholar
  27. 27.
    Kilgour RD, Vigano A, Trutschnigg B, Lucar E, Borod M, Morais JA (2013) Handgrip strength predicts survival and is associated with markers of clinical and functional outcomes in advanced cancer patients. Support Care Cancer 21(12):3261–3270. doi: 10.1007/s00520-013-1894-4 CrossRefPubMedGoogle Scholar
  28. 28.
    Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee IM, Nieman DC, Swain DP (2011) American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc 43(7):1334–1359. doi: 10.1249/MSS.0b013e318213fefb CrossRefPubMedGoogle Scholar
  29. 29.
    Hagerman FC, Walsh SJ, Staron RS, Hikida RS, Gilders RM, Murray TF, Toma K, Ragg KE (2000) Effects of high-intensity resistance training on untrained older men. I. Strength, cardiovascular, and metabolic responses. J Gerontol A Biol Sci Med Sci 55(7):B336–B346CrossRefPubMedGoogle Scholar
  30. 30.
    Beaudart C, Reginster JY, Petermans J, Gillain S, Quabron A, Locquet M, Slomian J, Buckinx F, Bruyere O (2015) Quality of life and physical components linked to sarcopenia: the SarcoPhAge study. Exp Gerontol 69:103–110. doi: 10.1016/j.exger.2015.05.003 CrossRefPubMedGoogle Scholar
  31. 31.
    Steindorf K, Schmidt ME, Klassen O, Ulrich CM, Oelmann J, Habermann N, Beckhove P, Owen R, Debus J, Wiskemann J, Potthoff K (2014) Randomized, controlled trial of resistance training in breast cancer patients receiving adjuvant radiotherapy: results on cancer-related fatigue and quality of life. Ann Oncol 25(11):2237–2243. doi: 10.1093/annonc/mdu374 CrossRefPubMedGoogle Scholar
  32. 32.
    Schmidt ME, Wiskemann J, Armbrust P, Schneeweiss A, Ulrich CM, Steindorf K (2015) Effects of resistance exercise on fatigue and quality of life in breast cancer patients undergoing adjuvant chemotherapy: a randomized controlled trial. Int J Cancer 137(2):471–480. doi: 10.1002/ijc.29383 CrossRefPubMedGoogle Scholar
  33. 33.
    Segal RJ, Reid RD, Courneya KS, Malone SC, Parliament MB, Scott CG, Venner PM, Quinney HA, Jones LW, D'Angelo ME, Wells GA (2003) Resistance exercise in men receiving androgen deprivation therapy for prostate cancer. J Clin Oncol 21(9):1653–1659. doi: 10.1200/JCO.2003.09.534 CrossRefPubMedGoogle Scholar
  34. 34.
    Motzer RJ, Escudier B, Tomczak P, Hutson TE, Michaelson MD, Negrier S, Oudard S, Gore ME, Tarazi J, Hariharan S, Chen C, Rosbrook B, Kim S, Rini BI (2013) Axitinib versus sorafenib as second-line treatment for advanced renal cell carcinoma: overall survival analysis and updated results from a randomised phase 3 trial. Lancet Oncol 14(6):552–562. doi: 10.1016/S1470-2045(13)70093-7
  35. 35.
    Schwarz R, Hinz A (2001) Reference data for the quality of life questionnaire EORTC QLQ-C30 in the general German population. Eur J Cancer 37(11):1345–1351CrossRefPubMedGoogle Scholar
  36. 36.
    Scott NW, Fayers PM, Aaronson NK, Bottomly A, de Graeff A, Groenvold M, Gundy C, Koller M, Petersen MA, Sprangers MA (2008) Reference values manual—EORTC-QLQ-C30. European Organisation for Research and Treatment in Cancer, BrusselsGoogle Scholar
  37. 37.
    Schwartz CE, Rapkin BD (2004) Reconsidering the psychometrics of quality of life assessment in light of response shift and appraisal. Health Qual Life Outcomes 2:16. doi: 10.1186/1477-7525-2-16 CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  1. 1.Department of Medical Oncology, National Center for Tumor Diseases (NCT)Heidelberg University HospitalHeidelbergGermany
  2. 2.Division of Health SciencesGerman University of Applied Sciences for Prevention and Health Management (DHfPG)SaarbrückenGermany
  3. 3.Department of Internal MedicineMedical University of KremsKremsAustria

Personalised recommendations