The role of resistance training in mitigating cancer-induced cachexia: A systematic review

Abstract

Background: Cancer induced cachexia, the involuntary loss of lean body mass and adipose tissue, is a debilitating syndrome experienced in up to 80% of all cancer patients. Cachexia is associated with poor treatment outcomes including decreased quality of life, increased risk of infection, disease progression, and mortality. Recent research suggests that exercise interventions may improve cachexia; however, there is a need for comprehensive and systematic review of the literature to evaluate the role of specific interventions on cancer-induced cachexia.

Methods: We conducted a systematic review examining the efficacy of physical activity interventions, particularly resistance training, on cancer-induced cachexia outcomes. We searched seven electronic databases (PubMed, Embase, EBSCO, SCOPUS, Web of Science, PsychINFO, Cochrane) for articles published up to September 2023, yielding 7 eligible studies.

Results: Sample sizes ranged from 20 to 190 participants per study. Studies included pancreatic (n = 3), head & neck (n = 3), and Gastrointestinal (n = 1) cancers. Mean age ranged from 51.90 to 67.1 years old and females comprised 51% of the participants. Most studies implemented resistance training interventions (73%), ranging from 3 months to 6 months in duration. Although the patterns of outcomes indicate promising results, the effect sizes for all models were small and not statistically significant.

Conclusions: The science of exercise interventions to improve outcomes in those with cancer-related cachexia is still emerging although progressive resistance training appears to be the most promising countermeasure. Authors encourage the development of high-quality, fully powered randomized controlled trials (RCTs) examining physical exercise interventions aimed at mitigating cancer-induced cachexia.

Keywords

Cancer / Cachexia / Physical activity / Exercise

CRediT authorship contribution statement

Jennifer L. Horawski: Writing - review & editing, Writing - original draft, Resources, Methodology, Investigation, Conceptualization. Sara E. Fleszar-Pavlovic: Writing - review & editing, Writing - original draft, Formal analysis, Conceptualization. Melissa Lopez-Pentecost: Writing - review & editing, Writing - original draft, Methodology, Investigation, Conceptualization. Tracy E. Crane: Writing - review & editing, Method- ology. Madalyn G. Wheeler: Writing - original draft, Investigation, Data curation. Eric Kholodovsky: Investigation. Thomas M. Best: Writing - review & editing, Supervision, Methodology, Conceptualization.

Availability of data and materials

The data that support the findings of this study are available upon reasonable request from the corresponding author, Jennifer L. Horawski.

Manuscript registration statement

This study followed the PRISMA guidelines for systematic reviews and was pre-registered with PROSPERO (CRD42023457237).

Funding

S.F.P. and M.L.P. are funded by The Ruth L. Kirschstein NRSA Insti- tution Research Training Grant (T32; 5T32CA251064-03) in Cancer Training in Disparities and Equity (CTIDE).

Declaration of conflict of interest

Thomas M. Best is an Editorial Board Member for this journal and was not involved in the editorial review or the decision to publish this article. We wish to confirm that there are no known conflicts of interest associ- ated with this publication and there has been no significant financial support for this work that could have influenced its outcome.

We confirm that the manuscript has been read and approved by all named authors and that there are no other persons who satisfied the criteria for authorship but are not listed. We further confirm that the order of authors listed in the manuscript has been approved by all of us. We confirm that we have given due consideration to the protection of intellectual property associated with this work and that there are no impediments to publication, including the timing of publication, with respect to intellectual property. In so doing we confirm that we have followed the regulations of our institutions concerning intellectual property.

We understand that the Corresponding Author is the sole contact for the Editorial process (including Editorial Manager and direct communi- cations with the office). She is responsible for communicating with the other authors about progress, submissions of revisions and final approval of proofs. We confirm that we have provided a current, correct email address which is accessible by the Corresponding Author and which has been configured to accept email from [e-mail].

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