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There are numerous published controlled trials assessing the safety and the benefits of physical activity (PA) for child and adult cancer survivors. However, trials exclusively comprised of adolescent cancer survivors aged 13-19 years, who may experience different health and quality of life (QOL) effects as a function of their developmental status, are lacking. Rather, some trials have included both adolescent and child cancer survivors together.
The aim of this systematic review was to synthesize the findings from randomized controlled trails (RCTs) and controlled clinical trials (CCTs) investigating the effects of PA on health and QOL outcomes in samples comprised of >50% adolescent cancer survivors to summarize the current state of evidence, identify knowledge gaps, and highlight areas in need of additional research within this population.
Using a search strategy developed for this review, 10 electronic databases were searched for RCTs and CCTs that reported on the effects of PA on at least 1 health and/or QOL outcome in samples comprised of >50% adolescent cancer survivors.
From the 2249 articles identified, 2 CCTs met the predetermined eligibility criteria and were included in this review. Combined, 28 adolescents (of 41 participants) who were receiving active treatment participated in the 2 studies reviewed. A total of 4 health and QOL outcomes (ie, bone mass, fatigue, grip strength, QOL) were assessed pre- and post-PA intervention.
On the basis of the 2 studies reviewed, PA appears to be safe and feasible. PA also shows promise to mitigate reductions in bone mass and might be a viable strategy to improve fatigue, grip strength, and QOL. High-quality controlled trials with larger samples exclusively comprised of adolescent cancer survivors that assess a wide range of outcomes are needed to determine the effects of PA on health and QOL outcomes in this population.
Each year in North America, more than 7500 adolescents are diagnosed with cancer [
There have been several trials testing the effects of physical activity (PA) on health and QOL outcomes among cancer survivors [eg,
The Public Health Agency of Canada defines adolescents as individuals aged 13-19 years [
Given that adolescence is a time of tremendous growth and development [
The review was carried out following established criteria for the good conduct and reporting of systematic reviews (ie, Preferred Reporting Items for Systematic Review and Meta-Analyses, Cochrane Handbook for Systematic Reviews of Interventions, Consolidated Standards of Reporting Trials, Guidance on the Conduct of Narrative Synthesis in Systematic Reviews [
First, 10 electronic databases were searched (ie, CINAHL, Cochrane Central Register of Controlled Trials, EMBASE, LILACS, MEDLINE, PEDro, Physical Education Index, PsycINFO, PubMed, SPORTDiscus) for articles published in English in peer-reviewed scientific journals from database inception to November 2015. A combination of Medical Subject Heading terms and keywords covering the target population (eg, adolescent, young person, teen, cancer patient), intervention (eg, exercise, PA, physical fitness), and comparison condition (eg, control group, usual care) were used after consultation with an expert librarian (YL). Of note, these search terms were revised and refined after conducting an initial search. The rationale for this is presented in the published systematic review protocol [
Both authors screened the titles and abstracts of all studies identified during the search using the following predetermined eligibility criteria: (1) reported the effect(s) of PA on at least 1 health and/or QOL outcome, (2) used a RCT or CCT study design, (3) had at least pre- and post-intervention assessments, and (4) had a sample comprised of >50% cancer survivors aged 13-19 years. The latter criterion was based on precursory knowledge that no PA trials have been conducted with samples exclusively comprised of adolescent cancer survivors. For the purpose of this review, an intervention was considered as anything greater than 1 PA session. Studies were excluded if they had multiple program features that could be attributed to the outcomes reported or if they had insufficient details on the target population, intervention, comparison condition, and/or outcomes (after the study authors were contacted by email and it was determined that the requested data were unavailable). The inter-rater agreement between both authors on the eligibility of studies was >95%, representing a high level of agreement [
Both authors extracted the following information from the eligible articles: (1) study characteristics (ie, year of publication, country, study design), (2) sample characteristics (ie, number of participants randomized, age, type(s) of cancer diagnosed, treatment status), (3) intervention characteristics (ie, supervision, setting, length, frequency, duration, intensity, activity types(s)), (4) outcome measures, and (5) outcomes (ie, health, QOL). Additional relevant information such as the use of theory and whether intention-to-treat analysis was performed were also recorded. In cases where details were missing, authors were contacted by email
As illustrated in
Flow chart of search results.
There were a total of 41 participants between the 2 studies. Müller et al [
Both interventions varied considerably with regard to the type of PA intervention and reported characteristics. Thus, each intervention is described separately. Müller et al [
Rosenhagen et al [
The results of the PA interventions are presented in
Müller et al [
Rosenhagen et al [
Rosenhagen et al [
Rosenhagen et al [
Müller et al [
Rosenhagen et al [
Müller et al [
This systematic review summarizes the best available evidence regarding the effects of PA on health and QOL outcomes for samples comprised of >50% adolescent cancer survivors. A total of 2 CCTs were identified that had mixed samples of children and adolescents [
Given the evidence that PA can improve symptoms of fatigue in adult cancer survivors [
Although the included studies had samples comprised of 67% [
In line with a previous systematic review conducted with pediatric cancer survivors aged 2-21 years [
The effects of PA on a wider range of health and QOL outcomes cannot be established as the CCTs included in this review focused mainly on physical health outcomes (ie, bone mass, fatigue, grip strength [
Although for the most part, PA was not shown to significantly affect adolescent cancer survivors’ health and QOL at the conventional 5% level of significance, it is important to balance the lack of evidence based on the reviewed CCTs with the previously mentioned limitations of each. Combined with evidence from case-series studies linking PA to improvements on various outcomes in this population (eg, [
The limitations of the current review should be taken into account. First, although the strength of conducting a systematic review is the ability to integrate and pool existing data to draw firm conclusions and determine effect sizes [
On the basis of the current review, there is insufficient evidence available to conclude that PA affects adolescent cancer survivors’ health and QOL. The lack of RCTs and CCTs stands in stark contrast to the extant literature providing evidence for the effects of PA on health and QOL in younger [
Characteristics of the included physical activity interventions.
Measures and outcome results from the included physical activity interventions.
bone mineral content
bone mineral density
controlled clinical trials
physical activity
quality of life
randomized controlled trial
The authors would like to thank Müller et al [
AW and JB conceptualized and designed the systematic review protocol, performed the systematic literature searches, screened and selected studies, and extracted and interpreted the data. They were involved in all aspects of drafting, revising, and finalizing this manuscript. Furthermore, both approved the order of authorship.
None declared.