SEARCHSYSTEMATIC_REVIEWoncology, gynecologic oncology

systematic_review·oncology, gynecologic oncology, physical medicine and rehabilitation, sports medicine·PMC10191940

Efficacy of exercise interventions for women during and after gynaecological cancer treatment – a systematic scoping review

Supportive Care in Cancer · 9 authors, 9 centres

AI SUMMARY

FIDELITY 100%

POPULATIONWomen ≥18 years with a diagnosis of gynaecological cancer (ovarian, endometrial, cervical, uterine, vulva, peritoneal, mixed) during or following treatment.

INTERVENTIONExercise-only interventions (aerobic, resistance, combined, or other) of 8-24 weeks, mostly unsupervised, with prescribed frequency 2-5 days/week and session duration 10-120 minutes.

COMPARISONUsual care, waitlist control, information book with weekly phone contact, or non-exercising control; some studies had no comparison group (single-arm pre-post or prospective cohort).

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TL;DR

This systematic scoping review of 11 studies found that exercise interventions for women during or after gynaecological cancer treatment improve aerobic capacity (V̇O₂ Peak +1.6 mL/kg/min, 6-minute walk distance +20-27 m), muscular strength (30-second sit-to-stand +2-4 reps, arm curl +5 reps), and agility (timed up-and-go -0.6 seconds). Changes in quality of life, body composition, and other outcomes were inconsistent, but no worsening was observed. These findings support the inclusion of exercise, particularly combined aerobic and resistance training, to counteract declines in physical function common after gynaecological cancer.

Full summary

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**Background:** Gynaecological cancers (ovarian, endometrial, cervical, vaginal, vulvar, fallopian tube) are increasing in incidence, with 1,398,601 women diagnosed worldwide in 2020. Treatment-related side effects include lower limb lymphoedema, fatigue, depression, anxiety, pain, reduced physical function, and decreased quality of life. Exercise has pluripotent benefits across bodily systems, and guidelines recommend aerobic and resistance training for people with cancer, but evidence specific to gynaecological cancer is limited. This systematic scoping review aimed to synthesise evidence on the efficacy of exercise-only interventions for physical and psychosocial outcomes in women during or after gynaecological cancer treatment.

**Methods:** Five databases (PubMed, EMBASE, CINAHL, PsychInfo, Scopus) were searched up to 18 March 2022. Inclusion criteria: RCTs, quasi-RCTs, cohort, or pre-post single-arm studies; women ≥18 years with gynaecological cancer (≥80% of sample or separate results); exercise-only interventions (pre-determined block of prescribed physical exercise sessions); any physical or psychosocial health-related outcome. Exclusion criteria: multimodal interventions (e.g., exercise plus diet), complete decongestive therapy, pelvic floor exercises, dilator use, non-English, no full text, animal studies. Quality was assessed using the Revised Cochrane Risk of Bias tool for RCTs and a modified Newcastle-Ottawa Scale for non-controlled studies. Data were extracted by four reviewers and cross-checked.

**Key Results:** Eleven studies (7 RCTs, 3 single-arm pre-post, 1 prospective cohort) with 640 participants (range 12-144) were included. Most participants had ovarian (52%) or endometrial (34%) cancer, mean age 57 years, mean BMI 30 kg/m², and were post-treatment (91%). Interventions averaged 15 weeks (range 8-24), were mostly home-based (64%), and included combined aerobic+resistance (36%), aerobic-only (36%), resistance-only (18%), or other (indoor rock climbing, 9%). Supervision was fully/mostly unsupervised in 63% of studies. Risk of bias was moderate-to-high overall.

- **Aerobic capacity:** Three of five RCTs showed significant between-group improvements: V̇O₂ Peak +1.6 mL/kg/min, 6-minute walk distance +20-27 m. Two RCTs reported non-significant improvements of 20 m and 52 m. - **Muscular strength:** Lower limb strength (30-second chair stand) improved by +2-4 repetitions in three RCTs. Upper limb strength (30-second arm curl) improved by +5 repetitions in two RCTs; grip strength improved by +3.1 kg in one RCT but not another (+0.5 kg). One prospective cohort reported +10.6 kg grip strength improvement. - **Body composition:** No significant changes in waist circumference, body mass, BMI, body fat percentage, or lean mass in six RCTs. One waitlist-controlled RCT reported a -5.4 cm waist circumference reduction. Lower limb lymphoedema prevalence did not change. - **Physical function:** Agility (8-foot up-and-go) improved by -0.6 seconds in two RCTs. Flexibility results were mixed (one study improved sit-and-reach by -1.1 cm, another showed no change). Balance improved in one single-arm study. - **Physical activity:** One RCT found no increase in self-reported PA; two single-arm studies reported +4 min/day and +8 MET-hours/week improvements. - **Quality of life:** Three of five RCTs (60%) reported significant improvements in global QoL/composite scores (p=0.02-0.05). Two of three single-arm studies also showed improvements. Overall, 7 of 15 QoL outcomes improved. - **Fatigue:** One RCT reported significant reduction (p=0.046). - **Mental wellbeing:** Two RCTs showed improvements in anxiety and depression (p<0.05); one single-arm study found no effect on anxiety/depression but improved somatization (p=0.03). - **Stress and sleep:** No significant changes in single-arm studies.

**Clinical Implications:** Exercise interventions improve aerobic capacity, muscular strength, and agility in women after gynaecological cancer treatment, with level II-IV evidence. These improvements may counteract typical declines in physical function and potentially reduce fatigue and enhance daily activities. Combined aerobic and resistance training appears most beneficial. However, effects on quality of life, body composition, and psychosocial outcomes are inconsistent, likely due to small sample sizes, variable assessment methods, and ceiling effects. Exercise appears safe and feasible, with no reported adverse events beyond muscle soreness. Future research should include larger, adequately powered trials with gold-standard outcome measures and explore differential effects by cancer type, stage, and treatment.

PICO

PPOPULATION

Women ≥18 years with a diagnosis of gynaecological cancer (ovarian, endometrial, cervical, uterine, vulva, peritoneal, mixed) during or following treatment.

IINTERVENTION

Exercise-only interventions (aerobic, resistance, combined, or other) of 8-24 weeks, mostly unsupervised, with prescribed frequency 2-5 days/week and session duration 10-120 minutes.

OOUTCOME

Physical outcomes (aerobic capacity, muscular strength, body composition, physical function, physical activity) and psychosocial outcomes (quality of life, fatigue, stress, mental wellbeing, sleep).

STUDY TYPE

systematic_review

SPECIALTY

oncology

SUMMARISED BY

AI pipeline

FIDELITY CHECK

100% · A

ORIGINAL PAPER

PMC10191940

Efficacy of exercise interventions for women during and after gynaecological cancer treatment – a systematic scoping review

Supportive Care in Cancer

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ABSTRACT

Abstract Purpose To systematically synthesise evidence of exercise intervention efficacy for physical/psychosocial outcomes that matter to women during/following treatment for gynaecological cancer. Methods Five databases were searched (PubMed, EMBASE, CINAHL, PsychInfo, Scopus). Exercise-only intervention studies that included women during/ following treatment for any gynaecological cancer, with/ without control comparison, on any physical or psychosocial outcome(s), were included and qualitatively appraised using the Revised Cochrane Risk of Bias tool and a modified Newcastle-Ottawa Scale. Results Seven randomised controlled trials (RCTs), three single-arm pre-post studies, and one prospective cohort study satisfied were included (11 studies). Most studies were completed following treatment (91%), included combined (aerobic and resistance; 36%) and aerobic (36%) training, were fully/mostly (63%) unsupervised, and had a moderate-to-high risk of bias. Overall, 33 outcomes (64% objectively-measured) were assessed. Improvements were observed in aerobic capacity (V̇O 2 Peak +1.6 mL/kg/min, 6-minute walk distance +20-27 m), lower- (30-second sit-to-stand +2-4 repetitions) and upper-limb strength (30-second arm curl +5 repetitions; 1RM grip strength/chest press +2.4-3.1 kg), and agility (timed up-and-go -0.6 seconds). However, changes in quality of life, anthropometry/body composition, balance and flexibility were inconsistent. There was no evidence to support worsening of outcomes. Conclusion Preliminary research into the role of exercise post-gynaecological cancer suggests an improvement in exercise capacity, muscular strength, and agility which, in the absence of exercise, typically decline following gynaecological cancer. Future exercise trials involving larger and more diverse gynaecological cancer samples will improve understanding of the potential and magnitude of effect of guideline-recommended exercise on outcomes that matter to patients. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-023-07790-8. Keywords: fitness, strength, body composition, oncology, agility

CITATION EXPORT

Grace Laura Rose, Elizabeth Mary Stewart, Briana Kristine Clifford et al.. Efficacy of exercise interventions for women during and after gynaecological cancer treatment – a systematic scoping review. Supportive Care in Cancer. (2023). https://doi.org/10.1007/s00520-023-07790-8

AUTHORS

9 · 9 CENTRES

Grace Laura Rose, Elizabeth Mary Stewart, Briana Kristine Clifford, Tom George Bailey, Alexandra Jane Rush, Claudia Rose Abbott, Sandra Christine Hayes, Andreas Obermair, Alexandra Leigh McCarthy

1School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
2School of Health, University of the Sunshine Coast, Sippy Downs, Australia
3School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
4School of Health Sciences, University of New South Wales, Sydney, Australia
5School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
6Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
7School of Medicine, The University of Queensland, Brisbane, Australia
8Queensland Centre for Gynaecological Cancer, Royal Brisbane and Women’s Hospital, Brisbane, Australia
9Mater Research Institute, Brisbane, Australia