GENERAL AND SUPPORTIVE CARE Is exercise an acceptable and practical therapy for people with or cured of cancer? A systematic review Matthew Maddocks * , Simon Mockett, Andrew Wilcock Hayward House Macmillan Specialist Palliative Care Cancer Unit, Nottingham University Hospitals NHS Trust, City Hospital Campus, Nottingham NG5 1PB, United Kingdom article info Article history: Received 20 September 2008 Received in revised form 19 November 2008 Accepted 27 November 2008 Keywords: Acceptability Adherence Cancer Exercise Rehabilitation summary Introduction: Therapeutic exercise, although potentially beneficial, does not appear acceptable to many cancer patients. A greater understanding of the reasons for this is required. We have systematically reviewed the use of exercise in this group, identifying rates of uptake, adherence and completion along with factors influencing acceptability. Methods: Searches were completed using relevant key words. Data on study design, patient group, exercise intervention, patient flow data and reasons for declining or withdrawing from a programme were independently extracted by two researchers. Rates of study uptake, completion and adherence were compared according to dichotomised patient or programme characteristics using Mann Whit- ney U test (p = 0.05). Reasons provided when declining or withdrawing from a study were categorised. Results: Sixty five studies were included. The majority contained groups made up entirely or pre- dominantly of patients with breast cancer offered an aerobic or resistance exercise programme. The median [IQR] rates of uptake, adherence and completion were 63 [33–80]%, 84 [72–93]% and 87 [80–96]%, respectively. No characteristic influenced the proportion of patients taking up or com- pleting a programme. The main reasons for refusal were disinterest or the impracticality of under- taking the programme and for withdrawal, medical complication or deterioration. Conclusions: The invitation to undertake a programme of therapeutic exercise is accepted by about two-thirds of patients. Rates of adherence and completion are relatively high, but overall, only about half of patients offered a programme complete one. There is a need to modify exercise programmes if they are to be acceptable for the majority of patients. Ó 2008 Elsevier Ltd. All rights reserved. Introduction Physical exercise is reported to be therapeutic in patients with or cured of cancer, enhancing physical functioning and psycholog- ical well-being. 1–3 However, rates of uptake, adherence and com- pletion of exercise programmes vary, suggesting that not all patients find it an acceptable or practical therapy. This appears more so for patients undergoing anti-cancer treatment or with ad- vanced disease. 4,5 If exercise is to be developed as a therapy suit- able for the majority of patients with cancer, greater understanding of the factors limiting its utility is required. We have begun by systematically reviewing exercise programmes of- fered to this group of patients in order to identify rates of uptake, adherence and completion together with reasons for declining or withdrawing from the programme. Methods Search strategy and selection criteria Medline, Embase, Cochrane Controlled Trials Register and Ci- nahl electronic databases were searched from their respective inceptions to July 2008 for studies of exercise programmes for peo- ple with or cured of cancer. Searches used key words based on: cancer (carcinoma, neoplasm, tumour, chemotherapy, radiother- apy, and surgery), exercise (physical activity, exercise therapy, physical training, aerobic, strength, walking) and clinical trials (programme, intervention, scheme, trial) modified according to the specific vocabulary of each database. In addition, hand searches were conducted in European Journal of Cancer Care, Psycho-Oncol- ogy and Journal of Clinical Oncology, and the reference lists of rel- evant reviews and studies already located were checked. To be eligible, the exercise intervention studies had to contain a minimum of five patients, 18 years or older, who had previously or were currently receiving treatment for cancer. Studies were 0305-7372/$ - see front matter Ó 2008 Elsevier Ltd. All rights reserved. doi:10.1016/j.ctrv.2008.11.008 * Corresponding author. Tel.: +44 0115 8231801; fax: +44 0115 9627778. E-mail address: matthew.maddocks@nottingham.ac.uk (M. Maddocks). Cancer Treatment Reviews 35 (2009) 383–390 Contents lists available at ScienceDirect Cancer Treatment Reviews journal homepage: www.elsevierhealth.com/journals/ctrv