Elsevier

The Lancet Oncology

Volume 9, Issue 8, August 2008, Pages 757-765
The Lancet Oncology

Review
Cardiorespiratory exercise testing in clinical oncology research: systematic review and practice recommendations

https://doi.org/10.1016/S1470-2045(08)70195-5Get rights and content

Summary

The use of exercise testing as an objective assessment of cardiorespiratory fitness in clinical oncology research has increased substantially over the past decade. However, its quality has not been assessed. We did a systematic review of studies of formal exercise testing for adults with cancer. Studies were assessed according to the American Thoracic Society/American College of Chest Physicians (ATS/ACCP) recommendations for exercise testing. Overall, the reporting of exercise-testing methods and data for adults with cancer suggests that the conduct of these tests does not comply with national and international quality guidelines. We give recommendations for exercise testing in clinical oncology research. The adoption of consistent, formal standards for methods and data reporting in exercise testing is needed to ensure high-quality research in clinical oncology. Overall, we present information for clinicians and exercise-oncology researchers who assess and care for patients with cancer.

Introduction

The objective assessment of cardiorespiratory fitness is an important recognised outcome in various clinical and research settings. The ability to deliver oxygen (O2) to metabolically active skeletal muscles for ATP resynthesis to drive muscular contraction is a fundamental need of mammals. In accordance with the Fick principle,1 peak oxygen consumption (VO2peak) is the product of cardiac output (Q) and arteriovenous oxygen difference (a–vO2diff). Changes in any step of O2 transport can cause predictable changes in the body's ability to consume and use O2. Measurement of VO2peak is most commonly determined during an incremental cardiopulmonary exercise test (CPET) to exhaustion or symptom limitation (figure). VO2peak is an objective measure of cardiorespiratory fitness, which varies between individuals and is inversely associated with death from cardiovascular disease or any cause in patients and healthy individuals.2, 3, 4, 5, 6, 7, 8 Formal exercise testing is used widely in various clinical settings and gives comprehensive information to aid diagnosis, prognosis, and decision making.9 Several national and international organisations have issued guidelines for the optimum conduct and interpretation of exercise tests.9, 10, 11, 12, 13

However, the assessment of cardiorespiratory fitness and use of exercise testing, is not routine in the clinical management of patients with cancer, other than to determine the physiological status before surgery for lung cancer.14, 15, 16, 17 Nevertheless, over the past decade interest has increased in the role of exercise-training interventions after a cancer diagnosis to assess cardiorespiratory fitness.18, 19, 20, 21 In these investigations, exercise testing is done before and after treatment; moreover, testing informs the development of individual exercise regimens.18, 19, 20, 21 However, despite increasing use of exercise testing and its importance, quality has not been assessed in the cancer setting. We did a systematic review of the quality of methods and data reporting in exercise testing for adults diagnosed with cancer. Furthermore, we aim to give appropriate recommendations to aid the standardisation of exercise testing in this setting.

Section snippets

Methods

We used PubMed, Medline, Sport Discus, and Cochrane Controlled Trials Register to search for relevant studies published between 1966 and November, 2007. We used the following MESH terms: exercise; cardiorespiratory fitness; exercise capacity; cardiopulmonary fitness; functional capacity; exercise test; oncology; cancer; and neoplasms. Relevant reference lists were also hand-searched. Studies of objective exercise testing for adults diagnosed with cancer were eligible. We excluded studies with

Results

We identified 852 potential citations. After initial screening, 102 were regarded potentially eligible. On secondary screening, 90 met inclusion criteria (webappendix).

Table 1 shows overall study characteristics. The 90 studies assessed 5179 adults. 41 studies did CPET (2931 patients) and 51 studies did an intervention (3400 patients). Most participants were women, who were particularly over-represented in intervention studies. Most studies assessed patients with lung cancer or breast cancer.

Discussion

To our knowledge, this systematic review is the first to assess critically the quality of methods and reporting in exercise testing in any clinical population. The quality of methods in exercise testing was suboptimum: most studies did not report adherence to fundamental principles of exercise testing as recommended for patients by ATS/ACCP.9 Moreover, data-reporting standards were of low quality: many studies did not report key exercise response outcomes. Table 4 shows guidelines for reporting

Conclusion

The reporting of methods and data generated in exercise testing of adults with cancer suggests that such testing does not comply with national and international quality guidelines. Although the clinical application of exercise testing in cancer management outside the setting of those with preoperative lung cancer remains to be determined, the rapid development of exercise-oncology research suggests that the application of exercise testing is likely to increase in the future. An immediate aim

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