Safety, feasibility, and effectiveness of exercise interventions in patients with hematologic malignancy during chemotherapy: a systematic review and meta-analysis.

Purpose: To evaluate the safety, feasibility, and effectiveness of exercise interventions aimed at improving the physical and/or mental health of patients with hematologic malignancies (HM) during chemotherapy.

Methods: We systematically searched nine electronic databases for studies from their inception up to February 2024. The review process strictly adhered to the Cochrane guidelines and followed the PRISMA checklist for reporting systematic reviews. Sensitivity and subgroup analyses were conducted. When appropriate, we ran meta-regressions to locate the source of heterogeneity. Where statistical pooling was not appropriate, trials were instead summarized in narrative form.

Results: Thirty-three studies were included in this systematic review, of which 19 were included in the meta-analysis. Five studies reported 19 exercise-related no serious adverse events. Twenty-eight studies reported that exercise interventions were feasible or had high participation rates. The results revealed significant improvements in physical fitness parameters among the exercise intervention group compared to the control group. Specifically, we observed substantial enhancements in the timed walking distance (TMD) (SMD = 0.696; 95%CI, [0.455,0.988]; p < 0.001)), timed up and go test (TUG) (SMD = -0.570; 95%CI, [-0.867, -0.273]; p < 0.001), peak oxygen consumption (VO peak) (SMD = 0.532; 95%CI, [0.261, 0.804]; p < 0.001), lower muscle strength (SMD = 0.346; 95%CI, [0.018,0.674]; p = 0.039) and upper muscle strength. Moreover, our findings demonstrated that exercise intervention significantly reduced depression scores (SMD = -0.692; 95%CI, [-0.631,-0.157]; p = 0.001) compared to usual care. However, non significant effects were found for anxiety and quality of life (QOL). The narrative summary of evidence for fatigue showed uncertain intervention effects, and our meta-regression analysis did not identify any covariates significantly associated with fatigue outcomes.

Conclusion: Generally, the exercise intervention appear safe and feasible, and can improve physical fitness and depression in adult patients with HM during chemotherapy. Currently, there is inconclusive evidence regarding QOL, fatigue and anxiety. Further trials with larger sample size and longer follow-up periods are warranted to evaluate the effects of exercise interventions for patients with HM.