Review Impact of aerobic and resistance training on fatigue, quality of life, and physical activity in prostate cancer patients 2024 Nader et al

Background:
Prostate cancer (PCa) is a prevalent cancer with significant morbidity and mortality rates. In most cases, prostate cancer remains asymptomatic until advanced disease manifests with symptoms, such as benign prostate hyperplasia (BPH). Timely detection and better management have improved overall survival in patients with prostate cancer, and fatigue, reduced physical activity, and impaired quality of life (QoL) remain major challenges that impact daily life.

Objective:
This study aimed to systematically review and conduct a meta-analysis to evaluate the impact of aerobic and resistance training on fatigue, quality of life, and physical activity in prostate cancer patients undergoing treatment.

Material & Methods:
A comprehensive literature search was conducted using the PubMed, Cochrane Library, and clinicaltrials.gov databases, adhering to the PRISMA guidelines. Twenty studies, involving 1393 participants, were included in the final analysis. The inclusion criteria were Studies that evaluated the effects of exercise interventions relative to passive controls in patients with prostate cancer were included. The primary outcomes of interest were fatigue, QoL, and PA.. Data from eligible studies were extracted, and a meta-analysis was performed using RevMan 5.40.

Results:
Twenty studies met our inclusion criteria. Data Analysis of the included studies demonstrated a significant improvement in quality of life among prostate cancer patients in the exercise group compared to the control group (SMD=0.20, 95% CI=0.07 to 0.34, P=0.003). However, there was no significant association between exercise and fatigue (SMD=0.07, 95% CI=-0.13, 0.26, P=0.51). Sensitivity analysis did not alter these findings. Regarding physical activity outcomes, the control group exhibited superior performance in the 400-meter walk test (P<0.05). No significant associations were found between exercise and the 6-meter walk test or up-and-go time.

Conclusion:
This systematic review revealed that aerobic and resistance training enhance the quality of life of patients with prostate cancer, although it has a limited impact on fatigue and physical activity levels. These findings advocate a shift in clinical practice and positioning exercise as a core component of comprehensive cancer care. Tailoring exercise regimens according to individual patient needs and treatment stages should become the norm in treatment planning. This approach goes beyond physical wellness and addresses the psychological and emotional facets of cancer management. Moreover, there is an evident need for further research to develop holistic exercise interventions that effectively address the complex dynamics of fatigue, physical activity, and QoL in this patient group.

Open access, https://journals.lww.com/internatio...f_aerobic_and_resistance_training_on.957.aspx

 

Reading the paper, it's very obvious that the authors assumed it would be true, and badly want it to be true. The bias is all over the place, they simply can't believe that this wouldn't work for everyone and it has to be tried over and over again.

There are so many cofounders here that any interpretation over QoL is meaningless. The QoL questionnaires have many components to them, some of them don't even have anything to do with the patients, such as how much support they have. And since this is just a pooled analysis, there is no way to tell which of those components saw any change in any of the trials. As far as I can see, the differences are minimal, less than 10% in all cases, less than 5% in most cases. Given that they are blurry questions using subjective ratings, blurry results are expected and fall comfortably within an expected guesstimate range.

Somehow they decided that it was critical to put that the exercise be tailored to the individual. Probably out of tradition, this is the idea, and they repeat the idea dutifully. Somehow they think this should become a norm, based on nothing at all. This is seriously disturbing. The expenses and resources for this are significant, this is a model that does not scale, it's fully linear 1:1.

That somehow this methodology generally gets a low risk of bias is an extreme joke. The risk of bias is basically several orders of magnitude above what is typical in scientific experiments. But in EBM it's low risk. Pure nonsense. Systematic reviews are a GIGO process that themselves are subject to a lot of garbage, and wow do they produce a lot of garbage out the back end.