This review found insufficient evidence on the effects of physical exercise intervention in haematological cancer patients. The review had several flaws (especially regarding discrepancies in what was shown in the text and in the tables). The lack of firm conclusions reflected the low quality of the evidence presented.

To summarise and provide a systematic evaluation of the methodological quality of studies on exercise interventions in haematological cancer patients.

MEDLINE was searched from inception to 2007. Search terms were reported. Reference lists of the selected studies were searched for relevant studies. The search was restricted to articles published in English.

Studies of haematological cancer patients with a treatment regimen that included chemotherapy and bone marrow or peripheral blood stem cell transplantation were considered for inclusion if they examined the effect of physical exercise.

There were no restrictions on sex, age or study design. Outcomes, type and duration of the intervention were not specified as inclusion criteria. Patient strength, endurance, physical performance and psychological outcomes were reported in the selected studies.

Two authors independently screened the trials for eligibility.

The quality of the studies was evaluated using a nine-item list developed by the Delphi consensus. The list provided information regarding treatment allocation, control groups, eligibility criteria, blinding, statistical analysis and intention-to-treat. Attainable score range was 0 to 9. The authors rated the studies as high quality (score of 5 or higher), moderate (3 to 4) or poor quality (2 or less).

Two authors independently assessed quality. The authors did not state how they resolved disagreements.

Two authors independently extracted data from selected trials.

The studies were combined in a narrative synthesis grouped by study design, intervention, effectiveness of exercise programmes and assessment of methodological quality.

Description of the study population, intervention programmes and outcomes were shown in tables. Point estimates or measures of variability were not reported in any study. One study reported that it used intention-to-treat analysis.

Ten studies were included in the review (209 patients): three randomised controlled trials (RCT) (70 patients); one controlled clinical trial (12 patients); and six case-series studies (127 patients). Two of the included studies had a mixed cancer diagnosis study population, but were included in the review anyway.

The studies were heterogeneous with regard to study population, intervention, duration of intervention and outcomes (this was not analysed statistically). No studies were classified with a high methodological quality score, three studies were of moderate quality and seven were of poor methodological quality.

Intervention programmes: Five studies examined the effect of endurance training, three trials examined a combination of endurance and resistance training, one examined a combination of endurance, resistance training and physical therapy and another examined endurance training combined with physical exercise. Exercise programmes ranged from four to 36 weeks duration. They were performed at the hospital (six studies), home (three studies) or both (one study).

Effectiveness of exercise programmes: All but one study showed statistically significant differences for many of the reported outcomes, even though the review authors reported that no study reported point estimates or measures of variability. The RCTs showed improvement in body composition, muscle strength and ankle dorsiflexion active range of motion. Controlled clinical trial patients improved in muscle strength and aerobic capacity. Case-series patients showed progress in muscle strength, aerobic capacity, physical performance and self-reported symptom relief.

The evidence was insufficient to extract any firm conclusions due to poor methodological quality, but it was feasible to conduct physical exercise interventions in haematological cancer patients.

This review addressed a broadly-defined question in terms of participants, interventions, outcomes and study design. Eligibility criteria were specified, with few restrictions. Only one database was reviewed and the authors included only studies in English, which increased the chance of selection bias. Steps to minimise reviewer bias/errors were taken by independent assessment of eligibility and quality, and data extraction.

Methodological quality was assessed with a standardised list. The quality rating of the trials was moderate to poor, which limited the interpretation of the results. Heterogeneity of the retrieved studies made a narrative synthesis appropriate. However, there were discrepancies between the tables and narrative synthesis regarding participant numbers and methodological score.

This was a poorly conducted review, but the conclusions were consistent with the low quality of the selected data.

Practice: The authors did not state any implication for practice.

Research: The authors stated that future studies of physical exercise interventions in hematological cancer patients should standardise measurements and interventions, incorporate behavioural change strategies, focus on long-term effects of the intervention and improve on data reporting.

Not stated

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.