Saúde baseada em evidencias: Clube de revista - Encontro 01
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Saúde baseada em evidencias: Clube de revista - Encontro 01

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Saúde baseada em evidencias: Clube de revista - Encontro 01 Saúde baseada em evidencias: Clube de revista - Encontro 01 Presentation Transcript

  • Encontro 01 Ivan Ricardo Zimmermann 22/10/2013
  • Exercise interventions on healthrelated quality of life for cancer survivors Mishra SI, Scherer RW, Geigle PM, Berlanstein DR, Topaloglu O, Gotay CC, Snyder C. Cochrane Database of Systematic Reviews, Issue 8, 2012 (CD007566).
  • Background • As treatments for cancers improve, the number of cancer survivors is growing rapidly. • These survivors experience many disease and treatment-related adverse outcomes and poorer health-related quality of life (HRQoL). • Exercise interventions might alleviate these adverse outcomes.
  • Objectives • To evaluate the effectiveness of exercise on overall HRQoL outcomes and specific HRQoL domains (e.g. physical, psychological, etc) • A secondary objective examined the effectiveness of exercise on HRQoL outcomes stratified (e.g. intensity of exercise, sex, etc)
  • Methods • Participants: Cancer survivors diagnosed at 18 years or older. (Studies in people who were terminally ill or where most participants were undergoing active cancer treatment were not eligible.) • Intervention: Any physical activity causing an increase in energy expenditure, and involving a planned or structured movement of the body performed in a systematic manner (in terms of frequency, intensity, and duration designed to maintain or enhance health-related outcomes. (Dance was excluded.)
  • Methods • Comparison: No exercise, another intervention, or usual care. • Outcomes: Health-related quality of life, disease or treatment-related outcomes, adverse effects. • Studies: Randomised trials and controlled clinical trials.
  • Methods • • • • • CENTRAL, MEDLINE, EMBASE, CINAHL, LILACS • • • • • PsycINFO, PEDRO, SIGLE, SportDiscus, OTSeeker, • Sociological Abstracts • Registers of trials. • Citations were checked through Web of Science and Scopus, PubMed’s related article feature, and several websites. References in reports of included trials and other reviews were checked. No language restrictions.
  • Methods • Random-effects model when trials reported continuous data for health related quality of life: – The mean difference (MD) and a, having used the same method or scale; – The standardized mean difference (SMD) if different measurements were used for the same domain. • Trial data combined using Review Manager (RevMan 5.1)
  • Results • Searches were completed in October 2011, with 40 trials (3694 participants) identified as appropriate for inclusion in the current review (38 were RCTs). • Exercise intervention included strength training, resistance training, walking, cycling, yoga, Qigong, or Tai Chi. Frequency and varied across studies.
  • 1 It was not possible to blind study participants or people administering treatment. 2 Statistical heterogeneity was moderate to high. 3 The small total population sample size represents a small effect.
  • Results • No evidence of effect was found for HRQoL domains such as cognitive function, physical functioning, general health perspective, and spirituality • There were positive trends and impact of exercise intervention for depression and body image.
  • Conclusions • Exercise may have beneficial effects on HRQoL including cancer specific concerns (e.g. breast cancer), emotional well-being, sexuality, sleep disturbance, etc, at varying follow-up periods. • The results must be interpreted cautiously due to the heterogeneity of exercise programs tested and measures used to assess HRQoL, and the risk of bias in many trials.
  • Conclusions • Further research is required to determine essential attributes of exercise (mode, intensity, frequency, duration, timing) by cancer type and cancer treatment for optimal effects on HRQoL and its domains.
  • Pontos críticos • Quão aplicável é a definição de “exercícios” adotada? • Qual o impacto da ausência de cegamento nos estudos? • As evidências são aplicáveis a exercícios em geral? • Os resultados não se aplicam aos indivíduos excluídos por questões práticas?
  • Referências • Mishra SI, Scherer RW, Geigle PM, Berlanstein DR, Topaloglu O, Gotay CC, Snyder C. Exercise interventions on health-related quality of life for cancer survivors. Cochrane Database of Systematic Reviews 2012, Issue 8. Art. No.: CD007566. DOI: 10.1002/14651858.CD007566.pub2. • Cochrane Journal Club: http://www.cochranejournalclub.com/
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