An assessment of study characteristics, quality and reporting in cancer prehabilitation literature: a scoping review

Background

Cancer and its treatment can negatively impact physical function, general well-being and quality of life. An evidence-based strategy to manage this is to prescribe exercise. One approach is to prescribe exercise prehabilitation to improve pretreatment health and function. However, current exercise prehabilitation programmes are under-researched, and the quality of their reporting has not been systematically assessed.

Objectives

This review aimed to identify the following: the characteristics of prehabilitation exercise programmes; how intensity, physical function, patient-reported outcomes and treatment-related outcomes were measured; the quality of reporting and programme implementation.

Eligibility

criteria Studies were eligible for inclusion if they reported a cancer prehabilitation exercise intervention, reported outcomes relating to physical function and patient-reported outcomes, and full-text copies were available in English.

Sources of evidence

PubMed, Mednar and Scopus were screened for studies from inception until 4 of April 2024.

Charting methods

Exercise characteristics were extracted and manually charted in Microsoft Excel using the Template for Intervention Description and Replication. The tool for the assessment of study quality and reporting in exercise (TESTEX) framework was used to assess study quality and intervention reporting.

Results

1495 results were retrieved, 28 of which were included. Exercise sessions lasted a mean of 42.5±21.9 min and were completed 3.7±1.3 times per week. 22 studies implemented concurrent exercise, five prescribed aerobic, and one prescribed resistance. High-intensity exercise was prescribed in four studies, moderate-high in 12, seven prescribed moderate, three prescribed low-moderate, and one was low intensity. 10 studies prescribed exercise intensity using the Borg Rating of Perceived Exertion Scale, five prescribed heart rate (HR) zones, six used a set workload, and seven did not monitor intensity. A mean TESTEX score of 9.3±2.3 out of 15 was achieved. The lowest scoring criterion (n=3) related to the reporting of the exercise dose. 

Conclusions

There was heterogeneity among studies regarding exercise intervention characteristics and measures of effectiveness. The overall quality of reporting was satisfactory, yet inconsistencies were apparent regarding quantifying and monitoring exercise dose, which limits the ability of researchers and clinicians to replicate, evaluate or scale cancer prehabilitation exercise interventions, impeding evidence-based practice. As such, to be able to optimise cancer prehabilitation exercise programmes, research must first focus on improving the quality of reporting and standardising outcome measures and methods of monitoring and prescribing exercise.

What is it about?

The study conducted a scoping review to analyze the characteristics and quality of reporting in cancer prehabilitation exercise programs by examining existing literature. The methodology involved screening databases like PubMed, Mednar, and Scopus for studies available in English that reported on cancer prehabilitation exercise interventions, focusing on physical function and patient-reported outcomes. Out of 1495 articles retrieved, 28 studies met the inclusion criteria and were analyzed using the TESTEX framework and the Template for Intervention Description and Replication (TIDieR) to assess the quality of reporting and exercise characteristics. The findings indicated a wide variance in exercise modalities, with most studies implementing concurrent exercise and only one focusing on resistance training. Exercise sessions averaged 42.5 minutes, occurring approximately 3.7 times per week, with variations in prescribed intensity levels. The average TESTEX score was 9.3 out of 15, highlighting inconsistencies in reporting exercise dose and monitoring methods. The study concludes with a call for standardizing intervention design to improve the comparability and effectiveness of prehabilitation programs.

Why is it important?

This study is important as it systematically examines the characteristics and quality of reporting in cancer prehabilitation exercise programmes, a relatively new yet promising approach to mitigating the adverse effects of cancer treatment. By highlighting the inconsistencies in exercise modalities, outcome measures, and the monitoring of exercise doses, this research underscores the need for standardization in prehabilitation interventions. This is crucial for improving the reproducibility and effectiveness of these programmes, ultimately enhancing patient outcomes by better preparing them physically and mentally before treatment. The findings serve as a foundation for developing more consistent and evidence-based prehabilitation strategies in cancer care.

Key Takeaways:

1. Heterogeneity in Exercise Characteristics: The study reveals significant variability in exercise modalities among existing cancer prehabilitation programmes, with most studies employing concurrent exercise and only one focusing solely on resistance training.

2. Quality of Reporting: Despite satisfactory overall study quality, there are clear disparities in reporting exercise dose and intensity, which complicates the replication and evaluation of interventions and limits their scalability and integration into clinical practice.

3. Need for Standardization: The research identifies a critical gap in the standardization of outcome measures and exercise monitoring methods, emphasizing the necessity for improved reporting practices to optimize prehabilitation programmes and ensure they effectively enhance patient outcomes.