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What is the current evidence for the use of cycling to improve quality of life in adolescent cancer patients both during and after treatment?

Three Part Question

What is the current evidence for the [use of cycling] to improve [quality of life] in [adolescent cancer patients both during and after treatment]?

Clinical Scenario

A 14 year old girl is admitted to the Macmillan Cancer Centre for a cycle of MAP chemotherapy. She has recently undergone limb salvage surgery for a distal femoral tumour and is now undergoing rehabilitation and struggling with being unable to do activities which she found easy before, this in turn is impacting on her mood and quality of life. You wonder if there is evidence to support the use of cycling to aid return to function and improve quality of life after surgery

Search Strategy

Cochrane, NICE, Embase, Medline and Physiotherapy Evidence Database (PEDro) were searched using the terms: ‘bicycling OR cycling OR exercise bike’, ‘quality of life’, ‘cancer’
Cochrane library: 31 studies, 3 relevant
NICE: 0 studies
Embase: 47 papers, 10 relevant
Medline: 2 papers, 1 relevant
PEDro: 5 papers 1 relevant
Hand Searching: nil new
After duplicates removed 13 papers

LIMIT to English Language

Search Outcome

85 hits, 13 relevant

Relevant Paper(s)

Author, date and country Patient group Study type (level of evidence) Outcomes Key results Study Weaknesses
Thorsen, L et al
April 2005
139 Lymphoma, breast Ca, gynaelogic or testicular Ca patientsRCT 14 week training programme including cycling vs. standard care Astrand-rhyming indirect testSignificant difference found between groups for CRF Patients included in trial were relatively well and not limited by severe disease. Lack of follow up data available High drop-out rate 10 in intervention group, 18 in control group
EORTC QLQ-C30no significant difference
HADSno significant difference
fatiguesignificantly higher levels of fatigue in intervention group
Mishra S et al
3694 breast, colorectal, head and neck, lymphoma and other Ca diagnoses who had finished treatmentCochrane review 40 trials randomised to exercise or control Exercise interventions included cycling QoLExercise compared to control has a positive impact on HRQoL at 12 weeks CI 0.16-0.81 and at 6 month follow up CI 0.09-0.84Not looking at follow up after cancer treatment finished – lack of long term data Lots of different types of exercise included therefore unable to state which intervention is the most effective to improve HRQoL. Similarly different outcome measures used and difficult to analyse.
Lahart IM et al
5761 women with breast caCochrane review 63 trials physical activity vs control group QoLPhysical activity has significant small to moderate beneficial effects on HRQoL 95% CI 0.21-0.57Low quality evidence High risk of bias in trials
Mishra S et al
4826 participants breast, prostate, gynaelogic, haematologic and other cancer patients undergoing active treatmentCochrane review 56 trials Exercise vs comparison QoLExercise has significant positive impact on overall HRQoL with improvement from baseline to 12 week follow up. moderate to vigorous activity lead to larger changes in QoLHigh risk of bias in papers included Exercise interventioins varied in length and intensity Different outcome measures for QoL Short follow up period
fatigueSignificant decrease in fatigue
Krouse R et al
574 rectal cancer survivorsSurvey collectionQoLHRQoL outcomes rose significantly with physical activity. particularly an increase in psychological wellbeing and increased feeling of control CI 0.10-0.76High risk of bias with self-reporting questionnaire Low response rate – 60% Unable to capture data regarding increasing age and comorbidities and their impact on PA Outcomes tailored to ACSM guidelines therefore could be missing impact on patients who complete little/no PA.
Braam K
171 children/YA during treatment for ALLCochrane review 6 papers Exercise vs control QoLno change in HRQoLSmall sample sizes Unclear randomisation Single blinding Low-moderate quality studies
Cardiorespiratory fitness - 9 minute walk-run test significant increase in cardio respiratory fitness in intervention group CI 0.02-1.35
muscle strengthsignificant increase in muscle strength in back and leg muscles 95% CI 0.71-2.11
Sammut L et al
172 participants with head and neck cancersQuestionnaire Physical activitystatisiticaly significant reduction in physical activity levels after diagnosis/treatment (64% at start of treatment vs 40.1% at End of Treatment)Self-reported questionnaire leading to high risk of bias No data with regards to stage of H&N cancer, effect of NG tube, nutrition – all likely to impact on QoL
QOLstatistically significant increase in QoL for those who completed higher levels of PA (p<0.05). Cycling and swimming most common types of exercise pre and post treatment
Buffart L et al
Review of 6 guidelines 2003-2012 16 RCTs – 2339 participants – prostate, testicular, colon, breast ca patients ReviewQoLSignificant improvements in QoL can be expected when increasing activity levelsNo evidence of search strategy for literature Small number of studies/guidelines to review
Roland N, Rogers S
8 studies cancer survivors - not documented population numbersEditorial commentQoLExercise can increase QoL - not significantNo evidence of search criteria/strategy Trials are small and of poor quality No mention of specific outcome measures
Spence R et al
Breast, gynae, colorectal, lymphoma and testicular Ca participantsSystematic review – 13 articlesphysical functionsignificant improvements seen in physical functionSmall sample sizes – average 42 Poor quality trials Heterogeneity in populations, exercise programmes, outcomes and follow up period Only one study looking specifically at QoL all others include it as a secondary outcome
Fatigueno fatigue reported in patients who were allocated daily exercise compared with 25% in the control group
QoLsignificantly greater QoL in all domains in patients who completed 3 months of aerobic and resistance training
body compositionsignificant decrease in fat free mass in intervention group
Buffart L
1371 participants with colorectal cancerQuestionnaires – cross sectionalHRQoLSignificantly improved QoL with regular moderate-vigorous physical activity(p<0.05)Younger and predominantly male participants Early stages of cancer (I & II)
fatiguesignificantly lower fatigue in those who regularly do moderate-vigorous physical activity (p<0.05)
Morgan R
Cancer SurvivorsReport QoLPhysical activity significantly improves QoL during and after treatment for cancerFew references to support article
Voskuil DW et al
543 breast cancer patientsPoster abstractQoLno clinically significant changes in QoLOnly abstract available therefore unable to assess statistical analysis and methodology


The current evidence for cycling in cancer patients to improve quality of life is limited with most evidence including cycling as an exercise option and not looking at this specifically. There is even less evidence looking at the adolescent population. There is also a lack of high quality RCTs which are required to allow for standardised guidelines to be set in place.

Clinical Bottom Line

Current evidence suggests that exercise can improve quality of life in patients undergoing treatment and those who have finished treatment however there is limited evidence to say what type of exercise is best and when is best to start this intervention along with how long this intervention should last. This conclusion is based on limited moderate-low quality evidence and further clinical studies and RCTs are required in this area.


  1. Thorsen L, Skovhand E, Stromme S, Hernslien K, Dahl A, Fossa S Effectiveness of Physical Activity on Cardiorespiratory Fitness and Health-Related Quality of Life in Young and middle aged cancer patients shortly after Chemotherapy Journal of Clinical Oncology 2005; 23;10;2376-2388
  2. Mishra S, Scherer RW, Geigle PM, Bertanstein DR, Topaloglu, Gotay CC, Snyder C Exercise Interventions on Health-related quality of life for cancer survivors (review) Cochrane Library
  3. Lahart IM, Metsios G, Nevill A, Carmichael A Physical activity for women with breast cancer after adjuvant therapy (review) Cochrane Library 2018
  4. Mishra S, Scherer RW, Snyder C, Geigle PM, Berlanstein DR, Topaloglu O Exercise interventions on health-related quality of life for people with cancer during active treatment Cochrane Library
  5. Krouse R, Wendel C, Garcia D, Grant M, Temple L, Going S, Hornbrook M, Bulkley J, McMullen C, Herrinton L Physical activity, bowel function and quality of life among rectal cancer survivors Qual Life Res 2017; 26; 3131-3142
  6. Braam K, van der Torre P, Takken T, Veening M, van Dulmen-den Broeder E, Kaspers GJL Physical exercise training interventions for children and young adults during and after treatment for childhood cancer Cochrane Library 2016
  7. Sammut L, Fraser L, Ward M, Singh T, Patel N Participation in sport and physical activity in head and neck cancer survivors: associations with quality of life Clinical Otolaryngology 2015; 41; 241-248
  8. Buffart L, Galvao D, Brug J, Chinapaw M, Newton R Evidence-based physical activity guidelines for cancer survivors: current guidelines, knowledge gaps and future research directions Cancer Treatment Reviews 2014; 327-340
  9. Roland N, Rogers S Exercise interventions of health related quality of life for cancer suvivors Clinical Otolaryngology
  10. Spence R, Heesch K, Brown W Exercise and Cancer rehabilitation: a systematic review Cancer Treatment Reviews 2010; 185-194
  11. Buffart L Self-reported physical activity: Its correlates and relationship with health-related quality of life in a large cohort of colorectal cancer survivors Plos One 2012; 7(5) ; e36164
  12. Morgan R Underserved topics in oncology: the role of physical activity in improving quality of life and disease recurrence risk in patients with cancer Journal of National Comprehensive Cancer Network 2017; 735-737
  13. DW Voskuil, JG van Nes, JM Junggeburt, FE van Leeuwen, CJ van de Velde and HC de Haes Physical activity to maintain quality of life in breast cancer survivors in the Dutch Tamoxifen Exemestane Adjuvant Multicentre (TEAM) trial American Association of Cancer Research