The effectiveness of exercise-based interventions on muscle mass, muscle strength, functional performance, aerobic capacity, and health-related quality of life in adults with malignant lymphoma undergoing chemotherapy: a systematic review of randomized controlled trials

Purpose: This study aims to identify and summarize evidence on the effectiveness of exercise-based interventions on muscle mass, muscle strength, functional performance, aerobic capacity, health-related quality of life (HRQoL), feasibility of the interventions, in patients with malignant lymphoma undergoing chemotherapy. Methods: A systematic search was conducted in six electronic databases and trials registers on November 15, 2023. Peer-reviewed randomized controlled trials (RCTs) comparing exercise intervention with controls/usual care in adults (≥18 years) diagnosed with Hodgkin’s lymphoma and non-Hodgkin’s lymphoma undergoing chemotherapy were considered for inclusion. All study authors were contacted to obtain unpublished subgroup data. Two reviewers independently screened and extracted data and assessed the quality of evidence using the revised Cochrane risk-of-bias tool for randomized trials. Results: Six RCTs published between 2009 and 2021, with 838 participants, were included. Due to clinical heterogeneity, a meta-analysis was not feasible, therefore the results were synthesized narratively. Exercise interventions during treatment were found to be feasible with few adverse events reported. The included studies indicate positive effects of exercise during chemotherapy on muscle mass, muscle strength, functional performance, aerobic capacity, and HRQoL compared to usual care. Interpretation: Despite extensive search criteria, a limited number of heterogenous studies were eligible, which may explain the very low certainty of evidence for all outcomes. Nonetheless, exercise-based interventions conducted during treatment were feasible, safe and potentially effective. Further studies are needed to guide future exercise recommendations for these patients.