Efeito do exercício físico na força muscular, massa muscular e desempenho físico em pessoas sarcopenicas com câncer: uma revisão sistemática

Abstract

Cancer is the leading cause of secondary sarcopenia, representing a growing problem among people diagnosed with cancer. This condition is associated with unfavorable outcomes both in relation to disease progression and to the various types of cancer treatment. Physical exercise is recommended by several guidelines for cancer patients. However, the guidelines do not present specific recommendations for sarcopenia, and few systematic reviews have explored this topic. In addition, the effect of physical exercise on improving sarcopenia (muscle strength, muscle mass and physical performance) in cancer patients is not yet fully elucidated. Objective: To verify the effect of physical exercise on muscle strength, muscle mass and physical performance in sarcopenic people with cancer. Materials and methods: The study is a systematic review, we used the acronym PICOS as the inclusion criterion, population: adult patients diagnosed with cancer and diagnosed with sarcopenia; Intervention: physical exercise alone or associated with other interventions; control: patients in usual care, without treatment or without physical exercise; outcome: muscle strength, muscle mass, and physical performance; Types of studies: randomized controlled clinical trials. The databases used were Pubmed, Excerpta Medica database (EMBASE), Cochrane (CENTRAL), Physiotherapy Evidence Database (PEDro), Latin American and Caribbean Health Literature in Health Sciences (LILACS), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and SPORTDiscus. For gray literature, Clinical trials.gov, Proquest, and the Catalog of Theses and Dissertations of the Coordination for the Improvement of Higher Education Personnel were checked, with no language or time limit. The searches were conducted until October 10, 2024. The risk of bias of the included studies was assessed by the Cochrane Risk of Bias Tool 2 and the level of evidence by the Grading of Recommendations Assessment, Development and Evaluation. Qualitative (narrative) synthesis was performed in the review, presenting the effect measures extracted from the studies individually. Results: Eight randomized controlled clinical trials were included. Three studies demonstrated an effect on skeletal muscle mass index in favor of resistance exercise (MD = 0.32 kg/m2, 95% CI [0.04; 0.60), resistance and aerobic exercise on appendicular skeletal muscle mass index (MD = 2.4 kg/m2, 95% CI [4.1; 1.30]) and resistance exercise associated with protein supplementation (MD = 0.03 kg/m2, 95% CI [0.1 0.5]). There were no differences between the intervention and control groups for the variables muscle strength and physical performance. The included studies presented risk of bias with some concerns and high risk. Additionally, all outcomes received a low level of evidence in GRADE. Conclusion: Although exercise appears to be safe and three articles indicate a possible effect on muscle mass, the studies did not have sarcopenia as a primary outcome, with prevalence rates of <50% of sarcopenic individuals in 7 studies. Thus, there is still a lack of evidence on the real effect of physical exercise on sarcopenia in cancer patients.