Women classified as off treatment ranged from a few months to many years after treatment. Future observational studies repeating measures of physical function before, during, and after treatment are needed to more accurately determine the expected pattern of change in physical function throughout the cancer trajectory. Another source of variation between studies was the specific testing protocol used. Submaximal and maximal exercise tests may be performed on either a cycle ergometer or a treadmill Anti-cancer Compound Library mouse and may use a ramp or incremental protocol with a number of possibilities in length of test stage and workload increment per stage.
Values for VO2peak have been shown to be higher using a treadmill than cycle ergometer protocol in women diagnosed with breast cancer.31 Values for upper and lower extremity strength, such as grip strength, maximal contraction for leg press, or knee flexion/extension, may be reported as average of three trials or maximum value obtained. There was also variation in the protocols used for assessing muscular endurance and the chair stand test, which prevented selleck kinase inhibitor pooling of the results together. This highlights the importance of reporting full details of
the testing protocol in order to determine whether comparisons can be made between studies. Overall, 56 (66%) studies included some measure of aerobic capacity, indicating recognition of the importance of this component of health-related physical fitness. The most common method of measurement used was the gold-standard, maximal, cardiopulmonary exercise test, followed by a submaximal second exercise test terminated at a specified percentage of age-predicted heart rate reserve or maximal heart rate. Although formal, large-scale assessment of the safety of the cardiopulmonary exercise testing procedure in individuals with cancer has not been performed, it does appear to be relatively safe with appropriate screening and monitoring during the test.32 Submaximal exercise testing is considered
to be a safer option, and may not require medical supervision, but is not as accurate for quantifying VO2peak.11 Finally, walking tests (6MWT and 12MWT) were commonly reported. Research is needed to determine if the 12MWT is a more appropriate test for capturing physical function in women with breast cancer than the 6MWT. It may be that women diagnosed with breast cancer have greater physical capacity than individuals in cardiac and pulmonary rehabilitation where the 6MWT is commonly used, and therefore may experience a ceiling effect with the 6MWT.12 Grip strength was the most commonly used measure of strength in this review and has been recommended as an assessment of muscle function for oncology rehabilitation.