Effects of physical exercise on the functional capacity and muscle strength of patients with gastric and esophageal cancer: a systematic review





Exercise; Physical functional performance; Stomach neoplasms; Esophageal neoplasms.


Esophageal and gastric cancers have a significant prevalence. These patients often face a decline in functional capacity (FC) and muscle strength (MS), as consequence of neoadjuvant treatments and surgical resection; however, this decline can be minimized through appropriate exercise protocols. To assess evidence of the effects of physical exercise on HR and MS in patients with esophageal and stomach cancer. Systematic review of Randomized clinical trials with intervention based on exercises for patients with esophagogastric cancer (EGC). FC and MS were the outcomes.  Searches in Medline via Pubmed, PEDro, Cochrane Library, Embase and CINAHL databases were performed. Cochrane Collaboration tool and GRADE system for risk of bias assessment. From 117 articles identified, eight studies were included, involving a total of 673 patients. In general, the approach during neoadjuvant therapy had a positive effect on the 6-minute walk test (6MWT) and on FM. Exercise performed in the preoperative period showed divergent results for inspiratory muscle strength, but improved HR assessed by the 6-minute walk test (6MWT). The postoperative exercise protocol increased the FC in 6MWT, and maximal oxygen consumption (VO2max). However, it does not improve MS. Studies also showed a moderate-to-high risk of bias. Although some studies point to positive results in favor of physical exercise in improving FC and MS in patients being treated for esophagogastric cancer, the degree of clinical recommendation is low.


Adamsen, L., Quist, M., Andersen, C., Møller, T., Herrstedt, J., Kronborg, D., Baadsgaard, M. T., Vistisen, K., Midtgaard, J., Christiansen, B., Stage, M., Kronborg, M. T., Rørth, M., & al., et. (2009). Effect of a multimodal high intensity exercise intervention in cancer patients undergoing chemotherapy: randomised controlled trial. BMJ (Online), 339 CC-(7726), b3410. https://doi.org/10.1136/bmj.b3410

Argudo, N., Rodó-Pin, A., Martínez-Llorens, J., Marco, E., Visa, L., Messaggi-Sartor, M., Balañá-Corberó, A., Ramón, J. M., Rodríguez-Chiaradía, D. A., Grande, L., & Pera, M. (2021). Feasibility, tolerability, and effects of exercise-based prehabilitation after neoadjuvant therapy in esophagogastric cancer patients undergoing surgery: An interventional pilot study. Diseases of the Esophagus, 34(4). https://doi.org/10.1093/dote/doaa086

Bolger, J. C., Loughney, L., Tully, R., Cunningham, M., Keogh, S., McCaffrey, N., Hickey, W., & Robb, W. B. (2019). Perioperative prehabilitation and rehabilitation in esophagogastric malignancies: A systematic review. Diseases of the Esophagus, 32(9), 1–11. https://doi.org/10.1093/dote/doz058

Brugnolli, A., Cavada, L., & Saiani, L. (2014). II sistema GRADE. In Assistenza Infermieristica e Ricerca (Vol. 33, Número 4).

Carcas, L. (2014). Gastric cancer review. Journal of Carcinogenesis, 13(1). https://doi.org/10.4103/1477-3163.146506

Carli, F., & Zavorsky, G. S. (2005). Optimizing functional exercise capacity in the elderly surgical population. In Current Opinion in Clinical Nutrition and Metabolic Care (Vol. 8, Número 1). https://doi.org/10.1097/00075197-200501000-00005

Chang, Y.-L., Tsai, Y.-F. Y.-F., Hsu, C.-C. C.-L. C.-C. C.-L., Chao, Y.-K. Y.-K., Hsu, C.-C. C.-L. C.-C. C.-L., & Lin, K.-C. K.-C. (2020). The effectiveness of a nurse-led exercise and health education informatics program on exercise capacity and quality of life among cancer survivors after esophagectomy: A randomized controlled trial. International Journal of Nursing Studies, 101, 103418. https://doi.org/10.1016/j.ijnurstu.2019.103418

Cho, H., Yoshikawa, T., Oba, M. S., Hirabayashi, N., Shirai, J., Aoyama, T., Hayashi, T., Yamada, T., Oba, K., Morita, S., Sakamoto, J., & Tsuburaya, A. (2014). Matched pair analysis to examine the effects of a planned preoperative exercise program in early gastric cancer patients with metabolic syndrome to reduce operative risk: The adjuvant exercise for general elective surgery (AEGES) study group. Annals of Surgical Oncology, 21(6), 2044–2050. https://doi.org/10.1245/s10434-013-3394-7

Christensen, J. F., Simonsen, C., Banck-Petersen, A., Thorsen-Streit, S., Herrstedt, A., Djurhuus, S. S., Egeland, C., Mortensen, C. E., Kofoed, S. C., Kristensen, T. S., Garbyal, R. S., Pedersen, B. K., Svendsen, L. B., Højman, P., & de Heer, P. (2019). Safety and feasibility of preoperative exercise training during neoadjuvant treatment before surgery for adenocarcinoma of the gastro-oesophageal junction. BJS Open, 3(1), 74–84. https://doi.org/10.1002/bjs5.50110

Dettling, D. S., Van der Schaaf, M., Blom, R. L. G. M., Nollet, F., Busch, O. R. C., & Van Berge Henegouwen, M. I. (2013). Feasibility and Effectiveness of Pre-operative Inspiratory Muscle Training in Patients Undergoing Oesophagectomy: A Pilot Study. Physiotherapy Research International, 18(1), 16–26. https://doi.org/10.1002/pri.1524

Dronkers, J. J., Chorus, A. M. J., Van Meeteren, N. L. U., & Hopman-Rock, M. (2013). The association of pre-operative physical fitness and physical activity with outcome after scheduled major abdominal surgery. Anaesthesia, 68(1). https://doi.org/10.1111/anae.12066

Dunphy, M., & Schöder, H. (2014). Esophageal carcinoma. Nuclear Oncology, 68–84. https://doi.org/10.5694/j.1326-5377.1937.tb53511.x

Fagevik Olsen, M., Kjellby Wendt, G., Hammerlid, E., Smedh, U., Fagevik Olsén, M., Kjellby Wendt, G., Hammerlid, E., & Smedh, U. (2017). Effects of a Training Intervention for Enhancing Recovery after Ivor-Lewis Esophagus Surgery: a Randomized Controlled Trial. Scandinavian journal of surgery, 106(2 CC-Gynaecological, Neuro-oncology and Orphan Cancer), 116–125. https://doi.org/10.1177/1457496916655499

Feeney, C., Hussey, J., Carey, M., & Reynolds, J. V. (2010). Assessment of physical fitness for esophageal surgery, and targeting interventions to optimize outcomes. Diseases of the Esophagus, 23(7), 529–539. https://doi.org/10.1111/j.1442-2050.2010.01058.x

Ferguson, M. K., Celauro, A. D., & Prachand, V. (2011). Prediction of major pulmonary complications after esophagectomy. Annals of Thoracic Surgery, 91(5), 1494–1501. https://doi.org/10.1016/j.athoracsur.2010.12.036

Gonçalves, C. G., & Groth, A. K. (2019). Pré-habilitação: como preparar nossos pacientes para cirurgias abdominais eletivas de maior porte? Revista do Colégio Brasileiro de Cirurgiões, 46(5). https://doi.org/10.1590/0100-6991e-20192267

Guinan, E. M., Dowds, J., Donohoe, C., Reynolds, J. V., & Hussey, J. (2017). The physiotherapist and the esophageal cancer patient: From prehabilitation to rehabilitation. In Diseases of the Esophagus (Vol. 30, Número 1, p. 1–12). Oxford University Press. https://doi.org/10.1111/dote.12514

Guyatt, G., Oxman, A. D., Akl, E. A., Kunz, R., Vist, G., Brozek, J., Norris, S., Falck-Ytter, Y., Glasziou, P., Debeer, H., Jaeschke, R., Rind, D., Meerpohl, J., Dahm, P., & Schünemann, H. J. (2011). GRADE guidelines: 1. Introduction - GRADE evidence profiles and summary of findings tables. Journal of Clinical Epidemiology, 64(4), 383–394. https://doi.org/10.1016/j.jclinepi.2010.04.026

Higgins, J. P. T., Thomas, J., Chandler, J., Cumpston, M., Li, T., Page, M. J., & Welch, V. A. (2019). Cochrane handbook for systematic reviews of interventions. In Cochrane Handbook for Systematic Reviews of Interventions. https://doi.org/10.1002/9781119536604

Horowitz, M., Neeman, E., Sharon, E., & Ben-Eliyahu, S. (2015). Exploiting the critical perioperative period to improve long-term cancer outcomes. In Nature Reviews Clinical Oncology (Vol. 12, Número 4). https://doi.org/10.1038/nrclinonc.2014.224

Jones, L. W., Liang, Y., Pituskin, E. N., Battaglini, C. L., Scott, J. M., Hornsby, W. E., & Haykowsky, M. (2011). Effect of Exercise Training on Peak Oxygen Consumption in Patients with Cancer: A Meta‐Analysis. The Oncologist, 16(1). https://doi.org/10.1634/theoncologist.2010-0197

Lidoriki, I., Schizas, D., Mpaili, E., Vailas, M., Sotiropoulou, M., Papalampros, A., Misiakos, E., Karavokyros, I., Pikoulis, E., & Liakakos, T. (2019). Associations between skeletal muscle mass index, nutritional and functional status of patients with oesophago-gastric cancer. Clinical Nutrition ESPEN, 34. https://doi.org/10.1016/j.clnesp.2019.08.012

McHugh, M. L. (2012). Lessons in biostatistics interrater reliability : the kappa statistic. Biochemica Medica, 22(3), 276–282.

Minnella, E. M., Awasthi, R., Loiselle, S.-E., Agnihotram, R. V, Ferri, L. E., & Carli, F. (2018). Effect of Exercise and Nutrition Prehabilitation on Functional Capacity in Esophagogastric Cancer Surgery: A Randomized Clinical Trial. JAMA Surgery, 153(12), 1081–1089. https://doi.org/10.1001/jamasurg.2018.1645

Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., Altman, D., Antes, G., Atkins, D., Barbour, V., Barrowman, N., Berlin, J. A., Clark, J., Clarke, M., Cook, D., D’Amico, R., Deeks, J. J., Devereaux, P. J., Dickersin, K., Egger, M., Ernst, E., … Tugwell, P. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. In PLoS Medicine (Vol. 6, Número 7). Public Library of Science. https://doi.org/10.1371/journal.pmed.1000097

O’Neill, L. M., Guinan, E., Doyle, S. L., Bennett, A. E., Murphy, C., Elliott, J. A., O’Sullivan, J., Reynolds, J. V, Hussey, J., O’Neill, L. M., Guinan, E., Doyle, S. L., Bennett, A. E., Murphy, C., Elliott, J. A., OʼSullivan, J., Reynolds, J. V, & Hussey, J. (2018). The RESTORE randomized controlled trial: Impact of a multidisciplinary rehabilitative program on cardiorespiratory fitness in esophagogastric cancer survivorship. Annals of Surgery, 268(5), 747–755. https://doi.org/10.1097/SLA.0000000000002895

Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., … Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. The BMJ, 372. https://doi.org/10.1136/bmj.n71

Ryan, A. M., Power, D. G., Daly, L., Cushen, S. J., Ní Bhuachalla, E., & Prado, C. M. (2016). Cancer-associated malnutrition, cachexia and sarcopenia: The skeleton in the hospital closet 40 years later. In Proceedings of the Nutrition Society (Vol. 75, Número 2). https://doi.org/10.1017/S002966511500419X

Sato, N., Takahashi, W., Hirayama, A., Ajioka, M., Takahashi, N., Okishige, K., Wang, X., Maki, A., Maruyama, H., Ebinger, U., & al., et. (2015). Multicenter, Randomized, Double-Blinded, Placebo-Controlled Phase II Study of Serelaxin in Japanese Patients with Acute Heart Failure. Circulation journal, 79(6), 1237‐1247. https://doi.org/10.1253/circj.CJ-15-0227

Stuecher, K, Bolling, C., Vogt, L., Niederer, D., Schmidt, K., Dignaß, A., & Banzer, W. (2019). Exercise improves functional capacity and lean body mass in patients with gastrointestinal cancer during chemotherapy: a single-blind RCT. Supportive Care in Cancer, 27(6), 2159–2169. https://doi.org/10.1007/s00520-018-4478-5

Stuecher, Katrin, Bolling, C., Vogt, L., Niederer, D., Schmidt, K., Dignaß, A., & Banzer, W. (2019). Exercise improves functional capacity and lean body mass in patients with gastrointestinal cancer during chemotherapy: a single-blind RCT. Supportive Care in Cancer, 27(6), 2159–2169. https://doi.org/10.1007/s00520-018-4478-5

Sung, H., Ferlay, J., Siegel, R. L., Laversanne, M., Soerjomataram, I., Jemal, A., & Bray, F. (2021). Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA: A Cancer Journal for Clinicians, 71(3), 209–249. https://doi.org/10.3322/caac.21660

Tully, R., Loughney, L., Bolger, J., Sorensen, J., McAnena, O., Collins, C. G., Carroll, P. A., Arumugasamy, M., Murphy, T. J., Robb, W. B., al., et, Hickey, W., Coleman, C., Buckley, L., Lombard, E., McCaffrey, N., Gallagher, P., Timon, C., Kearney, P., … Twomey, A. (2020). The effect of a pre- And post-operative exercise programme versus standard care on physical fitness of patients with oesophageal and gastric cancer undergoing neoadjuvant treatment prior to surgery (The PERIOP-OG Trial): Study protocol for a randomised co. Trials, 21(1). https://doi.org/10.1186/s13063-020-04311-4

Valkenet, K., Trappenburg, J. C. A., Ruurda, J. P., Guinan, E. M., Reynolds, J. V, Nafteux, P., Fontaine, M., Rodrigo, H. E., van der Peet, D. L., Hania, S. W., Sosef, M. N., Willms, J., Rosman, C., Pieters, H., Scheepers, J. J. G., Faber, T., Kouwenhoven, E. A., Tinselboer, M., Räsänen, J., … et Al. (2018). Multicentre randomized clinical trial of inspiratory muscle training versus usual care before surgery for oesophageal cancer. British journal of surgery, 105(5), 502–511. https://doi.org/10.1002/bjs.10803

Van Adrichem, E. J., Meulenbroek, R. L., Plukker, J. T. M., Groen, H., & Van Weert, E. (2014). Comparison of two preoperative inspiratory muscle training programs to prevent pulmonary complications in patients undergoing esophagectomy: A randomized controlled pilot study. Annals of Surgical Oncology, 21(7). https://doi.org/10.1245/s10434-014-3612-y

van Vulpen, J. K., Hiensch, A. E., van Hillegersberg, R., Ruurda, J. P., Backx, F. J. G., Nieuwenhuijzen, G. A. P., Kouwenhoven, E. A., Groenendijk, R. P. R., van der Peet, D. L., Hazebroek, E. J., Rosman, C., Wijnhoven, B. P. L., van Berge Henegouwen, M. I., van Laarhoven, H. W. M., Siersema, P. D., & May, A. M. (2021). Supervised exercise after oesophageal cancer surgery: the PERFECT multicentre randomized clinical trial. The British Journal of Surgery, 108(7), 786–796. https://doi.org/10.1093/bjs/znab078

von Dobeln, G. A., Nilsson, M., Adell, G., Johnsen, G., Hatlevoll, I., Tsai, J., Lundell, L., Lund, M., & Lind, P. (2016). Pulmonary function and cardiac stress test after multimodality treatment of esophageal cancer. Practical radiation oncology, 6(3), e53‐e59. https://doi.org/10.1016/j.prro.2015.10.015

Xu, Y.-J., Cheng, J. C.-H., Lee, J.-M., Huang, P.-M., Huang, G.-H., & Chen, C. C.-H. (2015). A Walk-and-Eat Intervention Improves Outcomes for Patients With Esophageal Cancer Undergoing Neoadjuvant Chemoradiotherapy. The Oncologist, 20(10), 1216–1222. https://doi.org/10.1634/theoncologist.2015-0178




How to Cite

MONTENEGRO, A. K. S. .; BRAZ JÚNIOR, D. .; DANTAS, D. de S. Effects of physical exercise on the functional capacity and muscle strength of patients with gastric and esophageal cancer: a systematic review. Research, Society and Development, [S. l.], v. 11, n. 11, p. e256111133596, 2022. DOI: 10.33448/rsd-v11i11.33596. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/33596. Acesso em: 3 oct. 2022.



Health Sciences