Articles

Exercise During Chemotherapy in Colorectal Cancer: A Systematic Review

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This study investigates the effects of structured exercise on treatment tolerance, physical function, and frailty-related outcomes in adults with colorectal cancer (CRC) receiving chemotherapy, with separate appraisal for older patients to evaluate its potential to support safe and effective treatment delivery. Using a Systematic Review methodology, this study synthesized research published between January 2021 and March 2026 from PubMed, Taylor & Francis Online, and SAGE Journals searched (1 May–1 June 2026). Data were analyzed using a narrative synthesis approach, focusing on tolerance, function, fatigue, frailty, quality of life, adherence, and safety, with bias assessed via RoB 2 and ROBINS-I. The findings indicate that of 701 studies screened, 7 reports (5 cohorts) were eligible, with no serious exercise-related adverse events. A geriatric intervention with supervised physiotherapy showed higher chemotherapy completion than usual care (45% vs 28%, p=0.037), though not isolated from concurrent nutritional therapy and medication review. Unsupervised home-based resistance training did not improve relative dose intensity, while function improved most consistently with supervised or progressive resistance programs. Unlike previous review studies, this research integrates tolerance, function, frailty, and safety outcomes into a unified narrative framework specific to the CRC chemotherapy population. The study concludes that structured exercise appears feasible and may preserve physical function, though its independent contribution to treatment tolerance remains undetermined and frailty-specific evidence is limited to one geriatric cohort. Additionally, further research is required to compare exercise delivery models using adequately powered trials and standardized frailty/tolerance measures.

Safety and Efficacy of Antihypertensive Deprescribing in Frail Geriatric Patients: A Narrative Review of Contemporary Clinical Trial Evidence

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Polypharmacy with antihypertensive agents in frail older adults presents a clinical dilemma: continuing therapy may preserve cardiovascular protection, yet it simultaneously increases the risk of orthostatic hypotension, falls, and drug-related adverse events. This narrative review synthesizes contemporary clinical evidence on the safety and efficacy of antihypertensive deprescribing (gradual withdrawal or dose reduction) in frail geriatric populations, particularly those residing in long-term care facilities. Literature searches were conducted in PubMed/MEDLINE, Cochrane Library, and Google Scholar (2011–2025).

Key findings include: the OPTIMISE randomized trial, which demonstrated that withdrawing one antihypertensive agent in patients aged ≥80 years was non-inferior to usual care for systolic blood pressure control over 12 weeks, with 66% sustaining the reduction. The DANTE trial found no cognitive benefit from discontinuation in older adults with mild cognitive impairment. Observational data from the PARTAGE study revealed that low systolic blood pressure combined with ≥2 antihypertensives was associated with increased two-year mortality in frail nursing home residents, supporting the rationale for deprescribing in this subgroup. A Cochrane systematic review (2020, updated 2023) encompassing six trials (1,073 participants) found no significant association between antihypertensive withdrawal and mortality, myocardial infarction, stroke, or hospitalization, though evidence on falls and quality of life remains limited.

Overall, current evidence supports selective, closely monitored deprescribing in frail geriatric patients. However, long-term outcomes and data specific to Asian populations, including Indonesia, remain scarce, underscoring the need for further research.