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Meta-Analysis
. 2012 Nov 14;11(11):CD006145.
doi: 10.1002/14651858.CD006145.pub3.

Exercise for the management of cancer-related fatigue in adults

Fiona Cramp  1 , James Byron-Daniel
Affiliations
Meta-Analysis

Exercise for the management of cancer-related fatigue in adults

Fiona Cramp et al. Cochrane Database Syst Rev. .

Abstract

Background: Cancer-related fatigue is recognised as an important symptom associated with cancer and its treatment. A number of studies have investigated the effects of physical activity in reducing cancer-related fatigue. This is an updated version of the original Cochrane review published in The Cochrane Library (2008, Issue 1). The original review identified some benefits of physical activity on fatigue in cancer both during and after adjuvant treatment. We identified a number of limitations in the evidence, providing clear justification for an updated review.

Objectives: To evaluate the effect of exercise on cancer-related fatigue both during and after cancer treatment.

Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 1, 2011), MEDLINE (1966 to March 2011), EMBASE (1980 to March 2011), CINAHL (1982 to March 2011), British Nursing Index (January 1984 to March 2011), AMED (1985 to March 2011), SIGLE (1980 to March 2011) and Dissertation Abstracts International (1861 to March 2011) using key words. We also searched reference lists off all studies identified for inclusion and relevant reviews. In addition, we handsearched relevant journals and contacted experts in the field of cancer-related fatigue.

Selection criteria: We sought and included randomised controlled trials (RCTs) that investigated the effect of exercise on cancer-related fatigue in adults.

Data collection and analysis: Two review authors independently assessed the risk of bias of studies and extracted data based upon predefined criteria. Where data were available we performed meta-analyses for fatigue using a random-effects model.

Main results: For this update we identified a total of 56 studies (4068 participants) for inclusion (28 from the original search and 28 from the updated search), with the majority carried out in participants with breast cancer (28 studies). A meta-analysis of all fatigue data, incorporating 38 comparisons, provided data for 1461 participants who received an exercise intervention and 1187 control participants. At the end of the intervention period exercise was seen to be statistically more effective than the control intervention (standardised mean difference (SMD) -0.27, 95% confidence interval (CI) -0.37 to -0.17). Benefits of exercise on fatigue were observed for interventions delivered during or post-adjuvant cancer therapy. In relation to diagnosis, we identified benefits of exercise on fatigue for breast and prostate cancer but not for those with haematological malignancies. Finally, aerobic exercise significantly reduced fatigue but resistance training and alternative forms of exercise failed to reach significance.

Authors' conclusions: The findings of the updated review have enabled a more precise conclusion to be made in that aerobic exercise can be regarded as beneficial for individuals with cancer-related fatigue during and post-cancer therapy, specifically those with solid tumours. Further research is required to determine the optimal type, intensity and timing of an exercise intervention.

PubMed Disclaimer

Conflict of interest statement

None known.

Figures

1
1
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
2
2
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
1.1
1.1. Analysis
Comparison 1: Fatigue: all data, Outcome 1: Exercise versus no exercise control; post‐test means
2.1
2.1. Analysis
Comparison 2: Fatigue: during anti‐cancer therapy, Outcome 1: Exercise versus no exercise control; post‐test means
3.1
3.1. Analysis
Comparison 3: Fatigue: post anti‐cancer therapy, Outcome 1: Exercise versus no exercise control
4.1
4.1. Analysis
Comparison 4: Fatigue: breast cancer, Outcome 1: Exercise versus no intervention control; post‐test means
5.1
5.1. Analysis
Comparison 5: Fatigue: prostate cancer, Outcome 1: Exercise versus no exercise control; post‐test means
6.1
6.1. Analysis
Comparison 6: Fatigue: haematological malignancies, Outcome 1: Exercise versus no exercise control; post‐test means
7.1
7.1. Analysis
Comparison 7: Fatigue: aerobic training, Outcome 1: Exercise versus no exercise control; post‐test means
8.1
8.1. Analysis
Comparison 8: Fatigue: resistance training, Outcome 1: Exercise versus no exercise control; post‐test means
9.1
9.1. Analysis
Comparison 9: Fatigue: mind‐body exercise, Outcome 1: Exercise versus no exercise control; post‐test means
See this image and copyright information in PMC

Update of

Comment in

References

References to studies included in this review

Adamsen 2009 {published data only}
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Carson 2009 {published data only}
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Chandwani 2010 {published data only}
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Chang 2008 {published data only}
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Coleman 2003a {published data only}
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Courneya 2003a {published data only}
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Courneya 2003b {published data only}
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Courneya 2003c {published data only}
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Courneya 2007a {published data only}
    1. Courneya KS, Friedenrich CM, Reid RD, Gelmon K, Mackey JR, Ladha AB, et al. Predictors of follow-up exercise behavior 6 months after a randomized trial of exercise training during breast cancer chemotherapy. Breast Cancer Research and Treatment 2009;114:179-87. - PubMed
    1. Courneya KS, McKenzie DC, Reid RD, Mackey JR, Gelmon K, Friedenrich CM, et al. Barriers to supervised exercise training in a randomized controlled trial of breast cancer patients receiving chemotherapy. Annals of Behavioral Medicine 2008;35:116-22. - PubMed
    1. Courneya KS, Segal RJ, Gelmon K, Reid RD, Mackey JR, Friedenrich CM, et al. Six-month follow-up of patient-rated outcomes in a randomized controlled trial of exercise training during breast cancer chemotherapy. Cancer Epidemiology Biomarkers and Prevention 2007;16(12):2572-8. - PubMed
    1. Courneya KS, Segal RJ, Mackey JR, Gelmon K, Reid RD, Friedenreich CM, et al. Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomised controlled trial. Journal of Clinical Oncology 2007;25(28):4396-404. - PubMed
Courneya 2007b {published data only}
    1. Courneya KS, Friedenrich CM, Reid RD, Gelmon K, Mackey JR, Ladha AB, et al. Predictors of follow-up exercise behavior 6 months after a randomized trial of exercise training during breast cancer chemotherapy. Breast Cancer Research and Treatment 2009;114:179-87. - PubMed
    1. Courneya KS, McKenzie DC, Reid RD, Mackey JR, Gelmon K, Friedenrich CM, et al. Barriers to supervised exercise training in a randomized controlled trial of breast cancer patients receiving chemotherapy. Annals of Behavioral Medicine 2008;35:116-22. - PubMed
    1. Courneya KS, Segal RJ, Gelmon K, Reid RD, Mackey JR, Friedenrich CM, et al. Six-month follow-up of patient-rated outcomes in a randomized controlled trial of exercise training during breast cancer chemotherapy. Cancer Epidemiology Biomarkers and Prevention 2007;16(12):2572-8. - PubMed
    1. Courneya KS, Segal RJ, Mackey JR, Gelmon K, Reid RD, Friedenreich CM, et al. Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomised controlled trial. Journal of Clinical Oncology 2007;25:4396-404. - PubMed
Courneya 2008 {published data only}
    1. Courneya KS, Jones LW, Peddle CJ, Sellar CM, Reiman T, Joy AA, et al. Effects of aerobic exercise training in anemic cancer patients receiving darbepoetin alfa: a randomized controlled trial. The Oncologist 2008;13:1012-20. - PubMed
Courneya 2009 {published data only}
    1. Courneya KS, Sellar CM, Stevinson C, McNeely ML, Peddle CJ, Friedenreich CM, et al. Randomized controlled trial of the effects of aerobic exercise on physical functioning and quality of life in lymphoma patients. Journal of Clinical Oncology 2009;27(27):4605-12. - PubMed
Culos‐Reed 2006 {published data only}
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Culos‐Reed 2010 {published data only}
    1. Culos-Reed SN, Robinson JW, Lau H, Stephenson L, Keats M, Norris S, et al. Physical activity for men receiving androgen deprivation therapy for prostate cancer: benefits from a 16-week intervention. Supportive Care in Cancer 2010;18:591-9. - PubMed
Daley 2007 {published and unpublished data}
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Danhauer 2009 {published data only}
    1. Danhauer SC, Mihalko SL, Russell GB, Campbell CR, Felder L, Daley K, et al. Restorative yoga for women with breast cancer: findings from a randomized pilot study. Psycho-Oncology 2009;18:360-8. - PMC - PubMed
Dimeo 1999 {published and unpublished data}
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Dimeo 2004 {published and unpublished data}
    1. Dimeo FC, Thomas F, Raabe-Menssen C, Pröpper F, Mathias M. Effect of aerobic exercise and relaxation training on fatigue and physical performance of cancer patients after surgery. A randomised controlled trial. Supportive Care in Cancer 2004;12:774-9. - PubMed
Dodd 2010a {published data only}
    1. Dodd MJ, Cho MH, Miaskowski C, Painter PL, Paul SM, Cooper BA, et al. A randomized controlled trial of home-based exercise for cancer-related fatigue in women during and after chemotherapy with or without radiation therapy. Cancer Nursing 2010;33(4):245-57. - PMC - PubMed
Dodd 2010b {published data only}
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Drouin 2005 {published data only}
    1. Drouin JS, Armstrong H, Krause S, Orr J, Birk TJ, Hryniuk WM, et al. Effects of aerobic exercise training on peak aerobic capacity, fatigue, and psychological factors during radiation for breast cancer. Rehabilitation Oncology 2005;23(1):11-7.
Galantino 2003 {published data only}
    1. Galantino ML, Capito L, Kane RJ, Ottey N, Switzer S, Packel L. The effects of Tai Chi and walking on fatigue and body mass index in women living with breast cancer: a pilot study. Rehabilitation Oncology 2003;21(1):17-22.
Galvão 2010 {published data only}
    1. Galvão DA, Taaffe DR, Spry N, Joseph D, Newton RU. Combined resistance and aerobic exercise program reverses muscle loss in men undergoing androgen suppression therapy for prostate cancer without bone metastases: a randomized controlled trial. Journal of Clinical Oncology 2010;28(2):340-7. - PubMed
Headley 2004 {published data only}
    1. Headley JA, Ownby KK, John LD. The effect of seated exercise on fatigue and quality of life in women with advanced breast cancer. Oncology Nursing Forum 2004;31(5):977-83. - PubMed
Heim 2007 {published data only}
    1. Heim ME, vdMalsburg M-LE, Niklas A. Randomized controlled trial of a structured training program in breast cancer patients with tumor-related chronic fatigue. Onkologie 2007;30:429-34. - PubMed
Hwang 2008 {published data only}
    1. Hwang JH, Chang HJ, Shim YH, Park WH, Huh SJ, Yang J-H. Effects of supervised exercise therapy in patients receiving radiotherapy for breast cancer. Yonsei Medical Journal 2008;49(3):443-50. - PMC - PubMed
Lee 2010 {published data only}
    1. Lee SA, Kang J-Y, Kim YD, An AR, Kim S-W, Kim Y-S, et al. Effects of a scapula-oriented shoulder exercise programme on upper limb dysfunction in breast cancer survivors: a randomized controlled pilot trial. Clinical Rehabilitation 2010;24:600-13. - PubMed
McKenzie 2003 {published data only}
    1. McKenzie D, Kalda AL. Effect of upper extremity exercise on secondary lymphedema in breast cancer patients: a pilot study. Journal of Clinical Oncology 2003;21(3):463-6. - PubMed
McNeely 2008 {published data only}
    1. McNeely ML, Parliament MB, Seikaly H, Jha N, Magee DJ, Haykowsky MJ, et al. Effect of exercise on upper extremity pain and dysfunction in head and neck cancer survivors: a randomized controlled trial. Cancer 2008;113:214-22. - PubMed
Milne 2008 {published data only}
    1. Milne HM, Wallman KE, Gordon S, Courneya KS. Effects of a combined aerobic and resistance exercise program in breast cancer survivors: a randomized controlled trial. Breast Cancer Research and Treatment 2008;108:279-88. - PubMed
Moadel 2007 {published data only}
    1. Moadel AB, Shah C, Wylie-Rosett J, Harris MS, Patel SR, Hall CB, et al. Randomized controlled trial of yoga among a multiethnic sample of breast cancer patients: effects on quality of life. Journal of Clinical Oncology 2007;25(28):4387-95. - PubMed
Mock 1994 {published data only}
    1. Mock V, Burke MB, Sheehan P, Creaton EM, Winningham ML, McKenney-Tedder S, et al. A nursing rehabilitation program for women with breast cancer receiving adjuvant chemotherapy. Oncology Nursing Forum 1994;21(5):899-907. - PubMed
Mock 1997 {published data only}
    1. Mock V, Dow KH, Meares CJ, Grimm PM, Dienemann JA, Haisfield-Wolfe ME, et al. Effects of exercise on fatigue, physical functioning, and emotional distress during radiation therapy for breast cancer. Oncology Nursing Forum 1997;24(6):991-1000. - PubMed
Mock 2005 {published data only}
    1. Mock V, Frangakis C, Davidson NE, Ropka ME, Pickett M, Poniatowski B, et al. Exercise manages fatigue during breast cancer treatment: a randomised controlled trial. Psycho-Oncology 2005;14:464-77. - PubMed
Monga 2007 {published data only}
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Mustian 2009 {published data only}
    1. Mustian KM, Peppone L, Darling TV, Palesh O, Heckler CE, Morrow GR. A 4-week home-based aerobic and resistance exercise program during radiation therapy: a pilot randomized clinical trial. Journal of Supportive Oncology 2009;7(5):158-67. - PMC - PubMed
Mutrie 2007 {published data only}
    1. Mutrie N, Campbell AM, Whyte F, McConnachie A, Emslie C, Lee L, et al. Benefits of supervised group exercise programme for women being treated for early stage breast cancer: pragmatic randomised controlled trial. BMJ 2007;334:517-24. - PMC - PubMed
Oh 2008 {published data only}
    1. Oh B, Butow P, Mullan B. Medical Qigong for cancer patients: pilot study of impact on quality of life, side effects of treatment and inflammation. American Journal of Chinese Medicine 2008;36(3):459-72. - PubMed
Oh 2010 {published data only}
    1. Oh B, Butow P, Mullan B, Clarke S, Beale P, Pavlakis N, et al. Impact of medical Qigong on quality of life, fatigue, mood and inflammation in cancer patients: a randomized controlled trial. Annals of Oncology 2010;21(3):608-14. - PMC - PubMed
Payne 2008 {published data only}
    1. Payne JK, Held J, Thorpe J, Shaw H. Effect of exercise on biomarkers, fatigue, sleep disturbances, and depressive symptoms in older women with breast cancer receiving hormonal treatment. Oncology Nursing Forum 2008;35(4):635-42. - PubMed
Pinto 2003 {published data only}
    1. Pinton BM, Clark MM, Maruyama NC, Feder SI. Psychological and fitness changes associated with exercise participation among women with breast cancer. Psycho-Oncology 2003;12:118-26. - PubMed
Pinto 2005 {published data only}
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Rogers 2009 {published and unpublished data}
    1. Rogers LQ, Hopkins-Price P, Vicari S, Markwell S, Pamenter R, Courneya KS, et al. Physical activity and health outcomes three months after completing a physical activity behavior change intervention: persistent and delayed effects. Cancer Epidemiology Biomarkers and Prevention 2009;18(5):1410-8. - PubMed
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Santa Mina 2012 {unpublished data only}
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Segal 2001a {published data only}
    1. Segal R, Evans W, Johnson D, Smith J, Colletta S, Gayton J, et al. Structured exercise improves physical functioning in women with stages I and II breast cancer: results of a randomised controlled trial. Journal of Clinical Oncology 2001;19(3):657-65. - PubMed
Segal 2001b {published data only}
    1. Segal R, Evans W, Johnson D, Smith J, Colletta S, Gayton J, et al. Structured exercise improves physical functioning in women with stages I and II breast cancer: results of a randomised controlled trial. Journal of Clinical Oncology 2001;19(3):657-65. - PubMed
Segal 2003 {published data only}
    1. Segal RJ, Reid RD, Courneya KS, Malone SC, Parliament MB, Scott CG, et al. Resistance exercise in men receiving androgen deprivation therapy for prostate cancer. Journal of Clinical Oncology 2003;21(9):1653-9. - PubMed
Segal 2009a {published data only}
    1. Segal RJ, Reid RD, Courneya KS, Sigal RJ, Kenny GP, Prud'Homme DG, et al. Randomized controlled trial of resistance or aerobic exercise in men receiving radiation therapy for prostate cancer. Journal of Clinical Oncology 2009;27(3):344-51. - PubMed
Segal 2009b {published data only}
    1. Segal RJ, Reid RD, Courneya KS, Sigal RJ, Kenny GP, Prud'Homme DG, et al. Randomized controlled trial of resistance or aerobic exercise in men receiving radiation therapy for prostate cancer. Journal of Clinical Oncology 2009;27(3):344-51. - PubMed
Sequeira 2012 {unpublished data only}
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Shelton 2009 {published data only}
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Thorsen 2005 {published data only}
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van Weert 2010 {published data only}
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Windsor 2004 {published data only}
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Yuen 2007a {published data only}
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Yuen 2007b {published data only}
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References to studies excluded from this review

Aghili 2007 {published data only}
    1. Aghili M, Farhan F, Rade M. A pilot study of the effects of programmed aerobic exercise on the severity of fatigue in cancer patients during external radiotherapy. European Journal of Oncology Nursing 2007;11:179-82. - PubMed
Barinow‐Wojewódzki 2008 {published data only}
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Barsevick 2004 {published data only}
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Battaglini 2007 {published data only}
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Berglund 1994 {published data only}
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Buss 2010 {published data only}
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Cella 2004 {published data only}
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Coleman 2003b {published data only}
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Coleman 2008 {published data only}
    1. Coleman EA, Coon SK, Kennedy RL, Lockhart KD, Stewart CB, Anaissie EJ, et al. Effects of exercise in combination with epoetin alfa during high-dose chemotherapy and autologous peripheral blood stem cell transplantation for multiple myeloma. Oncology Nursing Forum 2008;35(3):E53-61. - PMC - PubMed
Culos‐Reed 2007 {published data only}
    1. Culos-Reed SN, Robinson JL, Lau H, O'Connor K, Keats MR. Benefits of a physical activity intervention for men with prostate cancer. Journal of Sport and Exercise Psychology 2007;29(1):118-27. - PubMed
Decker 1989 {published data only}
    1. Decker WA, Turner-McGlade J, Fehir KM. Psychosocial aspects and the physiological effects of a cardiopulmonary exercise program in patients undergoing bone marrow transplantation (BMT) for acute leukemia (AL). Transplantation Proceedings 1989;21(1):3068-9. - PubMed
Dimeo 1996 {published data only}
    1. Dimeo F, Bertz H, Finke J, Fetscher S, Mertelsmann R, Keul J. An aerobic exercise program for patients with haematological malignancies after bone marrow transplantation. Bone Marrow Transplantation 1996;18:1157-60. - PubMed
Dimeo 1997a {published data only}
    1. Dimeo FC, Tilmann MHM, Bertz H, Kanz L, Mertelsmann R, Keul J. Aerobic exercise in the rehabilitation of cancer patients after high dose chemotherapy and autologous peripheral stem cell transplantation. Cancer 1997;79:1717-22. - PubMed
Dimeo 1997b {published data only}
    1. Dimeo F, Fetscher S, Lange W, Mertelsmann R, Keul J. Effects of aerobic exercise on the physical performance and incidence of treatment-related complications after high dose chemotherapy. Blood 1997;90(9):3390-4. - PubMed
Dimeo 2008 {published data only}
    1. Dimeo F, Schwartz S, Wessel N, Voigt A, Thiel E. Effects of an endurance and resistance exercise program on persistent cancer-related fatigue after treatment. Annals of Oncology 2008;19(8):1495-9. - PubMed
Fillion 2008 {published data only}
    1. Fillion L, Gagnon P, Lebland F, Gélinas C, Savard J, Dupuis R, et al. A brief intervention for fatigue management in breast cancer survivors. Cancer Nursing 2008;31(2):145-59. - PubMed
Goedendorp 2010 {published data only}
    1. Goedendorp MM, Peters MEWJ, Gielissen MFM, Witjes JA, Leer JW, Verhagen CAHHVM, et al. Is increasing physical activity necessary to diminish fatigue during cancer treatment? Comparing cognitive behavior therapy and a brief nursing intervention with usual care in a multicenter randomized controlled trial. The Oncologist 2010;15:1122-32. - PMC - PubMed
Hansen 2009 {published data only}
    1. Hansen PA, Dechet CB, Porucznik CA, LaStayo PC. Comparing eccentric resistance exercise in prostate cancer survivors on and off hormone therapy: a pilot study. Physical Medicine and Rehabilitation 2009;1(11):1019-24. - PubMed
Hartvig 2006 {published data only}
    1. Hartvig P, Aulin J, Wallenberg S, Wagenius G. Physical exercise for cytotoxic drug induced fatigue. Journal of Oncology Pharmacy Practice 2006;12:183-91. - PubMed
Hayes 2004 {published data only}
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References to other published versions of this review

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