Supervised and Non-Supervised Exercise Programs for the Management of Cancer-Related Fatigue in Women with Breast Cancer: A Systematic Review and Meta-Analysis

Abstract

Physical exercise is considered to be a non-pharmacological strategy for reducing symptoms of cancer-related fatigue (CRF) in women with breast cancer (BC). This systematic review and meta-analysis aims to assess the effects of non-supervised exercise programs in comparison with the effects of supervised exercise interventions for CRF in BC patients. Randomized controlled trials that investigated the effect of exercise on CRF in women were searched for until 29 June 2022. Inclusion criteria comprised women diagnosed with BC; exercise-based interventions; trials comparing at least one exercise group vs. a control group; trials that assessed exercise effects on CRF. Thirty-one studies met the inclusion criteria (n = 2964). Both non-supervised and supervised exercise programs significantly reduced CRF (standard mean difference (SMD) = −0.46, confidence interval (CI) = (−0.64, −0.28), p < 0.0001 and SMD = −0.74, CI = (−0.99, −0.48), p < 0.0001, respectively), without statistical difference (p = 0.09). However, a short-term training program subgroup analyses showed significant differences between supervised and non-supervised training programs (p = 0.01), showing that supervised training programs have a greater effect (SMD = −1.33, CI = (−1.92, −0.73), p < 0.0001) than non-supervised ones (SMD = −0.44, CI = (−0.78, −0.11), p = 0.009). Both supervised and non-supervised exercise programs may reduce CRF in BC patients; however, in the short-term, supervised exercise may have a greater effect on CRF in BC patients.

Keywords: COVID-19; breast; exercise; fatigue; neoplasms.

Figure 1

Flowchart for search strategy methods. Flowchart is performed according to PRISMA framework [24].

Figure 2

Methodological quality of included studies using the Cochrane “risk of bias assessment tool” [35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,77,78]. 1: Random sequence generation (selection bias). 2: Allocation concealment (selection bias). 3: Blinding of participants and personnel (performance bias). 4: Blinding of outcome assessment (detection bias). 5: Incomplete outcome data (attrition bias). 6: Selective reporting (reporting bias). 7: Other bias. Green: Low risk. Red: High risk. Yellow: Unclear risk.

Figure 3

(a) Funnel plot of standard error (SE) against standardized mean difference (SMD) for the assessment of publication bias in the investigation of the CRF outcome in non-supervised training programs. (b) Funnel plot of standard error (SE) against standardized mean difference (SMD) for the assessment of publication bias in the investigation of the CRF outcome in supervised training programs.

Figure 4

Meta-analyses of the effects of supervised [35,43,44,46,47,48,49,50,51,52,53,55,56,58,59,61,63,64] and non-supervised exercise [36,37,38,39,40,41,42,45,49,51,54,57,59,60,62,65] in CRF. A: aerobic exercise group; COM: combination of printed materials and step pedometer; NS: non-supervised exercise group; PM: printed materials; R: resistance exercise group; S: supervised group; SP: step pedometer.

Figure 5

Meta-analyses of the effects of supervised [35,43,44,47,51,55,56,61,63] and non-supervised [36,37,39,41,45,51,54] exercise interventions of less than 12 weeks on CRF in BC patients. NS: non-supervised exercise group.

Figure 6

Meta-analyses of the effects of supervised [46,48,49,50,52,53,58,59,64] and non-supervised [38,40,42,49,57,59,60,62,65] exercise interventions of more than 12 weeks on CRF in BC patients. A: aerobic exercise group; COM: combination of printed materials and step pedometer; NS: non-supervised exercise group; PM: printed materials; R: resistance exercise group; S: supervised group; SP: step pedometer.

Figure 7

Meta-analyses of the effects of supervised [46,51,52,64] and non-supervised [36,37,41,51] exercise interventions of less than 80% adherence on CRF in BC patients. A: aerobic exercise group; NS: non-supervised exercise group; R: resistance exercise group.

Figure 8

Meta-analyses of the effects of supervised [43,47,48,49,50,53,55,61,64] and non-supervised [39,45,49,54,57,65] exercise interventions of more than 80% adherence on CRF in BC patients. COM: combination of printed materials and step pedometer; NS: non-supervised exercise group; R: resistance exercise group; S: supervised group; SP: step pedometer.