Which Exercise Approaches Work for Relieving Cancer-Related Fatigue? A Network Meta-analysis.

Abstract

<b>OBJECTIVE:</b> To determine the most effective exercise modalities for managing cancer-related fatigue during and after cancer treatment. <b>DESIGN:</b> Network meta-analysis (NMA) of randomized controlled trials. <b>LITERATURE SEARCH:</b> Seven electronic databases were systematically searched from inception to January 2022. <b>STUDY SELECTION CRITERIA:</b> Randomized controlled trials testing the effects of exercise on relieving cancer-related fatigue in adult patients with cancer. <b>DATA SYNTHESIS:</b> An NMA of 56 studies was conducted, and the PRISMA-NMA guidelines were followed when reporting results. To determine the most effective interventions, the surface under the cumulative ranking curve (SUCRA) value was calculated for each exercise modality. <b>RESULTS:</b> Combined aerobic and resistance exercise (standardized mean difference [SMD], 1.57; credible interval [CrI], 1.03-2.10), yoga (SMD, 1.02; CrI: 0.44, 1.60), and regular physical activity (SMD, 1.07; CrI: 0.21, 1.92) could significantly alleviate cancer-related fatigue compared to control groups (usual care, wait-list, and regular physical activity). Combined aerobic and resistance exercise (SUCRA, 97.2%) had the highest probability of efficacy, followed by yoga (SUCRA, 75.5%) and regular physical activity (SUCRA, 74.1%). During cancer treatment, combined aerobic and resistance exercise (SUCRA, 94.5%) ranked first in efficacy, followed by regular physical activity (SUCRA, 82.1%) and yoga (SUCRA, 73.8%). After cancer treatment, only combined aerobic and resistance exercise (SMD, 0.99; CrI: 0.13, 1.84) had a significant effect on cancer-related fatigue. <b>CONCLUSION:</b> Combined aerobic and resistance exercise, yoga, and regular physical activity were the most effective exercise modalities for alleviating cancer-related fatigue. Combined aerobic and resistance exercise is recommended during and after cancer treatment. <i>J Orthop Sports Phys Ther 2023;53(6):1-10. Epub: 23 March 2023. doi:10.2519/jospt.2023.11251</i>.