Abstract
BackgroundConduct a systematic review of previous systematic reviews with meta-analysis to determine the effects of exercise (aerobic, strength or both) on cancer-related-fatigue (CRF) in adults with any type of cancer.MethodsSystematic reviews with meta-analyses of previous randomized controlled trials published through July of 2016 were included by searching six electronic databases and cross-referencing. Dual-selection and data abstraction were conducted. Methodological quality was assessed using the Assessment of Multiple Systematic Reviews (AMSTAR) instrument. Standardized mean differences (SMD) that were pooled using random-effects models were included as the effect size. In addition, 95% prediction intervals (PI), number needed-to-treat (NNT) and percentile improvements were calculated.ResultsSixteen studies representing 2 to 48 SMD effect sizes per analysis (mean ± SD, 7 ± 8, median = 5) and 37 to 3254 participants (mean ± SD, 633 ± 690, median = 400) were included. Length of training lasted from 3 to 52 weeks (mean ± SD, 14.6 ± 3.1, median = 14), frequency from 1 to 10 times per week (mean ± SD, 3.4 ± 0.8, median = 3), and duration from 10 to 120 min per session (mean ± SD, 44.3 ± 5.5, median = 45). Adjusted AMSTAR scores ranged from 44.4% to 80.0% (mean ± SD, 68.8% ± 12.0%, median = 72.5%). Overall, mean SMD improvements in CRF ranged from −1.05 to −0.01, with 22 of 55 meta-analytic results (52.7%) statistically significant (non-overlapping 95% CI). When PI were calculated for results with non-overlapping 95% CI, only 3 of 25 (12%) yielded non-overlapping 95% PI favoring reductions in CRF. Number needed-to-treat and percentile improvements ranged from 3 to 16 and 4.4 to 26.4, respectively.ConclusionsA lack of certainty exists regarding the benefits of exercise on CRF in adults. However, exercise does not appear to increase CRF in adults.Trial registrationPROSPERO Registration # CRD42016045405.
Highlights
Conduct a systematic review of previous systematic reviews with meta-analysis to determine the effects of exercise on cancer-related-fatigue (CRF) in adults with any type of cancer
Study eligibility Studies were eligible for inclusion if they met all of the following a priori criteria: (1) adults 18 years of age and older who were cancer patients or cancer survivors with any type of cancer, (2) exercise lasting at least 3 weeks in length, (3) any measure of CRF as the primary outcome, (4) change outcome difference results between exercise and control group for CRF reported, (5) systematic review with meta-analysis of randomized controlled trials or data reported separately for randomized controlled trials in which at least two studies were pooled, (6) published and unpublished studies at any time point and in any language
Given the lack of certainty regarding the benefits of exercise on CRF in adults, additional well-designed randomized controlled trials and meta-analyses appear warranted
Summary
Conduct a systematic review of previous systematic reviews with meta-analysis to determine the effects of exercise (aerobic, strength or both) on cancer-related-fatigue (CRF) in adults with any type of cancer. Cancer is the second leading cause of death in the world, accounting for approximately 8.7 million deaths in 2015 [1]. The number of cases in 2015 was estimated at 17.5 million, an increase of 13% since 2005 [1]. Cancer was estimated to have resulted in 208.3 million disability-adjusted-life-years in 2015 [1]. The economic costs of cancer are high. In 2009, it was estimated that the 12.9 million new cases of cancer worldwide cost approximately $286 billion for that year only [2]. For the estimated 21.5 million new cases expected in 2030, costs are projected to increase to approximately $458 billion [3]
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