Including people with fatigue: a systematic review and meta-analysis of physical activity after cancer treatment

Abstract

Physical activity (PA) is recommended for the management of cancer-related fatigue (CRF), yet the evidence is primarily based on interventions delivered during cancer treatment, with no eligibility criterion for fatigue. The objective of this systematic review was to summarize and evaluate the effect of PA on CRF after cancer treatment (i.e. post-cancer fatigue), using randomized trials where fatigue was an eligibility criterion. Data from 19 eligible studies were extracted by two reviewers. An estimated 7% of all trials on PA for CRF include an eligibility criterion for fatigue after cancer treatment. Sixteen studies were included in a random-effects meta-analysis. Based on studies with substantial heterogeneity and high risk of bias, the effect of PA on post-cancer fatigue was modest and variable (Hedge’s g -0.40; p = 0.010; 95% prediction intervals -1.41 to 0.62). Additional transparently reported randomized clinical trials are needed to better understand the benefits of PA for post-cancer fatigue.

The role of exercise for pain management in adults living with and beyond cancer: a systematic review and meta-analysis

“…Although the estimated average SMD shows benefits of exercise for CRP, the overall effect prediction interval was large, indicating that in some settings, exercise will have no effect or may lead to worse pain. This is unsurprising, as similar meta-analytic findings have been demonstrated for post-treatment cancer-related fatigue [ 113 ]. This reinforces the understanding that exercise must be tailored to the individual in order to optimize potential benefits [ 11 ].…”

Chronic fatigue and post-exertional malaise in people living with long COVID

“…Evidence from other conditions may offer some insight while data is being collected in long COVID. For example, at least some people with chronic fatigue after cancer treatment can benefit from exercise [71][72][73]. The mechanisms for the improvement in chronic cancer-related fatigue remain under investigation, but considering that the biological effects of exercise are multiple and interacting, reversal of deconditioning is unlikely to be the only pathway [74].…”

“…Currently, there is limited information about whether exercise is beneficial for people living with long COVID, especially considering the heterogeneous range of symptoms. While seeking insight from studies in other clinical conditions is valuable, the methodological/reporting inadequacies of rehabilitation literature [73,86] should not be repeated in studies of long COVID. While exercise is likely to be beneficial for some, there are many unknowns, including whether all patients with persistent symptoms should undergo screening for respiratory and cardiac complications before beginning exercise; whether exercise rehabilitation needs to be medically supervised; what level of tailoring is required; what frequency, intensity, duration and type of exercise can be recommended; and the trajectory of recovery for people living with long COVID.…”