Moderators of Exercise Effects on Cancer-related Fatigue: A Meta-analysis of Individual Patient Data

Vulpen, Jonna K. van; Sweegers, Maike G.; Peeters, Petra H.; Courneya, Kerry S.; Newton, Robert U.; Aaronson, Neil K.; Jacobsen, Paul B.; Galvão, Daniel A.; Chinapaw, Mai J. M.; Steindorf, Karen; Irwin, Melinda L.; Stuiver, Martijn M.; Hayes, Sandra C.; Griffith, Kathleen A.; Mesters, Ilse; Knoop, Hans; Goedendorp, Martine M.; Mutrie, Nanette; Daley, Amanda; McConnachie, Alex; Bohus, Martin; Thorsen, Lene; Kh, Schulz; Short, Camille E.; James, Erica L.; Plotnikoff, Ronald C.; Schmidt, Martina E.; Ulrich, Cornelia M.; Beurden, Marc van; Oldenburg, Hester S.; Sonke, Gabe S.; Harten, Wim H. van; Schmitz, Kathryn H.; Winters-Stone, Kerri M.; Velthuis, Miranda J.; Taaffe, Dennis R.; Mechelen, Willem van; Kersten, Marie José; Nollet, Frans; Wenzel, Jennifer; Wiskemann, Joachim; Leeuw, Irma M. Verdonck‐de; Brug, Johannes; May, Anne M.; Buffart, Laurien M.

doi:10.1249/mss.0000000000002154

Cited by 63 publications

(58 citation statements)

References 75 publications

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“…Finally, our results also demonstrate similar effects between different exercise modes as denoted by the nonsignificant univariate meta-regression model. This result agrees with a previous study [ 56 ] showing that resistance, aerobic or combined resistance and aerobic exercise promotes similar effects on cancer-related fatigue in cancer patients (−0.21, −0.23 and −0.26 SMD, respectively) and demonstrates the potential use of a low dosage even when resistance exercise is prescribed as a single mode of exercise in men with prostate cancer.…”

Section: Discussionsupporting

confidence: 92%

What is the minimal dose for resistance exercise effectiveness in prostate cancer patients? Systematic review and meta-analysis on patient-reported outcomes

López

Taaffe

Newton

et al. 2020

Prostate Cancer Prostatic Dis

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Background Active treatments for prostate cancer are well known to result in several adverse effects such as fatigue, depression and anxiety symptoms, impacting the overall quality of life (QoL) and wellbeing of a considerable proportion of patients. Resistance-based exercise interventions have shown positive effects to reduce or mitigate these treatment-related side effects. However, the minimal dosage required to derive these benefits is unknown. We systematically reviewed the resistance training effects in prostate cancer patients to determine the minimal dosage regarding the exercise components (mode, duration, volume and intensity) on fatigue, QoL, depression and anxiety. Methods Using PRISMA guidelines, MEDLINE, CINAHL, EMBASE, SPORTDiscus and Web of Science databases were searched. Eligible randomised controlled trials examined prostate cancer patients undertaking resistance-based exercise programs during or following treatment. Meta-analysis was undertaken when more than three studies were included. Associations between resistance exercise components and its effects were tested by meta-regression analysis. Results Eighteen trials involving 1112 men with prostate cancer were included. Resistance-based exercise programs resulted in significant effects on fatigue (effect size = −0.3, 95% CI: −0.4 to −0.2, P < 0.001) and QoL (effect size = 0.2, 95% CI: 0.0 to 0.4, P = 0.018), with significant effects in specific questionnaires and domains of these outcomes. Resistance-based exercise effects on depression (effect size = −0.3, 95% CI: −0.7 to 0.0) and anxiety symptoms (effect size = −0.3, 95% CI: −0.5 to 0.0) were positive but not significant (P = 0.071 to 0.077). Meta-regression indicated no significant association between resistance exercise components with fatigue and QoL outcomes (P = 0.186–0.689). Conclusions Low volume resistance exercise undertaken at a moderate-to-high intensity is sufficient to achieve significant fatigue and QoL benefits for men with prostate cancer and also mitigate depression and anxiety symptoms. A lower resistance exercise dosage than usually prescribed may help enhance adherence by reducing exercise barriers.

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Section: Discussionsupporting

confidence: 92%

What is the minimal dose for resistance exercise effectiveness in prostate cancer patients? Systematic review and meta-analysis on patient-reported outcomes

López

Taaffe

Newton

et al. 2020

Prostate Cancer Prostatic Dis

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“…A large body of evidence supports the positive effects of physical activity (PA) and exercise for cancer patients all along the cancer trajectory (Fong et al, 2012 ; Furmaniak et al, 2016 ; Christensen et al, 2018 ). Exercise has shown to increase physical fitness (Strasser et al, 2013 ; Scott et al, 2018 ; Sweegers et al, 2019 ), health related quality of life (Mishra et al, 2012 ; Buffart et al, 2017 ) and improvement in cancer-related fatigue (CRF; Mustian et al, 2017 ; Van Vulpen et al, 2020 ). Prior to initial treatment, exercise can improve the fitness of cancer patients and reduce the likelihood of certain complications (Vermillion et al, 2018 ).…”

Section: Introductionmentioning

confidence: 99%

Relationship Between Cancer Related Fatigue, Physical Activity Related Health Competence, and Leisure Time Physical Activity in Cancer Patients and Survivors

Koeppel

Körbi

Winkels

et al. 2021

Front. Sports Act. Living

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Background: A large body of evidence supports the positive effects of leisure time physical activity (LTPA) and exercise on cancer survivors. However, only a fraction of survivors manages to attain international PA recommendations. This can be attributed to several external and internal barriers toward PA those patients seem to encounter, with cancer related fatigue (CRF) being the most reported internal barrier. Nevertheless, self-efficacy and knowledge about the utilization of LTPA can serve as facilitators of PA, which also correspond to certain constituents of physical activity related health competence (PAHCO). Since PAHCO is not investigated in cancer survivors we investigated if PAHCO can mediate the negative relationship between CRF and LTPA.Methods: We surveyed 398 cancer survivors with different cancer types and therapy status. The patients completed the EORTC QLQ-FA12 (EORTC FA12) to assess CRF, the PAHCO questionnaire to assess PAHCO and the SQUASH to assess LTPA. We followed a two-step structural equation modeling approach. The first step established the measurement model, in the second step we fitted the mediation model. Since 163 patients chose not to answer the SQUASH, the mediation model was only fitted to the data of the remaining 235 participants.Results: The proposed measurement model of the PAHCO offered an excellent fit. We found small to moderate positive associations between the PAHCO dimensions and the LTPA, and negative moderate relationships between the PAHCO and the EORTC FA12 dimensions. We did not observe a relationship between the EORTC FA12 dimensions and the LTPA (p > 0.05). The hypothesized mediation models did not display an appropriate fit.Conclusion: The PAHCO confirmed its factorial validity; furthermore, it appears to have a positive relationship to LTPA. Therefore, integrating psycho-educational aspects can be beneficial in order to increase the PAHCO in exercise interventions. Because of the cross-sectional character of this study, causal conclusions are not suitable, therefore the longitudinal relationships of LTPA, CRF, and PAHCO require further investigation.

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“…Physical activity is recommended for the management of CRF, both during and after cancer treatment [14]. This is based on evidence from more than 170 randomized trials to date [15], and there have been multiple systematic reviews on the topic in the past decade [15][16][17][18][19].…”

Section: Introductionmentioning

confidence: 99%

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

Twomey¹,

Yeung²,

Wrightson³

et al. 2020

Preprint

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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.

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Moderators of Exercise Effects on Cancer-related Fatigue: A Meta-analysis of Individual Patient Data

Cited by 63 publications

References 75 publications

What is the minimal dose for resistance exercise effectiveness in prostate cancer patients? Systematic review and meta-analysis on patient-reported outcomes

What is the minimal dose for resistance exercise effectiveness in prostate cancer patients? Systematic review and meta-analysis on patient-reported outcomes

Relationship Between Cancer Related Fatigue, Physical Activity Related Health Competence, and Leisure Time Physical Activity in Cancer Patients and Survivors

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

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