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.

The effectiveness of exercise on the symptoms in breast cancer patients undergoing adjuvant treatment: an umbrella review of systematic reviews and meta-analyses

“…We summarized the main characteristics of the 15 included reviews in Tables 2 , 3 . The 15 included reviews were conducted by Chinese ( 21 , 41 , 46 , 48 , 49 ) (n=5), German ( 40 , 42 )(n=2), Dutch ( 38 ) (n=1), American ( 45 ) (n=1), Brazil ( 51 ) (n=1), Australian ( 47 ) (n=1), Spanish ( 50 ) (n=1), Colombia ( 39 ) (n=1), Ireland ( 44 ) (n=1), and Greek ( 43 ) (n=1). The sample size included in meta-analyses varied with a wide range of 400 to 2964.…”

“…Among 15 systematic reviews, 9 involved multimodal exercise ( 21 , 38 , 40 , 43 – 45 , 47 , 50 , 51 ), which could be a combination of aerobic and resistance exercise ( 21 , 38 , 40 , 43 – 45 , 47 , 51 ), or a combination of supervised and unsupervised exercise ( 50 ). Yoga was mentioned in 4 systematic reviews ( 41 , 42 , 46 , 48 ).…”

“…During adjuvant treatment for breast cancer patients, one review ( 38 ) found that exercise helped reduce general fatigue, notably physical fatigue, but had no effect on affective fatigue. Another review ( 50 ) found that supervised exercise had a greater anti-fatigue effect than unsupervised exercise. In breast cancer patients receiving adjuvant therapy, several systematic reviews concluded that short-term exercise (within 6 months) was effective in reducing fatigue ( 38 , 39 , 41 , 42 , 44 , 48 , 49 , 51 ), although the effects of medium- and long-term exercise on reducing fatigue were erratic ( 40 , 45 , 46 , 50 ).…”

Effect of exercise therapy on cancer-related fatigue in patients with breast cancer: A systematic review and network meta-analysis

“…First, adherence to exercise has a significant impact on effect size, and higher levels of adherence lead to more significant relief of CRF, and in this review, adherence to combined exercise was higher than that to aerobic and resistance exercise 104 . Second, supervised exercise has been demonstrated to be superior to unsupervised exercise in relieving CRF in the short term, and combined exercise and aerobic exercise included in this systematic review differed significantly in terms of exercise programs 105 . Most combined exercises are guided and supervised by professionals, while most aerobic exercises are self-administered at home.…”

“…104 Second, supervised exercise has been demonstrated to be superior to unsupervised exercise in relieving CRF in the short term, and combined exercise and aerobic exercise included in this systematic review differed significantly in terms of exercise programs. 105 Most combined exercises are guided and supervised by professionals, while most aerobic exercises are self-administered at home. Characterized by reduced adherence and workability, home-based exercise training programs are more free-flowing and lack supervision and oversight, which may diminish the efficacy of aerobic exercise.…”