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Cancer – Improves cancer-related fatigue

Evidence summary (Updated 2022)
Systematic reviews and meta-analysis have demonstrated either a control in fatigue or small reductions in fatigue(1). This has been demonstrated in both exercise programmes during chemotherapy or radiotherapy, and has been seen in breast cancer, prostate cancer; during androgen therapy and radiotherapy; haematological malignancies, and head and neck cancers(2–6).
In a recent review of the evidence 54 reviews were shown to have a definite positive effect on cancer-related fatigue(7–60).
Thirteen of 54 studies reported an improvement on fatigue seen during the treatment stage(7,14,20,26,27,32,39,42,47,50,52,54,55). The majority reported on interventions during and post treatment(9,11,15–18,22,23,25,28,29,35–38,40,41,43–45,48,49,51,59). Eight of 54 studies reported on improved symptoms of fatigue with PA interventions following cancer treatment(13,19,21,24,30,31,34,53). Eight of 54 did not specify the treatment stage of the interventions(8,10,12,33,46,56,57,60).
While the majority reported on multiple cancer types(12,16,39–46,50,53,19,56,57,22–24,28,35,37,38), these included any combination of the following; breast, lung, gastrointestinal, gynaecological, prostate, testicular or haematological and with bone metastases(58). Several reported on a single cancer only; improved fatigue with the physical activity intervention group was seen in breast(7–11,13–15,26,27,29,31–34,36,54,59), gastrointestinal(17,24,25,30,47,52), prostate(18,20,48,49), lung(21), haematological(55), head and neck(51) cancer patients.
When considering the intervention type studies considered multiple or combination physical activity/exercise interventions (11,13,14,18,20,21,25,26,33,34,36,37,39–41,45,48,49,51,53,54,58–60). Combined aerobic and anaerobic activities were evaluated (7,9,19,22,27,28,30,35,43,44,50,52,55,57). Studies evaluating single activity type interventions found resistance training(10), HIIT(23), aerobic(17,47), walking(32), aquatic-based(31), mind-body exercises(16,29,56) such as Qigong(12), Tai Chi(38,46), and yoga(15,42) exercise interventions were shown to be effective(8).
Interventions of any frequency, intensity and duration were included in several the studies. Improvements in fatigue were seen in moderate(44), moderate-vigorous(7,19,28,47,51) intensity interventions. Published reviews also looked at the combined role of nutritional and exercise interventions and as above found a positive effect(24).

Quality of evidence
B – Moderate quality

Strength of recommendation
2 – Weak

A large body of meta-analyses exists for fatigue reduction for all cancer types and breast cancer. There is moderate to high quality of studies demonstrating either control or small reduction in fatigue during chemotherapy or radiotherapy. Overall, a reduction in fatigue is demonstrated with physical activity. The evidence has high heterogeneity.


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