Comparative Efficacy of Various Exercise Types on Cancer-Related Fatigue for Cancer Survivors: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials

Abstract

Background: This study compares the effectiveness of 7 types of guideline-recommended first-line exercises for cancer-related fatigue (CRF). Methods: A comprehensive search was conducted utilizing public databases, including Medline, Embase, Web of Science, and Cochrane Library. Randomized clinical trials examining the effects of aerobic exercise, resistance exercise, stretching exercise, combined aerobic and resistance exercise, Yoga, Qigong, or Tai Chi on CRF in various cancer types were included. A Bayesian network meta-analysis was used to synthesize the data. Subgroup analyses and sensitivity analyses were used to detect the effect modifiers and to confirm the robustness, respectively. Results: A total of 33 clinical trials were included in this analysis. Overall, both resistance (SMD, −1.72; 95% CI, −2.81 to −0.63) and Yoga (SMD, −1.27; 95% CI, −1.38 to −1.16) reduced the fatigue severity significantly better than standard care, but there was no significant decrease for other exercise types. For cancer survivors with an age over 55 years, only Yoga showed statistically significant improvement in CRF (SMD, −1.27; 95% CI, −1.38 to −1.16). For patients with an age less than 55 years, both resistance (SMD, −1.75; 95% CI, −2.91 to −0.58) and Yoga (SMD, −1.66; 95% CI, −2.81 to −0.51) reduced the fatigue severity compared to standard care. Conclusion: Both resistance exercise and yoga showed significant benefits in alleviating CRF compared to standard care. Yoga was particularly effective for cancer survivors over 55 years of age, while resistance exercise and yoga were comparably effective for those under 55 years.