Cramp, F., & Byron-Daniel, J. (2012). Exercise for the management of cancer-related fatigue in adults. Cochrane Database of Systematic Reviews, 11, CD006145.

To evaluate the effect of exercise on cancer-related fatigue during and after cancer treatment. This was an update of a study from 2008. A secondary objective, subject to available data, was to explore the effect of exercise in different types of cancer populations.

Databases searched were the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 1, 2011), MEDLINE (1966 to March 2011), EMBASE (1980 to March 2011), CINAHL (1982 to March 2011), British Nursing Index (January 1984 to March 2011), AMED (1985 to March 2011), SIGLE (1980 to March 2011), and Dissertation Abstracts International (1861 to March 2011).  The authors also searched references of all articles; hand searched the following journals up to April 2011: Cancer, Journal of Clinical Oncology, Psycho-Oncology, Cancer Practice, Oncology Nursing Forum; and searched unpublished literature through searches of conference proceedings up to June 2011.

Appendix 1 details the keywords searched, including expanded neoplasms, leukemia, lymphoma radiation therapy, bone marrow transplantation, exercise, movement, and fatigue.

Studies were included in the review if 

• They evaluated and reported the effect of physical exercise on cancer-related fatigue
• They compared exercise with no exercise, a usual care group (i.e., no specific exercise program prescribed), or an alternative treatment or exercise regime for fatigue associated with cancer
• The intervention took place in any setting and was delivered to a group or individual participant
• Any type of physical exercise, including aerobic exercise, strength training, and flexibility exercises, was performed
• They investigated an exercise program accompanied by attempts to promote participant engagement.

Studies were excluded if they explored multidimensional programs in which the effects of exercise alone could not be determined and if a specific exercise program was not described and participants were only given advice or education about the potential benefits of exercise.

Fifty-eight new references plus 28 from the original review were retrieved.

Two independent reviewers reached 100% consensus; they assessed the methodological quality of the studies from the previous review.

• Fifty-six total studies were included in the final review (28 new plus 28 from the original review).
• The sample sizes ranged from 10 to 242 participants; the total number of participants was 4,068.
• Participants had various cancer diagnoses and various timing since diagnosis.
• The majority of participants had breast cancer.
• There was a mix of female and male patients; however, 29 of 56 studies included only females.
• Mean age ranged from 39 to 70 years (mostly in the 50s).

Patients were undergoing multiple phases of care.

Statistically significant improvements in fatigue were identified following an exercise program performed either during cancer therapy (standardized mean difference [SMD] = -0.23; 95% confidence interval [CI] [-0.23, -0.33]) or following cancer therapy (SMD = -0.44; 95% CI [-0.79, -0.09]). Statistically significant beneficial effects were identified specific to breast cancer (n = 672) and prostate cancer (n = 239) populations, but not for those with hematological malignancies (n = 114). Statistically beneficial effects were identified following aerobic training but not following resistance training or low-intensity mind-body interventions.

Sufficient evidence exists to support the recommendation of aerobic exercise during and after treatment for patients with breast or prostate cancer. Insufficient evidence exists to support the recommendation of hematological malignancies or other solid tumors. Exercise modalities other than aerobic exercise do not have sufficient evidence to support their recommendation.

Most studies

• Had small sample sizes
• Did not blind the intervention
• Provided little information about those who refused to participate
• Included self-reports
• Had exercise programs that did not reach the current recommended amounts for adults.

Aerobic exercise is recommended for appropriate patients during and after treatment for breast or prostate cancer. Consider recommending exercise for other solid tumors. Research is needed for various cancer types and stages, including palliative care and for types and duration of exercise.