Exercise and other non-pharmaceutical interventions for cancer-related fatigue in patients during or after cancer treatment: A systematic review incorporating an indirect-comparisons meta-analysis

Aim To assess the relative effects of different types of exercise and other non-pharmaceutical interventions on cancer-related fatigue (CRF) in patients during and after cancer treatment. Design Systematic review and indirect-comparisons meta-analysis. Data sources Articles were searched in PubMed, Cochrane CENTRAL and published meta-analyses. Eligibility criteria for selecting studies Randomised studies published up to January 2017 evaluating different types of exercise or other non-pharmaceutical interventions to reduce CRF in any cancer type during or after treatment. Study appraisal and synthesis Risk of bias assessment with PEDro criteria and random effects Bayesian network meta-analysis. Results We included 245 studies. Comparing the treatments with usual care during cancer treatment, relaxation exercise was the highest ranked intervention with a standardisedmean difference (SMD) of 0.77 (95% Credible Interval (CrI) 1.22 to 0.31), while massage (0.78; 1.55 to 0.01), cognitive-behavioural therapy combined with physical activity (combined CBT, 0.72; 1.34 to 0.09), combined aerobic and resistance training (0.67; 1.01 to 0.34), resistance training (0.53; 1.02 to 0.03), aerobic (0.53; 0.80 to 0.26) and yoga (0.51; 1.01 to 0.00) all had moderate-to-large SMDs. After cancer treatment, yoga showed the highest effect (0.68; 0.93 to 0.43). Combined aerobic and resistance training (0.50; 0.66 to 0.34), combined CBT (0.45; 0.70 to 0.21), Tai-Chi (0.45; 0.84 to 0.06), CBT (0.42; 0.58 to 0.25), resistance training (0.35; 0.62 to 0.08) and aerobic (0.33; 0.51 to 0.16) showed all small-to-moderate SMDs. Conclusions Patients can choose among different effective types of exercise and non-pharmaceutical interventions to reduce CRF.