Highlights
- •
During chemotherapy, aerobic and/or resistance exercise showed a positive trend compared with flexibility exercise showed a positive trend in reducing cancer-related fatigue.
- •
Aerobic and/or resistance exercise also showed favorable trends versus usual care alone when these exercise types are instituted during chemotherapy.
Abstract
Objective
To assess and compare the effectiveness of different exercise modalities in reducing cancer-related fatigue (CRF) in patients with cancer undergoing chemotherapy. Exercise intensities for selected exercise types were also compared.
Data Sources
We conducted a search in MEDLINE, Embase, CINAHL, Scopus, SPORTDiscus, and Web of Science from inception to October 15, 2021.
Study Selection
Randomized controlled trials concerning the effectiveness of exercise modalities on CRF in patients with cancer undergoing chemotherapy were included.
Data Extraction
Study characteristics were extracted using a structured protocol. Methodological quality was assessed employing the PEDro scale and risk of bias was assessed using the Revised Cochrane Risk of Bias Tool for Randomized Trials. The certainty of evidence was assessed based on Grading of Recommendations, Assessment, Development and Evaluation. The measure of effect used was the adjusted standardized mean difference (SMD) or Hedge's g, together with the corresponding 95% confidence intervals (CI).
Data Synthesis
Forty-seven studies were included. Data were pooled employing a random-effects model. There was a trend that adding low-intensity aerobic and resistance exercise (SMD=1.28, 95% CI -0.18; 2.75, P=.086), or moderate-intensity aerobic and resistance exercise (SMD=0.85; 95% CI -0.12; 1.82, P=.087), was more effective than adding flexibility training to usual care (UC). There was also a trend that UC alone was less effective than adding moderate-intensity aerobic and resistance exercise (SMD=-0.47, 95% CI -0.96, 0.02, P=.060) to UC.
Conclusions
The addition of low- to moderate-intensity aerobic and/or resistance exercise demonstrated a positive trend for improvement in CRF in patients with cancer undergoing chemotherapy, when compared with UC alone or UC with flexibility training.
List of abbreviations:
CI (confidence intervals), CRF (cancer-related fatigue), GRADE (Grading of Recommendations, Assessment, Development and Evaluation), HIIT (high-intensity interval training), κ (Kappa coefficient), MICT (moderate-intensity continuous training), RCT (randomized controlled trials), SMD (standardized mean difference), UC (usual care)Cancer-related fatigue (CRF) is a distressing, persistent, and subjective sense of physical, emotional, and/or cognitive tiredness or exhaustion related to cancer or cancer treatment.
1- Berger AM
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Cancer-related fatigue, version 2.2015.
In contrast to the fatigue experienced by healthy population, it is perceived as more severe, disproportionate to the effort and not fully relieved by rest. It is not proportional to recent activity and interferes with usual functionating.
1- Berger AM
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Cancer-related fatigue, version 2.2015.
Patients with cancer experience it as a persistent feeling of exhaustion.
2- Ahlberg K
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Assessment and management of cancer-related fatigue in adults.
CRF is often accompanied by pain, insomnia, or depression, among others.
3- Ruiz-Casado A
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Cancer-related fatigue in breast cancer survivors: a review.
Feeling fatigue is 1 of the major adverse effects reported by cancer patients undergoing chemotherapy treatment.
4- Schmidt ME
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Fatigue and quality of life in breast cancer survivors: temporal courses and long-term pattern.
Approximately 70% of colorectal cancer patients receiving adjuvant chemotherapy report CRF, compared with 31% of those not receiving chemotherapy. This difference persists even after the end of the treatment.
5- Vardy JL
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Fatigue in people with localized colorectal cancer who do and do not receive chemotherapy: a longitudinal prospective study.
,6- Bower JE
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Fatigue in long-term breast carcinoma survivors: a longitudinal investigation.
In breast, colorectal, prostate, or lung cancers, 45% of patients on active treatment and 29% of survivors report moderate to severe CRF.
7- Wang XS
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Prevalence and characteristics of moderate-to-severe fatigue: a multicenter study in cancer patients and survivors.
It exerts a major burden on their life at short and long term: impairing patients’ physical, psychosocial, and/or occupational functions, and limiting their ability to perform daily activities.
8- Curt GA
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,9- Muthanna FMS
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Impact of fatigue on quality of life among breast cancer patients receiving chemotherapy.
The presence of CRF is an indicator of mortality in these patients.
10- Adam S
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The association of cancer-related fatigue with all-cause mortality of colorectal and endometrial cancer survivors: results from the population-based PROFILES registry.
,11- Suzuki K
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Clinical significance of cancer-related fatigue in multiple myeloma patients.
In patients newly diagnosed with multiple myeloma, CRF predicted lower overall survival and progression free survival compared with those without CRF.
11- Suzuki K
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Clinical significance of cancer-related fatigue in multiple myeloma patients.
Patients have strong beliefs and apprehension about chemotherapy. Around 95% of patients scheduled to receive chemotherapy or radiotherapy expect to experience CRF during cancer treatment.
12- Hofman M
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Cancer patients’ expectations of experiencing treatment-related side effects: a University of Rochester Cancer Center–Community Clinical Oncology Program study of 938 patients from community practices.
They expect more severe side effects (eg, CRF, nausea, or hair loss) than those scheduled to receive radiotherapy.
12- Hofman M
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Cancer patients’ expectations of experiencing treatment-related side effects: a University of Rochester Cancer Center–Community Clinical Oncology Program study of 938 patients from community practices.
Despite being 1 of the most common concerns post-treatment, CRF is undertreated: only about ∼40% of these patients received care for CRF.
13- Beckjord EB
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Population-level trends in posttreatment cancer survivors’ concerns and associated receipt of care: results from the 2006 and 2010 LIVESTRONG surveys.
,14- Carelle N
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Changing patient perceptions of the side effects of cancer chemotherapy.
The American Society of Clinical Oncology's guideline recommends that health professionals assessing and treating patients with cancer implement exercise, psychological approaches, and pharmacologic interventions, to manage CRF.
15- Bower JE
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Screening, assessment, and management of fatigue in adult survivors of cancer: an American Society of Clinical oncology clinical practice guideline adaptation.
Regarding exercise, the American Society of Clinical Oncology recommends that patients maintain a moderate level of physical activity, including aerobic (eg, walking, cycling, or swimming) and strength exercises (eg, lifting weights).
15- Bower JE
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Screening, assessment, and management of fatigue in adult survivors of cancer: an American Society of Clinical oncology clinical practice guideline adaptation.
,16- Mustian KM
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Comparison of pharmaceutical, psychological, and exercise treatments for cancer-related fatigue: a meta-analysis.
Psychological interventions include cognitive behavioral or psychoeducational therapy.
15- Bower JE
- Bak K
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Screening, assessment, and management of fatigue in adult survivors of cancer: an American Society of Clinical oncology clinical practice guideline adaptation.
,16- Mustian KM
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- et al.
Comparison of pharmaceutical, psychological, and exercise treatments for cancer-related fatigue: a meta-analysis.
Pharmacological interventions include psychostimulants or other wakefulness agents (eg, paroxetine hydrochloride, modafinil, dexmethylphenidate, or methylprednisolone).
15- Bower JE
- Bak K
- Berger A
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Screening, assessment, and management of fatigue in adult survivors of cancer: an American Society of Clinical oncology clinical practice guideline adaptation.
,16- Mustian KM
- Alfano CM
- Heckler C
- et al.
Comparison of pharmaceutical, psychological, and exercise treatments for cancer-related fatigue: a meta-analysis.
All interventions have been shown to improve the CRF. Exercise modalities provide a slightly larger improvement, followed by psychological interventions and the combination of exercise and psychological interventions, with weighted effect sizes and 95% confidence intervals (CI) of 0.30 (0.25; 0.36), 0.27 (0.21; 0.33), and 0.26 (0.13; 0.38), respectively.
16- Mustian KM
- Alfano CM
- Heckler C
- et al.
Comparison of pharmaceutical, psychological, and exercise treatments for cancer-related fatigue: a meta-analysis.
Pharmacological treatment produced a more modest improvement of 0.09 (0.00; 0.19).
16- Mustian KM
- Alfano CM
- Heckler C
- et al.
Comparison of pharmaceutical, psychological, and exercise treatments for cancer-related fatigue: a meta-analysis.
However, there is no clear consensus on the concrete clinical implementation of these interventions. A poor level of physical activity contributes to the presence of severe CRF before treatment, but physical activity before and during treatment limits treatment-related fatigue and improves quality of life.
17- Goedendorp MM
- Gielissen MFM
- Verhagen CAH
- Peters MEJW
- Bleijenberg G.
Severe fatigue and related factors in cancer patients before the initiation of treatment.
,18- Manneville F
- Rotonda C
- Conroy T
- Bonnetain F
- Guillemin F
- Omorou AY.
The impact of physical activity on fatigue and quality of life during and after adjuvant treatment for breast cancer.
Despite the guidelines showing that exercise has good results on CRF during oncology treatment, we cannot give the patient a precise answer as to what type of exercise would be most beneficial to them alongside their chemotherapy. Therefore, the aim of this systematic review and network meta-analysis was to compare the effectiveness of different exercise modalities in reducing CRF in patients with cancer undergoing chemotherapy.
Methods
Protocol and registration
This systematic review and network meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews incorporating Network Meta-Analysis (PRISMA-NMA) extension statement.
19- Hutton B
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The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations.
The protocol of this study was registered in an international register prior to starting the review (PROSPERO, CRD42022292706).
Eligibility criteria
The selection criteria for the systematic review were based on methodological and clinical factors such as population, intervention, comparison, outcomes, and study design criteria.
20Popping the (PICO) question in research and evidence-based practice.
Population
Patients with cancer over 18 years of age and undergoing chemotherapy were included. Patients could have received or be scheduled to receive other treatments such as surgery, as long as they included chemotherapy. There was no restriction by sex, type and stage of cancer, or type of chemotherapy.
Intervention and comparison
All patients in the study received first-choice chemotherapy. The study had to include at least 1 arm that included exercise during chemotherapy treatment (eg, aerobic, resistance, or flexibility exercise). We included studies that implemented the exercise session before, during, or after the chemotherapy session, as well as between chemotherapy sessions.
Outcomes
Studies were included if they assessed CRF and presented data from baseline, post-intervention and/or short-, medium-, and/or long-term follow-up assessment. When CRF was assessed with more than 1 questionnaire, we selected the 1 presented as the primary outcome. Studies had to present the data derived from the analyses, represented numerically and/or graphically.
Study design
Randomized controlled trials (RCTs) (including pilot RCT) were included. There was no restriction based on date, publication status, or any specific language as recommended by international criteria.
21- Moher D
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- Jones A
- et al.
Does quality of reports of randomised trials affect estimates of intervention efficacy reported in meta-analyses?.
Search strategy
We searched for scientific articles in the MEDLINE (PubMed), Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, SPORTDiscus, and Web of Science databases from inception to October 15, 2021. Databases were reviewed prior to statistical analysis to identify additional articles published up to January 15, 2022. We manually checked the reference sections of included studies, checked studies included in reviews related to the topic and contacted authors for additional information where necessary. We also use the Connected papers website, which displays articles according to their similarity (based on co-citation and bibliographic linking).
The search was adapted and performed in Google Scholar. The search strategy is shown in Supplemental Appendix A.1. There were no specific publication date or language restrictions.
21- Moher D
- Pham B
- Jones A
- et al.
Does quality of reports of randomised trials affect estimates of intervention efficacy reported in meta-analyses?.
Selection criteria
The identified references were exported to the Rayyan QCRI software, used to remove duplicates, and perform the screening process in 2 phases.
23- Ouzzani M
- Hammady H
- Fedorowicz Z
- Elmagarmid A.
Rayyan—a web and mobile app for systematic reviews.
In the first phase, we assessed the relevance of the studies in relation to the study questions and objectives using information from the study title, abstract, and keywords. The full text was reviewed in the absence of consensus or sufficient information. In the second phase, we assessed the full text of each study for compliance with the inclusion criteria. The article selection process was conducted by 2 independent researchers (A.H.G. and C.V.R.) and differences were resolved by consensus moderated by a third researcher (F.C.M.).
24- Furlan AD
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- van Tulder M.
2009 updated method guidelines for systematic reviews in the Cochrane Back Review Group.
Data extraction and efficacy measures
Two independent researchers (A.H.G. and M.P.M.) extracted study characteristics and outcome data using a structured protocol that ensured that the most relevant information was obtained from each study.
25Higgins J, Thomas J, Chandler J, et al. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [M], 2008. Retrieved February 2022. Available at: https://training.cochrane.org/handbook. Accessed February 20, 2023.
Exercise modalities were categorized as aerobic exercise, resistance exercise, flexibility exercise (including stretching), high-intensity interval training (HIIT) or moderate-intensity continuous training (MICT), yoga, light martial arts (including qigong or taichi). In aerobic and resistance exercise, intensity was categorized as low, moderate, or high according to the reference values for percentage of heart rate reserve, maximum heart rate, or maximal oxygen consumption, indicated by the American College of Sports Medicine's Guidelines for Exercise Testing and Prescription (ie, moderate-intensity corresponded with 40%-59% of heart rate reserve or oxygen uptake reserve or 64%-76% of maximal heart rate or 46%-63% maximum oxygen consumption; high-intensity corresponded with 60%-89% of heart rate reserve or oxygen uptake reserve, or 77%-95% of maximal heart rate or 64%-90% maximum oxygen consumption).
26Riebe D, Ehrman J, Liguori G and Magal M. American College of Sports Medicine, ACSM’S guidelines for exercise testing and prescription, 10th ed., 2018, Wolters Kluwer (Phyla Pa 1976).
Statistical results related to the effect of exercise training on CRF were extracted from the post-intervention and/or follow-up assessment. All the numeric data were converted to mean and SD. If necessary, CI and SE were converted in SD using the formulas recommended by the Cochrane Handbook for Systematic Reviews of Interventions version 6.2
: SD=√(N
)*(upper limit – lower limit)/3.92 and
SD=√(N
)*SE, respectively.
27Higgins JP, Li T, Deeks JJ. 6.5.2.3 Obtaining standard deviations from standard errors, confidence intervals, t statistics and P values for differences in means. Cochrane Handbook for Systematic Reviews of Interventions version 6.2 (updated February 2021). Retrieved February 2022. Available at: www.training.cochrane.org/handbook. Accessed February 20, 2023.
The Plot Digitizer software was employed to estimate outcome results when only figures were available (
http://plotdigitizer.sourceforge.net). Studies that referred to the same sample of patients with cancer were considered only once, in order to reduce bias in the results.
Methodological quality and risk of bias assessment
We assessed methodological quality using the PEDro scale.
28The PEDro scale is a valid measure of the methodological quality of, clinical trials: a demographic study.
This scale evaluates the internal and external validity of a study through 11 criteria: (1) specified study eligibility criteria; (2) random allocation of subjects; (3) concealed allocation; (4) measure of similarity between groups at baseline; (5) subject blinding; (6) therapist blinding; (7) assessor blinding; (8) fewer than 15% dropouts; (9) intention-to-treat analysis; (10) between-group statistical comparisons; and (11) point measures and variability data. Each criteria were scored as yes (1 point) or no/unknown (0 points). The PEDro score provided an indicator of the methodological quality of each study (9-10=excellent; 6-8=good; 4-5=fair; 3-0=poor).
29Clinimetrics: Physiotherapy Evidence Database (PEDro) Scale.
We assessed the risk of bias in the selected studies using the Revised Cochrane Risk of Bias Tool for Randomized Trials which includes the following 5 domains: bias arising from the randomization process, bias due to deviations from intended interventions, bias due to missing outcome data, bias in the measurement of the outcome, and bias in the selection of the reported results.
30- Sterne JAC
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RoB 2: a revised tool for assessing risk of bias in randomised trials.
The domains include signaling questions that are answered with yes, probably yes, probably no, no, or no information within the domains. These questions lead to a final judgment within the domains as “low risk of bias”, “some concerns of risk of bias”, or “high risk of bias”, which in turn lead to an overall risk of bias for each trial.
Two independent reviewers (A.H.G. and M.P.M.) assessed methodological quality and risk of bias and disagreements was resolved through consensus by a third researcher (F.C.M.). We calculated the linear weighted Cohen's kappa coefficient (κ)
31A new procedure for assessing reliability of scoring EEG sleep recordings.
using
Jamovi software
32Jamovi [Computer Software]. Version 1.6. Sydney, Australia: The Jamovi Project; 2021.
to assess inter-rater reliability prior to any consensus, according to the following values: none: κ=0.00-0.20; minimal: κ=0.21-0.39; weak: κ=0.40-0.59; moderate: κ=0.60-0.79; strong: κ=0.80-0.89; and almost perfect: κ=0.90-1.00.
33Interrater reliability: the kappa statistic.
Overall strength of the evidence
We evaluated the certainty of evidence analysis based on classifying the results into levels of evidence according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework. GRADE was assessed by 2 researchers (A.H.G. and C.V.R.) based on 5 domains according to the adaptation for network meta-analyses from Salanti et al: study design, imprecision, indirectness, inconsistency, and publication bias.
34- Salanti G
- Giovane C Del
- Chaimani A
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Evaluating the quality of evidence from a network meta-analysis.
,35- Guyatt GH
- Oxman AD
- Vist GE
GRADE Working Group
GRADE: an emerging consensus on rating quality of evidence and strength of recommendations.
The evidence was categorized as high, moderate, low, or very low quality of evidence. Supplemental Appendix A.2 specifies the criteria used for each domain.
Data synthesis and statistical analysis
The short-term effect of different exercise modalities on CRF was analyzed with a frequentist network meta-analysis (CVR) using
RStudio software version 1.4.1717, which is based on the
R software version 4.1.1
36RStudio: Integrated Development Environment for R [Computer Software]. Version. 1.4.171. Boston, MA: RStudio Team; 2020.
, 37R. A language and environment for statistical computing [Computer Software]. Version 4.1.1. Vienna, Austria: R Core Team; 2021.
, and different packages.
, 39Harrer M, Cuijpers P, Furukawa T, Daniel D and Ebert DD. dmetar: Companion R Package For The Guide ’Doing Meta-Analysis in R, 2019. Retrieved February 2022. Available at: http://dmetar.protectlab.org/. Accessed February 20, 2023.
, , 41Rücker G, Krahn U, König J, Efthimiou O, Papakonstantinou T, Schwarzer G. Netmeta: Network meta-analysis using frequentist methods. Retrieved February 2022. Available at: https://cran.r-project.org/package=netmeta. Accessed February 20, 2023.
, 42- Wickham H
- Averick M
- Bryan J
- et al.
Welcome to the Tidyverse.
, , , R scripts and raw data used for the analysis are available in the Open Science Framework repository (
https://osf.io/eyfnq/?view_only=7ca5eb0a4f9c4a40888cbe084f8fd2a0). The follow-up results were analyzed and synthesized qualitatively. Network meta-analysis allows to infer an estimation of a comparison's effect size based on direct evidence from observed comparisons in the different primary studies and indirect evidence from the inference of comparisons that have not been actually studied (The unfamiliar reader should consult Harrer et al's guide
to understand our analyses). A network graph was displayed to visualize direct comparisons between exercise modalities.
We used the adjusted standardized mean difference (SMD), or Hedge's g, over time as effect size measure, along with the corresponding 95% CI.
46Estimation of effect size from a series of independent experiments.
SMD were interpreted as described by Hopkins et al: >4.0 represented an extremely large clinical effect, 2.0-4.0 a very large effect, 1.2-2.0 a large effect, 0.6-1.2 a moderate effect, 0.2-0.6 a small effect, and 0.0-0.2 a trivial effect.
47- Hopkins WG
- Marshall SW
- Batterham AM
- Hanin J.
Progressive statistics for studies in sports medicine and exercise science.
We estimated the degree of heterogeneity and inconsistency among the studies using Cochran's Q statistic test (a
P value <0.05 was considered significant) and the inconsistency index. The Cochran's Q test allows us to assess the presence of between-study heterogeneity and between-design consistency.
48Misunderstandings about Q and “Cochran's Q test” in meta-analysis.
Despite its common use to assess heterogeneity, the inconsistency index represents the percentage of variability in the estimate caused by between-study heterogeneity.
49- Borenstein M
- Higgins JPT
- Hedges LV
- Rothstein HR.
Basics of meta-analysis: I(2) is not an absolute measure of heterogeneity.
Since we pooled different treatments, we could not assume that there was a unique true effect. So, we anticipated between-study heterogeneity and the necessity of a random-effects model to pool effect sizes. To justify the use a random-effects model, we calculated the difference in total inconsistency of the results between a fixed-effects model and a random-effects model using a full design-by-treatment interaction random-effects model.
50- Higgins JPT
- Jackson D
- Barrett JK
- Lu G
- Ades AE
- White IR.
Consistency and inconsistency in network meta-analysis: concepts and models for multi-arm studies.
To hold the assumption of transitivity, studies have to differ only by the treatment applied.
51- Cipriani A
- Higgins JPT
- Geddes JR
- Salanti G.
Conceptual and technical challenges in network meta-analysis.
If it is not, indirect evidence is influenced not only by the treatment but also confounders.
34- Salanti G
- Giovane C Del
- Chaimani A
- Caldwell DM
- Higgins JPT
Evaluating the quality of evidence from a network meta-analysis.
The statistical manifestation of transitivity is the consistency between comparisons.
51- Cipriani A
- Higgins JPT
- Geddes JR
- Salanti G.
Conceptual and technical challenges in network meta-analysis.
We performed a net heat plot using a fixed-effects model and a random-effects model to evaluate visually if inconsistency is improved with a random-effects model. Inconsistency was also evaluated with net splitting where network estimates are split into direct and indirect evidence in a forest plot.
The proportion of direct and indirect evidence was printed in an evidence plot. The evidence plot also provides measure of direct evidence proportion, the minimal parallelism, and mean path length of each estimated comparison.
52- König J
- Krahn U
- Binder H.
Visualizing the flow of evidence in network meta-analysis and characterizing mixed treatment comparisons.
A comparison with a mean path length>2 indicates indirectness and should be interpreted cautiously.
52- König J
- Krahn U
- Binder H.
Visualizing the flow of evidence in network meta-analysis and characterizing mixed treatment comparisons.
We visually represented the network estimation for each comparison based on direct and indirect evidence in a colored matrix.
Exercise modalities were ranked according to the extent of certainty that 1 technique provide higher improvement than another using
P-scores (0-1 score).
53Ranking treatments in frequentist network meta-analysis works without resampling methods.
A highest
P-score is indicative of superiority on the other techniques compared. As recommended, we realized a pairwise forest plot in which the “only usual care (UC) modality” was used as reference group.
54- Mbuagbaw L
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- Jaeschke R
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Approaches to interpreting and choosing the best treatments in network meta-analyses.
Risk of publication bias was assessed with a comparison-adjusted funnel plot.
34- Salanti G
- Giovane C Del
- Chaimani A
- Caldwell DM
- Higgins JPT
Evaluating the quality of evidence from a network meta-analysis.
Y-axis represents the inverted SE of the estimated effect size and the horizontal axis represents an adjusted effect size (difference between the observed effect size and the mean effect size for the specific comparison).
34- Salanti G
- Giovane C Del
- Chaimani A
- Caldwell DM
- Higgins JPT
Evaluating the quality of evidence from a network meta-analysis.
An asymmetrical distribution in the funnel plot might be indicative of the presence of publication bias. We also performed an Egger's test for funnel plot asymmetry, where a
P<.05 represent the presence of risk of publication bias.
Results
The study screening strategy is shown in Supplemental Fig A.3. Forty-seven studies were included in this systematic review and network meta-analysis.
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, 59- Bolam KA
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, 61- Carayol M
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, 62- Chang PH
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, 67- Courneya KS
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Six-month follow-up of patient-rated outcomes in a randomized controlled trial of exercise training during breast cancer chemotherapy.
, 68- Courneya KS
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, 69- Courneya KS
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Effects of exercise dose and type during breast cancer chemotherapy: multicenter randomized trial.
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, 71- Dhruva A
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, 72- Gokal K
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, 73- Hacker ED
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Strength training following hematopoietic stem cell transplantation.
, 74- Hammer MJ
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Prescribed walking for glycemic control and symptom management in patients without diabetes undergoing chemotherapy.
, 75- Hiensch AE
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Inflammation mediates exercise effects on fatigue in patients with breast cancer.
, 76- Hornsby WE
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, 77- Husebø AML
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, 78- Jarden M
- Møller T
- Christensen KB
- Kjeldsen L
- Birgens HS
- Adamsen L.
Multimodal intervention integrated into the clinical management of acute leukemia improves physical function and quality of life during consolidation chemotherapy: a randomized trial ‘PACE-AL.
, 79- Jensen W
- Baumann FT
- Stein A
- et al.
Exercise training in patients with advanced gastrointestinal cancer undergoing palliative chemotherapy: a pilot study.
, 80- Kirkham AA
- Bland KA
- Zucker DS
- et al.
Chemotherapy-periodized” exercise to accommodate for cyclical variation in fatigue.
, 81- Lee K
- Norris MK
- Wang E
- Dieli-Conwright CM.
Effect of high-intensity interval training on patient-reported outcomes and physical function in women with breast cancer receiving anthracycline-based chemotherapy.
, 82- Lin KY
- Cheng HC
- Yen CJ
- et al.
Effects of exercise in patients undergoing chemotherapy for head and neck cancer: a pilot randomized controlled trial.
, 83- Lu Y
- Qu HQ
- Chen FY
- et al.
Effect of Baduanjin Qigong exercise on cancer-related fatigue in patients with colorectal cancer undergoing chemotherapy: a randomized controlled trial.
, 84- Mijwel S
- Backman M
- Bolam KA
- et al.
Adding high-intensity interval training to conventional training modalities: optimizing health-related outcomes during chemotherapy for breast cancer: the OptiTrain randomized controlled trial.
, 85- Mijwel S
- Jervaeus A
- Bolam KA
- et al.
High-intensity exercise during chemotherapy induces beneficial effects 12 months into breast cancer survivorship.
, 86- Møller T
- Andersen C
- Lillelund C
- et al.
Physical deterioration and adaptive recovery in physically inactive breast cancer patients during adjuvant chemotherapy: a randomised controlled trial.
, 87- Møller T
- Lillelund C
- Andersen C
- et al.
The challenge of preserving cardiorespiratory fitness in physically inactive patients with colon or breast cancer during adjuvant chemotherapy: a randomised feasibility study.
, 88- Mostafaei F
- Azizi M
- Jalali A
- Salari N
- Abbasi P.
Effect of exercise on depression and fatigue in breast cancer women undergoing chemotherapy: a randomized controlled trial.
, 89- Naraphong W
- Lane A
- Schafer J
- Whitmer K
- Wilson BRA.
Exercise intervention for fatigue-related symptoms in Thai women with breast cancer: a pilot study.
, 90- Samuel SR
- Maiya AG
- Fernandes DJ
- et al.
Effectiveness of exercise-based rehabilitation on functional capacity and quality of life in head and neck cancer patients receiving chemo-radiotherapy.
, 91- Travier N
- Velthuis MJ
- Steins Bisschop CN
- et al.
Effects of an 18-week exercise programme started early during breast cancer treatment: a randomised controlled trial.
, 92- Van Vulpen JK
- Velthuis MJ
- Bisschop CNS
- et al.
Effects of an exercise program in colon cancer patients undergoing chemotherapy.
, 93- van Waart H
- Stuiver MM
- van Harten WH
- et al.
Recruitment to and pilot results of the PACES randomized trial of physical exercise during adjuvant chemotherapy for colon cancer.
, 94- Van Waart H
- Stuiver MM
- Van Harten WH
- et al.
Effect of low-intensity physical activity and moderate- to high-intensity physical exercise during adjuvant chemotherapy on physical fitness, fatigue, and chemotherapy completion rates: results of the PACES randomized clinical trial.
, 95- Vincent F
- Deluche E
- Bonis J
- et al.
Home-based physical activity in patients with breast cancer: during and/or after chemotherapy? Impact on cardiorespiratory fitness. A 3-arm randomized controlled trial (APAC).
, 96- Witlox L
- Hiensch AE
- Velthuis MJ
- et al.
Four-year effects of exercise on fatigue and physical activity in patients with cancer.
, 97A randomized controlled trial of qigong on fatigue and sleep quality for non-Hodgkin's lymphoma patients undergoing chemotherapy.
, 98- Zhang LL
- Wang SZ
- Chen HL
- Yuan AZ.
Tai Chi exercise for cancer-related fatigue in patients with lung cancer undergoing chemotherapy: a randomized controlled trial.
, 99- Zhang Q
- Li F
- Zhang H
- Yu X
- Cong Y.
Effects of nurse-led home-based exercise & cognitive behavioral therapy on reducing cancer-related fatigue in patients with ovarian cancer during and after chemotherapy: a randomized controlled trial.
, 100- Zhou W
- Wan YH
- Chen Q
- Qiu YR
- Luo XM.
Effects of Tai Chi exercise on cancer-related fatigue in patients with nasopharyngeal carcinoma undergoing chemoradiotherapy: a randomized controlled trial.
, 101- Schmidt T
- Weisser B
- Dürkop J
- et al.
Comparing endurance and resistance training with standard care during chemotherapy for patients with primary breast cancer.
Supplemental Table B.1 shows the characteristics of the included RCTs (demographic characteristics, interventions, outcomes, and study design).
Study characteristics
A total of 4056 participants were included in 47 studies. Some studies referred to the same population, assessed at different time points,
59- Bolam KA
- Mijwel S
- Rundqvist H
- Wengström Y.
Two-year follow-up of the OptiTrain randomised controlled exercise trial.
,67- Courneya KS
- Segal RJ
- Gelmon K
- et al.
Six-month follow-up of patient-rated outcomes in a randomized controlled trial of exercise training during breast cancer chemotherapy.
,75- Hiensch AE
- Mijwel S
- Bargiela D
- Wengström Y
- May AM
- Rundqvist H.
Inflammation mediates exercise effects on fatigue in patients with breast cancer.
,85- Mijwel S
- Jervaeus A
- Bolam KA
- et al.
High-intensity exercise during chemotherapy induces beneficial effects 12 months into breast cancer survivorship.
this was taken in account when calculating the total sample. The mean age of the included population was 52.6±11.3 and 82.1% of the sample were women.
Regarding the type of cancer, 23 studies included participants with breast cancer,
57- Al-Majid S
- Wilson LD
- Rakovski C
- Coburn JW.
Effects of exercise on biobehavioral outcomes of fatigue during cancer treatment: results of a feasibility study.
,59- Bolam KA
- Mijwel S
- Rundqvist H
- Wengström Y.
Two-year follow-up of the OptiTrain randomised controlled exercise trial.
,61- Carayol M
- Ninot G
- Senesse P
- et al.
Short- and long-term impact of adapted physical activity and diet counseling during adjuvant breast cancer therapy: the “APAD1” randomized controlled trial.
,63- Chaoul A
- Milbury K
- Spelman A
- et al.
Randomized trial of Tibetan yoga in patients with breast cancer undergoing chemotherapy.
,66- Cornette T
- Vincent F
- Mandigout S
- et al.
Effects of home-based exercise training on VO2 in breast cancer patients under adjuvant or neoadjuvant chemotherapy (SAPA): a randomized controlled trial.
, 67- Courneya KS
- Segal RJ
- Gelmon K
- et al.
Six-month follow-up of patient-rated outcomes in a randomized controlled trial of exercise training during breast cancer chemotherapy.
, 68- Courneya KS
- Segal RJ
- Mackey JR
- et al.
Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomized controlled trial.
, 69- Courneya KS
- McKenzie DC
- Mackey JR
- et al.
Effects of exercise dose and type during breast cancer chemotherapy: multicenter randomized trial.
,72- Gokal K
- Wallis D
- Ahmed S
- Boiangiu I
- Kancherla K
- Munir F.
Effects of a self-managed home-based walking intervention on psychosocial health outcomes for breast cancer patients receiving chemotherapy: a randomised controlled trial.
,75- Hiensch AE
- Mijwel S
- Bargiela D
- Wengström Y
- May AM
- Rundqvist H.
Inflammation mediates exercise effects on fatigue in patients with breast cancer.
,76- Hornsby WE
- Douglas PS
- West MJ
- et al.
Safety and efficacy of aerobic training in operable breast cancer patients receiving neoadjuvant chemotherapy: a phase II randomized trial.
,77- Husebø AML
- Dyrstad SM
- Mjaaland I
- Søreide JA
- Bru E.
Effects of scheduled exercise on cancer-related fatigue in women with early breast cancer.
,80- Kirkham AA
- Bland KA
- Zucker DS
- et al.
Chemotherapy-periodized” exercise to accommodate for cyclical variation in fatigue.
,81- Lee K
- Norris MK
- Wang E
- Dieli-Conwright CM.
Effect of high-intensity interval training on patient-reported outcomes and physical function in women with breast cancer receiving anthracycline-based chemotherapy.
,84- Mijwel S
- Backman M
- Bolam KA
- et al.
Adding high-intensity interval training to conventional training modalities: optimizing health-related outcomes during chemotherapy for breast cancer: the OptiTrain randomized controlled trial.
, 85- Mijwel S
- Jervaeus A
- Bolam KA
- et al.
High-intensity exercise during chemotherapy induces beneficial effects 12 months into breast cancer survivorship.
, 86- Møller T
- Andersen C
- Lillelund C
- et al.
Physical deterioration and adaptive recovery in physically inactive breast cancer patients during adjuvant chemotherapy: a randomised controlled trial.
,88- Mostafaei F
- Azizi M
- Jalali A
- Salari N
- Abbasi P.
Effect of exercise on depression and fatigue in breast cancer women undergoing chemotherapy: a randomized controlled trial.
,89- Naraphong W
- Lane A
- Schafer J
- Whitmer K
- Wilson BRA.
Exercise intervention for fatigue-related symptoms in Thai women with breast cancer: a pilot study.
,91- Travier N
- Velthuis MJ
- Steins Bisschop CN
- et al.
Effects of an 18-week exercise programme started early during breast cancer treatment: a randomised controlled trial.
,94- Van Waart H
- Stuiver MM
- Van Harten WH
- et al.
Effect of low-intensity physical activity and moderate- to high-intensity physical exercise during adjuvant chemotherapy on physical fitness, fatigue, and chemotherapy completion rates: results of the PACES randomized clinical trial.
,95- Vincent F
- Deluche E
- Bonis J
- et al.
Home-based physical activity in patients with breast cancer: during and/or after chemotherapy? Impact on cardiorespiratory fitness. A 3-arm randomized controlled trial (APAC).
,101- Schmidt T
- Weisser B
- Dürkop J
- et al.
Comparing endurance and resistance training with standard care during chemotherapy for patients with primary breast cancer.
4 with leukemia,
56- Alibhai SMH
- Durbano S
- Breunis H
- et al.
A phase II exercise randomized controlled trial for patients with acute myeloid leukemia undergoing induction chemotherapy.
,60- Bryant AL
- Deal AM
- Battaglini CL
- et al.
The effects of exercise on patient-reported outcomes and performance-based physical function in adults with acute leukemia undergoing induction therapy: exercise and quality of life in acute leukemia (EQUAL).
,62- Chang PH
- Lai YH
- Shun SC
- et al.
Effects of a walking intervention on fatigue-related experiences of hospitalized acute myelogenous leukemia patients undergoing chemotherapy: a randomized controlled trial.
,78- Jarden M
- Møller T
- Christensen KB
- Kjeldsen L
- Birgens HS
- Adamsen L.
Multimodal intervention integrated into the clinical management of acute leukemia improves physical function and quality of life during consolidation chemotherapy: a randomized trial ‘PACE-AL.
3 with colon cancer,
83- Lu Y
- Qu HQ
- Chen FY
- et al.
Effect of Baduanjin Qigong exercise on cancer-related fatigue in patients with colorectal cancer undergoing chemotherapy: a randomized controlled trial.
,92- Van Vulpen JK
- Velthuis MJ
- Bisschop CNS
- et al.
Effects of an exercise program in colon cancer patients undergoing chemotherapy.
,93- van Waart H
- Stuiver MM
- van Harten WH
- et al.
Recruitment to and pilot results of the PACES randomized trial of physical exercise during adjuvant chemotherapy for colon cancer.
1 with nasopharyngeal cancer,
100- Zhou W
- Wan YH
- Chen Q
- Qiu YR
- Luo XM.
Effects of Tai Chi exercise on cancer-related fatigue in patients with nasopharyngeal carcinoma undergoing chemoradiotherapy: a randomized controlled trial.
2 with Non-Hodgkin´s lymphoma,
64- Chuang TY
- Yeh ML
- Chung YC.
A nurse facilitated mind-body interactive exercise (Chan-Chuang qigong) improves the health status of non-Hodgkin lymphoma patients receiving chemotherapy: randomised controlled trial.
,97A randomized controlled trial of qigong on fatigue and sleep quality for non-Hodgkin's lymphoma patients undergoing chemotherapy.
1 with lung cancer,
98- Zhang LL
- Wang SZ
- Chen HL
- Yuan AZ.
Tai Chi exercise for cancer-related fatigue in patients with lung cancer undergoing chemotherapy: a randomized controlled trial.
1 with ovary cancer,
99- Zhang Q
- Li F
- Zhang H
- Yu X
- Cong Y.
Effects of nurse-led home-based exercise & cognitive behavioral therapy on reducing cancer-related fatigue in patients with ovarian cancer during and after chemotherapy: a randomized controlled trial.
and 1 with multiple myeloma.
65- Coleman EA
- Goodwin JA
- Kennedy R
- et al.
Effects of exercise on fatigue, sleep, and performance: a randomized trial.
The remaining 11 studies included population with different types of cancer.
55- Adamsen L
- Quist M
- Andersen C
- et al.
Effect of a multimodal high intensity exercise intervention in cancer patients undergoing chemotherapy: randomised controlled trial.
,58- Andersen C
- Rørth M
- Ejlertsen B
- et al.
The effects of a six-week supervised multimodal exercise intervention during chemotherapy on cancer-related fatigue.
,70- Demmelmaier I
- Brooke HHL
- Henriksson A
- et al.
Does exercise intensity matter for fatigue during (neo-)adjuvant cancer treatment? The Phys-Can randomized clinical trial.
,71- Dhruva A
- Miaskowski C
- Abrams D
- et al.
Yoga breathing for cancer chemotherapy-associated symptoms and quality of life: results of a pilot randomized controlled trial.
,73- Hacker ED
- Larson J
- Kujath A
- Peace D
- Rondelli D
- Gaston L.
Strength training following hematopoietic stem cell transplantation.
,74- Hammer MJ
- Eckardt P
- Cartwright F
- Miaskowski C.
Prescribed walking for glycemic control and symptom management in patients without diabetes undergoing chemotherapy.
,79- Jensen W
- Baumann FT
- Stein A
- et al.
Exercise training in patients with advanced gastrointestinal cancer undergoing palliative chemotherapy: a pilot study.
,82- Lin KY
- Cheng HC
- Yen CJ
- et al.
Effects of exercise in patients undergoing chemotherapy for head and neck cancer: a pilot randomized controlled trial.
,87- Møller T
- Lillelund C
- Andersen C
- et al.
The challenge of preserving cardiorespiratory fitness in physically inactive patients with colon or breast cancer during adjuvant chemotherapy: a randomised feasibility study.
,90- Samuel SR
- Maiya AG
- Fernandes DJ
- et al.
Effectiveness of exercise-based rehabilitation on functional capacity and quality of life in head and neck cancer patients receiving chemo-radiotherapy.
,96- Witlox L
- Hiensch AE
- Velthuis MJ
- et al.
Four-year effects of exercise on fatigue and physical activity in patients with cancer.
Studies most commonly enrolled individuals with a range of cancer stages: specifically, stages I–III were included in 48.9% of the studies. In 21 studies, patients received adjuvant chemotherapy (eg, taxane or anthracycline-based therapy),
55- Adamsen L
- Quist M
- Andersen C
- et al.
Effect of a multimodal high intensity exercise intervention in cancer patients undergoing chemotherapy: randomised controlled trial.
,58- Andersen C
- Rørth M
- Ejlertsen B
- et al.
The effects of a six-week supervised multimodal exercise intervention during chemotherapy on cancer-related fatigue.
,59- Bolam KA
- Mijwel S
- Rundqvist H
- Wengström Y.
Two-year follow-up of the OptiTrain randomised controlled exercise trial.
,61- Carayol M
- Ninot G
- Senesse P
- et al.
Short- and long-term impact of adapted physical activity and diet counseling during adjuvant breast cancer therapy: the “APAD1” randomized controlled trial.
,67- Courneya KS
- Segal RJ
- Gelmon K
- et al.
Six-month follow-up of patient-rated outcomes in a randomized controlled trial of exercise training during breast cancer chemotherapy.
, 68- Courneya KS
- Segal RJ
- Mackey JR
- et al.
Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomized controlled trial.
, 69- Courneya KS
- McKenzie DC
- Mackey JR
- et al.
Effects of exercise dose and type during breast cancer chemotherapy: multicenter randomized trial.
,75- Hiensch AE
- Mijwel S
- Bargiela D
- Wengström Y
- May AM
- Rundqvist H.
Inflammation mediates exercise effects on fatigue in patients with breast cancer.
,77- Husebø AML
- Dyrstad SM
- Mjaaland I
- Søreide JA
- Bru E.
Effects of scheduled exercise on cancer-related fatigue in women with early breast cancer.
,84- Mijwel S
- Backman M
- Bolam KA
- et al.
Adding high-intensity interval training to conventional training modalities: optimizing health-related outcomes during chemotherapy for breast cancer: the OptiTrain randomized controlled trial.
, 85- Mijwel S
- Jervaeus A
- Bolam KA
- et al.
High-intensity exercise during chemotherapy induces beneficial effects 12 months into breast cancer survivorship.
, 86- Møller T
- Andersen C
- Lillelund C
- et al.
Physical deterioration and adaptive recovery in physically inactive breast cancer patients during adjuvant chemotherapy: a randomised controlled trial.
, 87- Møller T
- Lillelund C
- Andersen C
- et al.
The challenge of preserving cardiorespiratory fitness in physically inactive patients with colon or breast cancer during adjuvant chemotherapy: a randomised feasibility study.
,89- Naraphong W
- Lane A
- Schafer J
- Whitmer K
- Wilson BRA.
Exercise intervention for fatigue-related symptoms in Thai women with breast cancer: a pilot study.
,91- Travier N
- Velthuis MJ
- Steins Bisschop CN
- et al.
Effects of an 18-week exercise programme started early during breast cancer treatment: a randomised controlled trial.
, 92- Van Vulpen JK
- Velthuis MJ
- Bisschop CNS
- et al.
Effects of an exercise program in colon cancer patients undergoing chemotherapy.
, 93- van Waart H
- Stuiver MM
- van Harten WH
- et al.
Recruitment to and pilot results of the PACES randomized trial of physical exercise during adjuvant chemotherapy for colon cancer.
, 94- Van Waart H
- Stuiver MM
- Van Harten WH
- et al.
Effect of low-intensity physical activity and moderate- to high-intensity physical exercise during adjuvant chemotherapy on physical fitness, fatigue, and chemotherapy completion rates: results of the PACES randomized clinical trial.
,96- Witlox L
- Hiensch AE
- Velthuis MJ
- et al.
Four-year effects of exercise on fatigue and physical activity in patients with cancer.
,99- Zhang Q
- Li F
- Zhang H
- Yu X
- Cong Y.
Effects of nurse-led home-based exercise & cognitive behavioral therapy on reducing cancer-related fatigue in patients with ovarian cancer during and after chemotherapy: a randomized controlled trial.
,101- Schmidt T
- Weisser B
- Dürkop J
- et al.
Comparing endurance and resistance training with standard care during chemotherapy for patients with primary breast cancer.
in 1 neo-adjuvant,
76- Hornsby WE
- Douglas PS
- West MJ
- et al.
Safety and efficacy of aerobic training in operable breast cancer patients receiving neoadjuvant chemotherapy: a phase II randomized trial.
in 7 neo-and/or adjuvant,
63- Chaoul A
- Milbury K
- Spelman A
- et al.
Randomized trial of Tibetan yoga in patients with breast cancer undergoing chemotherapy.
,66- Cornette T
- Vincent F
- Mandigout S
- et al.
Effects of home-based exercise training on VO2 in breast cancer patients under adjuvant or neoadjuvant chemotherapy (SAPA): a randomized controlled trial.
,70- Demmelmaier I
- Brooke HHL
- Henriksson A
- et al.
Does exercise intensity matter for fatigue during (neo-)adjuvant cancer treatment? The Phys-Can randomized clinical trial.
,72- Gokal K
- Wallis D
- Ahmed S
- Boiangiu I
- Kancherla K
- Munir F.
Effects of a self-managed home-based walking intervention on psychosocial health outcomes for breast cancer patients receiving chemotherapy: a randomised controlled trial.
,80- Kirkham AA
- Bland KA
- Zucker DS
- et al.
Chemotherapy-periodized” exercise to accommodate for cyclical variation in fatigue.
,81- Lee K
- Norris MK
- Wang E
- Dieli-Conwright CM.
Effect of high-intensity interval training on patient-reported outcomes and physical function in women with breast cancer receiving anthracycline-based chemotherapy.
,95- Vincent F
- Deluche E
- Bonis J
- et al.
Home-based physical activity in patients with breast cancer: during and/or after chemotherapy? Impact on cardiorespiratory fitness. A 3-arm randomized controlled trial (APAC).
in 5 inductive,
56- Alibhai SMH
- Durbano S
- Breunis H
- et al.
A phase II exercise randomized controlled trial for patients with acute myeloid leukemia undergoing induction chemotherapy.
,60- Bryant AL
- Deal AM
- Battaglini CL
- et al.
The effects of exercise on patient-reported outcomes and performance-based physical function in adults with acute leukemia undergoing induction therapy: exercise and quality of life in acute leukemia (EQUAL).
,62- Chang PH
- Lai YH
- Shun SC
- et al.
Effects of a walking intervention on fatigue-related experiences of hospitalized acute myelogenous leukemia patients undergoing chemotherapy: a randomized controlled trial.
,65- Coleman EA
- Goodwin JA
- Kennedy R
- et al.
Effects of exercise on fatigue, sleep, and performance: a randomized trial.
,100- Zhou W
- Wan YH
- Chen Q
- Qiu YR
- Luo XM.
Effects of Tai Chi exercise on cancer-related fatigue in patients with nasopharyngeal carcinoma undergoing chemoradiotherapy: a randomized controlled trial.
in 1 palliative,
79- Jensen W
- Baumann FT
- Stein A
- et al.
Exercise training in patients with advanced gastrointestinal cancer undergoing palliative chemotherapy: a pilot study.
in 1 consolidation,
78- Jarden M
- Møller T
- Christensen KB
- Kjeldsen L
- Birgens HS
- Adamsen L.
Multimodal intervention integrated into the clinical management of acute leukemia improves physical function and quality of life during consolidation chemotherapy: a randomized trial ‘PACE-AL.
and 11 studies did not report the type of chemotherapy.
57- Al-Majid S
- Wilson LD
- Rakovski C
- Coburn JW.
Effects of exercise on biobehavioral outcomes of fatigue during cancer treatment: results of a feasibility study.
,64- Chuang TY
- Yeh ML
- Chung YC.
A nurse facilitated mind-body interactive exercise (Chan-Chuang qigong) improves the health status of non-Hodgkin lymphoma patients receiving chemotherapy: randomised controlled trial.
,71- Dhruva A
- Miaskowski C
- Abrams D
- et al.
Yoga breathing for cancer chemotherapy-associated symptoms and quality of life: results of a pilot randomized controlled trial.
,73- Hacker ED
- Larson J
- Kujath A
- Peace D
- Rondelli D
- Gaston L.
Strength training following hematopoietic stem cell transplantation.
,74- Hammer MJ
- Eckardt P
- Cartwright F
- Miaskowski C.
Prescribed walking for glycemic control and symptom management in patients without diabetes undergoing chemotherapy.
,82- Lin KY
- Cheng HC
- Yen CJ
- et al.
Effects of exercise in patients undergoing chemotherapy for head and neck cancer: a pilot randomized controlled trial.
,83- Lu Y
- Qu HQ
- Chen FY
- et al.
Effect of Baduanjin Qigong exercise on cancer-related fatigue in patients with colorectal cancer undergoing chemotherapy: a randomized controlled trial.
,88- Mostafaei F
- Azizi M
- Jalali A
- Salari N
- Abbasi P.
Effect of exercise on depression and fatigue in breast cancer women undergoing chemotherapy: a randomized controlled trial.
,90- Samuel SR
- Maiya AG
- Fernandes DJ
- et al.
Effectiveness of exercise-based rehabilitation on functional capacity and quality of life in head and neck cancer patients receiving chemo-radiotherapy.
,97A randomized controlled trial of qigong on fatigue and sleep quality for non-Hodgkin's lymphoma patients undergoing chemotherapy.
,98- Zhang LL
- Wang SZ
- Chen HL
- Yuan AZ.
Tai Chi exercise for cancer-related fatigue in patients with lung cancer undergoing chemotherapy: a randomized controlled trial.
Twenty-two reported a percentage of patients with previous surgery (9.3%-100%),
55- Adamsen L
- Quist M
- Andersen C
- et al.
Effect of a multimodal high intensity exercise intervention in cancer patients undergoing chemotherapy: randomised controlled trial.
,61- Carayol M
- Ninot G
- Senesse P
- et al.
Short- and long-term impact of adapted physical activity and diet counseling during adjuvant breast cancer therapy: the “APAD1” randomized controlled trial.
,63- Chaoul A
- Milbury K
- Spelman A
- et al.
Randomized trial of Tibetan yoga in patients with breast cancer undergoing chemotherapy.
,67- Courneya KS
- Segal RJ
- Gelmon K
- et al.
Six-month follow-up of patient-rated outcomes in a randomized controlled trial of exercise training during breast cancer chemotherapy.
, 68- Courneya KS
- Segal RJ
- Mackey JR
- et al.
Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomized controlled trial.
, 69- Courneya KS
- McKenzie DC
- Mackey JR
- et al.
Effects of exercise dose and type during breast cancer chemotherapy: multicenter randomized trial.
,71- Dhruva A
- Miaskowski C
- Abrams D
- et al.
Yoga breathing for cancer chemotherapy-associated symptoms and quality of life: results of a pilot randomized controlled trial.
, 72- Gokal K
- Wallis D
- Ahmed S
- Boiangiu I
- Kancherla K
- Munir F.
Effects of a self-managed home-based walking intervention on psychosocial health outcomes for breast cancer patients receiving chemotherapy: a randomised controlled trial.
, 73- Hacker ED
- Larson J
- Kujath A
- Peace D
- Rondelli D
- Gaston L.
Strength training following hematopoietic stem cell transplantation.
, 74- Hammer MJ
- Eckardt P
- Cartwright F
- Miaskowski C.
Prescribed walking for glycemic control and symptom management in patients without diabetes undergoing chemotherapy.
,79- Jensen W
- Baumann FT
- Stein A
- et al.
Exercise training in patients with advanced gastrointestinal cancer undergoing palliative chemotherapy: a pilot study.
,83- Lu Y
- Qu HQ
- Chen FY
- et al.
Effect of Baduanjin Qigong exercise on cancer-related fatigue in patients with colorectal cancer undergoing chemotherapy: a randomized controlled trial.
,86- Møller T
- Andersen C
- Lillelund C
- et al.
Physical deterioration and adaptive recovery in physically inactive breast cancer patients during adjuvant chemotherapy: a randomised controlled trial.
,87- Møller T
- Lillelund C
- Andersen C
- et al.
The challenge of preserving cardiorespiratory fitness in physically inactive patients with colon or breast cancer during adjuvant chemotherapy: a randomised feasibility study.
,89- Naraphong W
- Lane A
- Schafer J
- Whitmer K
- Wilson BRA.
Exercise intervention for fatigue-related symptoms in Thai women with breast cancer: a pilot study.
,91- Travier N
- Velthuis MJ
- Steins Bisschop CN
- et al.
Effects of an 18-week exercise programme started early during breast cancer treatment: a randomised controlled trial.
, 92- Van Vulpen JK
- Velthuis MJ
- Bisschop CNS
- et al.
Effects of an exercise program in colon cancer patients undergoing chemotherapy.
, 93- van Waart H
- Stuiver MM
- van Harten WH
- et al.
Recruitment to and pilot results of the PACES randomized trial of physical exercise during adjuvant chemotherapy for colon cancer.
, 94- Van Waart H
- Stuiver MM
- Van Harten WH
- et al.
Effect of low-intensity physical activity and moderate- to high-intensity physical exercise during adjuvant chemotherapy on physical fitness, fatigue, and chemotherapy completion rates: results of the PACES randomized clinical trial.
, 95- Vincent F
- Deluche E
- Bonis J
- et al.
Home-based physical activity in patients with breast cancer: during and/or after chemotherapy? Impact on cardiorespiratory fitness. A 3-arm randomized controlled trial (APAC).
,99- Zhang Q
- Li F
- Zhang H
- Yu X
- Cong Y.
Effects of nurse-led home-based exercise & cognitive behavioral therapy on reducing cancer-related fatigue in patients with ovarian cancer during and after chemotherapy: a randomized controlled trial.
,101- Schmidt T
- Weisser B
- Dürkop J
- et al.
Comparing endurance and resistance training with standard care during chemotherapy for patients with primary breast cancer.
and 16 studies with radiotherapy (4.2%-100%).
58- Andersen C
- Rørth M
- Ejlertsen B
- et al.
The effects of a six-week supervised multimodal exercise intervention during chemotherapy on cancer-related fatigue.
,61- Carayol M
- Ninot G
- Senesse P
- et al.
Short- and long-term impact of adapted physical activity and diet counseling during adjuvant breast cancer therapy: the “APAD1” randomized controlled trial.
,66- Cornette T
- Vincent F
- Mandigout S
- et al.
Effects of home-based exercise training on VO2 in breast cancer patients under adjuvant or neoadjuvant chemotherapy (SAPA): a randomized controlled trial.
,70- Demmelmaier I
- Brooke HHL
- Henriksson A
- et al.
Does exercise intensity matter for fatigue during (neo-)adjuvant cancer treatment? The Phys-Can randomized clinical trial.
,71- Dhruva A
- Miaskowski C
- Abrams D
- et al.
Yoga breathing for cancer chemotherapy-associated symptoms and quality of life: results of a pilot randomized controlled trial.
,77- Husebø AML
- Dyrstad SM
- Mjaaland I
- Søreide JA
- Bru E.
Effects of scheduled exercise on cancer-related fatigue in women with early breast cancer.
,79- Jensen W
- Baumann FT
- Stein A
- et al.
Exercise training in patients with advanced gastrointestinal cancer undergoing palliative chemotherapy: a pilot study.
,86- Møller T
- Andersen C
- Lillelund C
- et al.
Physical deterioration and adaptive recovery in physically inactive breast cancer patients during adjuvant chemotherapy: a randomised controlled trial.
,90- Samuel SR
- Maiya AG
- Fernandes DJ
- et al.
Effectiveness of exercise-based rehabilitation on functional capacity and quality of life in head and neck cancer patients receiving chemo-radiotherapy.
,91- Travier N
- Velthuis MJ
- Steins Bisschop CN
- et al.
Effects of an 18-week exercise programme started early during breast cancer treatment: a randomised controlled trial.
, 92- Van Vulpen JK
- Velthuis MJ
- Bisschop CNS
- et al.
Effects of an exercise program in colon cancer patients undergoing chemotherapy.
, 93- van Waart H
- Stuiver MM
- van Harten WH
- et al.
Recruitment to and pilot results of the PACES randomized trial of physical exercise during adjuvant chemotherapy for colon cancer.
, 94- Van Waart H
- Stuiver MM
- Van Harten WH
- et al.
Effect of low-intensity physical activity and moderate- to high-intensity physical exercise during adjuvant chemotherapy on physical fitness, fatigue, and chemotherapy completion rates: results of the PACES randomized clinical trial.
, 95- Vincent F
- Deluche E
- Bonis J
- et al.
Home-based physical activity in patients with breast cancer: during and/or after chemotherapy? Impact on cardiorespiratory fitness. A 3-arm randomized controlled trial (APAC).
, 96- Witlox L
- Hiensch AE
- Velthuis MJ
- et al.
Four-year effects of exercise on fatigue and physical activity in patients with cancer.
,100- Zhou W
- Wan YH
- Chen Q
- Qiu YR
- Luo XM.
Effects of Tai Chi exercise on cancer-related fatigue in patients with nasopharyngeal carcinoma undergoing chemoradiotherapy: a randomized controlled trial.
Both radiotherapy and previous surgery showed a percentage of more than 50% of patients in most cases.
Exercise interventions were based on aerobic, resistance and/or flexibility training, alone, combined with each other or with other types of interventions, as well as yoga or light martial arts. Supplemental Table B.1 shows in detail the intervention performed in each study. Intervention duration ranged from 3 to 27 weeks, while follow-up of outcome variables ranged from 3 weeks to 4 years post-intervention. Thirty studies presented only immediate post-intervention assessment data,
55- Adamsen L
- Quist M
- Andersen C
- et al.
Effect of a multimodal high intensity exercise intervention in cancer patients undergoing chemotherapy: randomised controlled trial.
,58- Andersen C
- Rørth M
- Ejlertsen B
- et al.
The effects of a six-week supervised multimodal exercise intervention during chemotherapy on cancer-related fatigue.
,60- Bryant AL
- Deal AM
- Battaglini CL
- et al.
The effects of exercise on patient-reported outcomes and performance-based physical function in adults with acute leukemia undergoing induction therapy: exercise and quality of life in acute leukemia (EQUAL).
,62- Chang PH
- Lai YH
- Shun SC
- et al.
Effects of a walking intervention on fatigue-related experiences of hospitalized acute myelogenous leukemia patients undergoing chemotherapy: a randomized controlled trial.
,64- Chuang TY
- Yeh ML
- Chung YC.
A nurse facilitated mind-body interactive exercise (Chan-Chuang qigong) improves the health status of non-Hodgkin lymphoma patients receiving chemotherapy: randomised controlled trial.
,65- Coleman EA
- Goodwin JA
- Kennedy R
- et al.
Effects of exercise on fatigue, sleep, and performance: a randomized trial.
,68- Courneya KS
- Segal RJ
- Mackey JR
- et al.
Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomized controlled trial.
, 69- Courneya KS
- McKenzie DC
- Mackey JR
- et al.
Effects of exercise dose and type during breast cancer chemotherapy: multicenter randomized trial.
, 70- Demmelmaier I
- Brooke HHL
- Henriksson A
- et al.
Does exercise intensity matter for fatigue during (neo-)adjuvant cancer treatment? The Phys-Can randomized clinical trial.
, 71- Dhruva A
- Miaskowski C
- Abrams D
- et al.
Yoga breathing for cancer chemotherapy-associated symptoms and quality of life: results of a pilot randomized controlled trial.
-76- Hornsby WE
- Douglas PS
- West MJ
- et al.
Safety and efficacy of aerobic training in operable breast cancer patients receiving neoadjuvant chemotherapy: a phase II randomized trial.
,78- Jarden M
- Møller T
- Christensen KB
- Kjeldsen L
- Birgens HS
- Adamsen L.
Multimodal intervention integrated into the clinical management of acute leukemia improves physical function and quality of life during consolidation chemotherapy: a randomized trial ‘PACE-AL.
, 79- Jensen W
- Baumann FT
- Stein A
- et al.
Exercise training in patients with advanced gastrointestinal cancer undergoing palliative chemotherapy: a pilot study.
, 80- Kirkham AA
- Bland KA
- Zucker DS
- et al.
Chemotherapy-periodized” exercise to accommodate for cyclical variation in fatigue.
, 81- Lee K
- Norris MK
- Wang E
- Dieli-Conwright CM.
Effect of high-intensity interval training on patient-reported outcomes and physical function in women with breast cancer receiving anthracycline-based chemotherapy.
, 82- Lin KY
- Cheng HC
- Yen CJ
- et al.
Effects of exercise in patients undergoing chemotherapy for head and neck cancer: a pilot randomized controlled trial.
, 83- Lu Y
- Qu HQ
- Chen FY
- et al.
Effect of Baduanjin Qigong exercise on cancer-related fatigue in patients with colorectal cancer undergoing chemotherapy: a randomized controlled trial.
, 84- Mijwel S
- Backman M
- Bolam KA
- et al.
Adding high-intensity interval training to conventional training modalities: optimizing health-related outcomes during chemotherapy for breast cancer: the OptiTrain randomized controlled trial.
,87- Møller T
- Lillelund C
- Andersen C
- et al.
The challenge of preserving cardiorespiratory fitness in physically inactive patients with colon or breast cancer during adjuvant chemotherapy: a randomised feasibility study.
,89- Naraphong W
- Lane A
- Schafer J
- Whitmer K
- Wilson BRA.
Exercise intervention for fatigue-related symptoms in Thai women with breast cancer: a pilot study.
,90- Samuel SR
- Maiya AG
- Fernandes DJ
- et al.
Effectiveness of exercise-based rehabilitation on functional capacity and quality of life in head and neck cancer patients receiving chemo-radiotherapy.
,95- Vincent F
- Deluche E
- Bonis J
- et al.
Home-based physical activity in patients with breast cancer: during and/or after chemotherapy? Impact on cardiorespiratory fitness. A 3-arm randomized controlled trial (APAC).
,97A randomized controlled trial of qigong on fatigue and sleep quality for non-Hodgkin's lymphoma patients undergoing chemotherapy.
,98- Zhang LL
- Wang SZ
- Chen HL
- Yuan AZ.
Tai Chi exercise for cancer-related fatigue in patients with lung cancer undergoing chemotherapy: a randomized controlled trial.
,100- Zhou W
- Wan YH
- Chen Q
- Qiu YR
- Luo XM.
Effects of Tai Chi exercise on cancer-related fatigue in patients with nasopharyngeal carcinoma undergoing chemoradiotherapy: a randomized controlled trial.
,101- Schmidt T
- Weisser B
- Dürkop J
- et al.
Comparing endurance and resistance training with standard care during chemotherapy for patients with primary breast cancer.
4 studies presented follow-up data,
59- Bolam KA
- Mijwel S
- Rundqvist H
- Wengström Y.
Two-year follow-up of the OptiTrain randomised controlled exercise trial.
,67- Courneya KS
- Segal RJ
- Gelmon K
- et al.
Six-month follow-up of patient-rated outcomes in a randomized controlled trial of exercise training during breast cancer chemotherapy.
,85- Mijwel S
- Jervaeus A
- Bolam KA
- et al.
High-intensity exercise during chemotherapy induces beneficial effects 12 months into breast cancer survivorship.
,96- Witlox L
- Hiensch AE
- Velthuis MJ
- et al.
Four-year effects of exercise on fatigue and physical activity in patients with cancer.
and 13 studies presented both data.
56- Alibhai SMH
- Durbano S
- Breunis H
- et al.
A phase II exercise randomized controlled trial for patients with acute myeloid leukemia undergoing induction chemotherapy.
,57- Al-Majid S
- Wilson LD
- Rakovski C
- Coburn JW.
Effects of exercise on biobehavioral outcomes of fatigue during cancer treatment: results of a feasibility study.
,61- Carayol M
- Ninot G
- Senesse P
- et al.
Short- and long-term impact of adapted physical activity and diet counseling during adjuvant breast cancer therapy: the “APAD1” randomized controlled trial.
,63- Chaoul A
- Milbury K
- Spelman A
- et al.
Randomized trial of Tibetan yoga in patients with breast cancer undergoing chemotherapy.
,66- Cornette T
- Vincent F
- Mandigout S
- et al.
Effects of home-based exercise training on VO2 in breast cancer patients under adjuvant or neoadjuvant chemotherapy (SAPA): a randomized controlled trial.
,77- Husebø AML
- Dyrstad SM
- Mjaaland I
- Søreide JA
- Bru E.
Effects of scheduled exercise on cancer-related fatigue in women with early breast cancer.
,86- Møller T
- Andersen C
- Lillelund C
- et al.
Physical deterioration and adaptive recovery in physically inactive breast cancer patients during adjuvant chemotherapy: a randomised controlled trial.
,88- Mostafaei F
- Azizi M
- Jalali A
- Salari N
- Abbasi P.
Effect of exercise on depression and fatigue in breast cancer women undergoing chemotherapy: a randomized controlled trial.
,91- Travier N
- Velthuis MJ
- Steins Bisschop CN
- et al.
Effects of an 18-week exercise programme started early during breast cancer treatment: a randomised controlled trial.
, 92- Van Vulpen JK
- Velthuis MJ
- Bisschop CNS
- et al.
Effects of an exercise program in colon cancer patients undergoing chemotherapy.
, 93- van Waart H
- Stuiver MM
- van Harten WH
- et al.
Recruitment to and pilot results of the PACES randomized trial of physical exercise during adjuvant chemotherapy for colon cancer.
, 94- Van Waart H
- Stuiver MM
- Van Harten WH
- et al.
Effect of low-intensity physical activity and moderate- to high-intensity physical exercise during adjuvant chemotherapy on physical fitness, fatigue, and chemotherapy completion rates: results of the PACES randomized clinical trial.
,99- Zhang Q
- Li F
- Zhang H
- Yu X
- Cong Y.
Effects of nurse-led home-based exercise & cognitive behavioral therapy on reducing cancer-related fatigue in patients with ovarian cancer during and after chemotherapy: a randomized controlled trial.
Results of the methodological quality and risk of bias
Methodological quality was good in 27 (57.4%) of the 47 included studies
55- Adamsen L
- Quist M
- Andersen C
- et al.
Effect of a multimodal high intensity exercise intervention in cancer patients undergoing chemotherapy: randomised controlled trial.
,56- Alibhai SMH
- Durbano S
- Breunis H
- et al.
A phase II exercise randomized controlled trial for patients with acute myeloid leukemia undergoing induction chemotherapy.
,59- Bolam KA
- Mijwel S
- Rundqvist H
- Wengström Y.
Two-year follow-up of the OptiTrain randomised controlled exercise trial.
, 60- Bryant AL
- Deal AM
- Battaglini CL
- et al.
The effects of exercise on patient-reported outcomes and performance-based physical function in adults with acute leukemia undergoing induction therapy: exercise and quality of life in acute leukemia (EQUAL).
, 61- Carayol M
- Ninot G
- Senesse P
- et al.
Short- and long-term impact of adapted physical activity and diet counseling during adjuvant breast cancer therapy: the “APAD1” randomized controlled trial.
,68- Courneya KS
- Segal RJ
- Mackey JR
- et al.
Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomized controlled trial.
, 69- Courneya KS
- McKenzie DC
- Mackey JR
- et al.
Effects of exercise dose and type during breast cancer chemotherapy: multicenter randomized trial.
, 70- Demmelmaier I
- Brooke HHL
- Henriksson A
- et al.
Does exercise intensity matter for fatigue during (neo-)adjuvant cancer treatment? The Phys-Can randomized clinical trial.
, 71- Dhruva A
- Miaskowski C
- Abrams D
- et al.
Yoga breathing for cancer chemotherapy-associated symptoms and quality of life: results of a pilot randomized controlled trial.
, 72- Gokal K
- Wallis D
- Ahmed S
- Boiangiu I
- Kancherla K
- Munir F.
Effects of a self-managed home-based walking intervention on psychosocial health outcomes for breast cancer patients receiving chemotherapy: a randomised controlled trial.
,76- Hornsby WE
- Douglas PS
- West MJ
- et al.
Safety and efficacy of aerobic training in operable breast cancer patients receiving neoadjuvant chemotherapy: a phase II randomized trial.
,77- Husebø AML
- Dyrstad SM
- Mjaaland I
- Søreide JA
- Bru E.
Effects of scheduled exercise on cancer-related fatigue in women with early breast cancer.
,81- Lee K
- Norris MK
- Wang E
- Dieli-Conwright CM.
Effect of high-intensity interval training on patient-reported outcomes and physical function in women with breast cancer receiving anthracycline-based chemotherapy.
,84- Mijwel S
- Backman M
- Bolam KA
- et al.
Adding high-intensity interval training to conventional training modalities: optimizing health-related outcomes during chemotherapy for breast cancer: the OptiTrain randomized controlled trial.
, 85- Mijwel S
- Jervaeus A
- Bolam KA
- et al.
High-intensity exercise during chemotherapy induces beneficial effects 12 months into breast cancer survivorship.
, 86- Møller T
- Andersen C
- Lillelund C
- et al.
Physical deterioration and adaptive recovery in physically inactive breast cancer patients during adjuvant chemotherapy: a randomised controlled trial.
,88- Mostafaei F
- Azizi M
- Jalali A
- Salari N
- Abbasi P.
Effect of exercise on depression and fatigue in breast cancer women undergoing chemotherapy: a randomized controlled trial.
, 89- Naraphong W
- Lane A
- Schafer J
- Whitmer K
- Wilson BRA.
Exercise intervention for fatigue-related symptoms in Thai women with breast cancer: a pilot study.
, 90- Samuel SR
- Maiya AG
- Fernandes DJ
- et al.
Effectiveness of exercise-based rehabilitation on functional capacity and quality of life in head and neck cancer patients receiving chemo-radiotherapy.
, 91- Travier N
- Velthuis MJ
- Steins Bisschop CN
- et al.
Effects of an 18-week exercise programme started early during breast cancer treatment: a randomised controlled trial.
, 92- Van Vulpen JK
- Velthuis MJ
- Bisschop CNS
- et al.
Effects of an exercise program in colon cancer patients undergoing chemotherapy.
,94- Van Waart H
- Stuiver MM
- Van Harten WH
- et al.
Effect of low-intensity physical activity and moderate- to high-intensity physical exercise during adjuvant chemotherapy on physical fitness, fatigue, and chemotherapy completion rates: results of the PACES randomized clinical trial.
,95- Vincent F
- Deluche E
- Bonis J
- et al.
Home-based physical activity in patients with breast cancer: during and/or after chemotherapy? Impact on cardiorespiratory fitness. A 3-arm randomized controlled trial (APAC).
,97A randomized controlled trial of qigong on fatigue and sleep quality for non-Hodgkin's lymphoma patients undergoing chemotherapy.
, 98- Zhang LL
- Wang SZ
- Chen HL
- Yuan AZ.
Tai Chi exercise for cancer-related fatigue in patients with lung cancer undergoing chemotherapy: a randomized controlled trial.
, 99- Zhang Q
- Li F
- Zhang H
- Yu X
- Cong Y.
Effects of nurse-led home-based exercise & cognitive behavioral therapy on reducing cancer-related fatigue in patients with ovarian cancer during and after chemotherapy: a randomized controlled trial.
, 100- Zhou W
- Wan YH
- Chen Q
- Qiu YR
- Luo XM.
Effects of Tai Chi exercise on cancer-related fatigue in patients with nasopharyngeal carcinoma undergoing chemoradiotherapy: a randomized controlled trial.
and fair in the remaining 20 (42.6%) studies
57- Al-Majid S
- Wilson LD
- Rakovski C
- Coburn JW.
Effects of exercise on biobehavioral outcomes of fatigue during cancer treatment: results of a feasibility study.
,58- Andersen C
- Rørth M
- Ejlertsen B
- et al.
The effects of a six-week supervised multimodal exercise intervention during chemotherapy on cancer-related fatigue.
,62- Chang PH
- Lai YH
- Shun SC
- et al.
Effects of a walking intervention on fatigue-related experiences of hospitalized acute myelogenous leukemia patients undergoing chemotherapy: a randomized controlled trial.
, 63- Chaoul A
- Milbury K
- Spelman A
- et al.
Randomized trial of Tibetan yoga in patients with breast cancer undergoing chemotherapy.
, 64- Chuang TY
- Yeh ML
- Chung YC.
A nurse facilitated mind-body interactive exercise (Chan-Chuang qigong) improves the health status of non-Hodgkin lymphoma patients receiving chemotherapy: randomised controlled trial.
, 65- Coleman EA
- Goodwin JA
- Kennedy R
- et al.
Effects of exercise on fatigue, sleep, and performance: a randomized trial.
, 66- Cornette T
- Vincent F
- Mandigout S
- et al.
Effects of home-based exercise training on VO2 in breast cancer patients under adjuvant or neoadjuvant chemotherapy (SAPA): a randomized controlled trial.
, 67- Courneya KS
- Segal RJ
- Gelmon K
- et al.
Six-month follow-up of patient-rated outcomes in a randomized controlled trial of exercise training during breast cancer chemotherapy.
,73- Hacker ED
- Larson J
- Kujath A
- Peace D
- Rondelli D
- Gaston L.
Strength training following hematopoietic stem cell transplantation.
, 74- Hammer MJ
- Eckardt P
- Cartwright F
- Miaskowski C.
Prescribed walking for glycemic control and symptom management in patients without diabetes undergoing chemotherapy.
, 75- Hiensch AE
- Mijwel S
- Bargiela D
- Wengström Y
- May AM
- Rundqvist H.
Inflammation mediates exercise effects on fatigue in patients with breast cancer.
,78- Jarden M
- Møller T
- Christensen KB
- Kjeldsen L
- Birgens HS
- Adamsen L.
Multimodal intervention integrated into the clinical management of acute leukemia improves physical function and quality of life during consolidation chemotherapy: a randomized trial ‘PACE-AL.
, 79- Jensen W
- Baumann FT
- Stein A
- et al.
Exercise training in patients with advanced gastrointestinal cancer undergoing palliative chemotherapy: a pilot study.
, 80- Kirkham AA
- Bland KA
- Zucker DS
- et al.
Chemotherapy-periodized” exercise to accommodate for cyclical variation in fatigue.
,82- Lin KY
- Cheng HC
- Yen CJ
- et al.
Effects of exercise in patients undergoing chemotherapy for head and neck cancer: a pilot randomized controlled trial.
,83- Lu Y
- Qu HQ
- Chen FY
- et al.
Effect of Baduanjin Qigong exercise on cancer-related fatigue in patients with colorectal cancer undergoing chemotherapy: a randomized controlled trial.
,87- Møller T
- Lillelund C
- Andersen C
- et al.
The challenge of preserving cardiorespiratory fitness in physically inactive patients with colon or breast cancer during adjuvant chemotherapy: a randomised feasibility study.
,93- van Waart H
- Stuiver MM
- van Harten WH
- et al.
Recruitment to and pilot results of the PACES randomized trial of physical exercise during adjuvant chemotherapy for colon cancer.
,96- Witlox L
- Hiensch AE
- Velthuis MJ
- et al.
Four-year effects of exercise on fatigue and physical activity in patients with cancer.
,101- Schmidt T
- Weisser B
- Dürkop J
- et al.
Comparing endurance and resistance training with standard care during chemotherapy for patients with primary breast cancer.
(Supplemental Table A.4). Twenty (42.6%) studies had some concerns risk of bias,
55- Adamsen L
- Quist M
- Andersen C
- et al.
Effect of a multimodal high intensity exercise intervention in cancer patients undergoing chemotherapy: randomised controlled trial.
,58- Andersen C
- Rørth M
- Ejlertsen B
- et al.
The effects of a six-week supervised multimodal exercise intervention during chemotherapy on cancer-related fatigue.
, 59- Bolam KA
- Mijwel S
- Rundqvist H
- Wengström Y.
Two-year follow-up of the OptiTrain randomised controlled exercise trial.
, 60- Bryant AL
- Deal AM
- Battaglini CL
- et al.
The effects of exercise on patient-reported outcomes and performance-based physical function in adults with acute leukemia undergoing induction therapy: exercise and quality of life in acute leukemia (EQUAL).
, 61- Carayol M
- Ninot G
- Senesse P
- et al.
Short- and long-term impact of adapted physical activity and diet counseling during adjuvant breast cancer therapy: the “APAD1” randomized controlled trial.
,64- Chuang TY
- Yeh ML
- Chung YC.
A nurse facilitated mind-body interactive exercise (Chan-Chuang qigong) improves the health status of non-Hodgkin lymphoma patients receiving chemotherapy: randomised controlled trial.
,66- Cornette T
- Vincent F
- Mandigout S
- et al.
Effects of home-based exercise training on VO2 in breast cancer patients under adjuvant or neoadjuvant chemotherapy (SAPA): a randomized controlled trial.
, 67- Courneya KS
- Segal RJ
- Gelmon K
- et al.
Six-month follow-up of patient-rated outcomes in a randomized controlled trial of exercise training during breast cancer chemotherapy.
, 68- Courneya KS
- Segal RJ
- Mackey JR
- et al.
Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomized controlled trial.
, 69- Courneya KS
- McKenzie DC
- Mackey JR
- et al.
Effects of exercise dose and type during breast cancer chemotherapy: multicenter randomized trial.
,71- Dhruva A
- Miaskowski C
- Abrams D
- et al.
Yoga breathing for cancer chemotherapy-associated symptoms and quality of life: results of a pilot randomized controlled trial.
,72- Gokal K
- Wallis D
- Ahmed S
- Boiangiu I
- Kancherla K
- Munir F.
Effects of a self-managed home-based walking intervention on psychosocial health outcomes for breast cancer patients receiving chemotherapy: a randomised controlled trial.
,74- Hammer MJ
- Eckardt P
- Cartwright F
- Miaskowski C.
Prescribed walking for glycemic control and symptom management in patients without diabetes undergoing chemotherapy.
,76- Hornsby WE
- Douglas PS
- West MJ
- et al.
Safety and efficacy of aerobic training in operable breast cancer patients receiving neoadjuvant chemotherapy: a phase II randomized trial.
,79- Jensen W
- Baumann FT
- Stein A
- et al.
Exercise training in patients with advanced gastrointestinal cancer undergoing palliative chemotherapy: a pilot study.
,81- Lee K
- Norris MK
- Wang E
- Dieli-Conwright CM.
Effect of high-intensity interval training on patient-reported outcomes and physical function in women with breast cancer receiving anthracycline-based chemotherapy.
,91- Travier N
- Velthuis MJ
- Steins Bisschop CN
- et al.
Effects of an 18-week exercise programme started early during breast cancer treatment: a randomised controlled trial.
,92- Van Vulpen JK
- Velthuis MJ
- Bisschop CNS
- et al.
Effects of an exercise program in colon cancer patients undergoing chemotherapy.
,95- Vincent F
- Deluche E
- Bonis J
- et al.
Home-based physical activity in patients with breast cancer: during and/or after chemotherapy? Impact on cardiorespiratory fitness. A 3-arm randomized controlled trial (APAC).
,99- Zhang Q
- Li F
- Zhang H
- Yu X
- Cong Y.
Effects of nurse-led home-based exercise & cognitive behavioral therapy on reducing cancer-related fatigue in patients with ovarian cancer during and after chemotherapy: a randomized controlled trial.
and the remaining 27 (57.4%) studies had a high risk of bias
56- Alibhai SMH
- Durbano S
- Breunis H
- et al.
A phase II exercise randomized controlled trial for patients with acute myeloid leukemia undergoing induction chemotherapy.
,57- Al-Majid S
- Wilson LD
- Rakovski C
- Coburn JW.
Effects of exercise on biobehavioral outcomes of fatigue during cancer treatment: results of a feasibility study.
,62- Chang PH
- Lai YH
- Shun SC
- et al.
Effects of a walking intervention on fatigue-related experiences of hospitalized acute myelogenous leukemia patients undergoing chemotherapy: a randomized controlled trial.
,63- Chaoul A
- Milbury K
- Spelman A
- et al.
Randomized trial of Tibetan yoga in patients with breast cancer undergoing chemotherapy.
,65- Coleman EA
- Goodwin JA
- Kennedy R
- et al.
Effects of exercise on fatigue, sleep, and performance: a randomized trial.
,70- Demmelmaier I
- Brooke HHL
- Henriksson A
- et al.
Does exercise intensity matter for fatigue during (neo-)adjuvant cancer treatment? The Phys-Can randomized clinical trial.
,73- Hacker ED
- Larson J
- Kujath A
- Peace D
- Rondelli D
- Gaston L.
Strength training following hematopoietic stem cell transplantation.
,75- Hiensch AE
- Mijwel S
- Bargiela D
- Wengström Y
- May AM
- Rundqvist H.
Inflammation mediates exercise effects on fatigue in patients with breast cancer.
,77- Husebø AML
- Dyrstad SM
- Mjaaland I
- Søreide JA
- Bru E.
Effects of scheduled exercise on cancer-related fatigue in women with early breast cancer.
,78- Jarden M
- Møller T
- Christensen KB
- Kjeldsen L
- Birgens HS
- Adamsen L.
Multimodal intervention integrated into the clinical management of acute leukemia improves physical function and quality of life during consolidation chemotherapy: a randomized trial ‘PACE-AL.
,80- Kirkham AA
- Bland KA
- Zucker DS
- et al.
Chemotherapy-periodized” exercise to accommodate for cyclical variation in fatigue.
,82- Lin KY
- Cheng HC
- Yen CJ
- et al.
Effects of exercise in patients undergoing chemotherapy for head and neck cancer: a pilot randomized controlled trial.
, 83- Lu Y
- Qu HQ
- Chen FY
- et al.
Effect of Baduanjin Qigong exercise on cancer-related fatigue in patients with colorectal cancer un
