The Differential Effects of Exercise on Cancer-Related Fatigue in Cancer Patients During and Following Treatment: A Systematic Review and Meta-Analysis of Randomized Controlled Trials Open Access

Puetz, Timothy William (2012)

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The Differential Effects of Exercise on Cancer-Related Fatigue in Cancer Patients During And Following Treatment: A Systematic Review and Meta-Analysis of Randomized Controlled Trials Exercise-induced improvements in cancer-related fatigue may be differentially moderated in patients during and following treatment. However, these effects have not been systematically reviewed. In accordance with PRISMA guidelines, the population effect size for exercise training on cancer-related fatigue during and following treatment was estimated and the extent to which the effect is differentiated across the time course of treatment and recovery was determined. Articles published before August, 2011 were retrieved using Google Scholar, MEDLINE, PsychINFO, PubMed, and Web of Science databases. Seventy studies involving 4,881 cancer patients during or following treatment were selected. Articles included a cancer-related fatigue outcome measured at baseline and post-intervention and randomized allocation to an exercise or non-exercise comparison. Hedges' d effect sizes were computed, study quality was evaluated, and random effects models were used to estimate sampling error and population variance. Exercise significantly reduced cancer-related fatigue by a mean effect size Δ (95%CI) of 0.32 (0.21, 0.43) and 0.38 (0.21, 0.54) during and following cancer treatment, respectively. During treatment, patients with lower baseline fatigue scores and higher exercise adherence rates realized the largest improvements. Following treatment, improvements were largest for trials with longer durations between completion of treatment and initiation of exercise, trials with shorter exercise program lengths, and trials using waitlist comparisons. Exercise reduces cancer-related fatigue among patients during and following cancer treatment. These effects are differentially moderated over the time course of treatment and recovery. Exercise has a palliative effect in patients undergoing treatment and a recuperative effect following treatment.

INDEX WORDS: Cancer, Cancer-Related Fatigue, Exercise, Fatigue, Meta-Analysis, Physical Activity, Randomized Controlled Trial, Systematic Review

Table of Contents


Statement of the Problem...2



Statistical Analyses...4


Definition of Terms...5



Overview & Organization...8


Prevalence & Social Impact...10

A Brief History...13

Conceptualization, Operationalization, & Measurement...15

Time Course of Cancer-Related Fatigue...20

Research on Exercise & Cancer-Related Fatigue...25

Proposed Correlates & Mechanisms...31


Data Sources & Searches...40

Study Selection...40

Data Extraction & Quality Assessment...42

Study Quality Assessment...44

Data Synthesis & Analysis...44

Primary Moderators & Analysis...45

Secondary Moderators & Analysis...47


Overall Model...51

Patients During Treatment...57

Patients Post-Treatment...60

Secondary Moderator Analyses...62


Overall Model...70

Patients During Treatment...71

Patients Post-Treatment...72


Implications for Future Research...73



Cancer Meta-Analysis Coding Sheet...98

References of Included Trials...105

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