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.
- cancer related fatigue
- non-pharmaceutical interventions
- network meta-analysis
- indirect comparison meta-analysis.
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Contributors RH and JT had the idea for the study. RH, JT and LNB searched and screened the studies and extracted the data. AM, RH and JT contributed to statistical analysis. RH and JT wrote the first draft of the manuscript. ME, MLV, AM, RK, RH and JT revised the manuscript. All authors contributed to the design of the study, contributed to the interpretation and discussion of the data and results, read and agreed on the final version.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.