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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
  1. Roger Hilfiker1,
  2. Andre Meichtry2,
  3. Manuela Eicher3,4,
  4. Lina Nilsson Balfe1,
  5. Ruud H Knols5,
  6. Martin L Verra6,
  7. Jan Taeymans7,8
  1. 1 School of Health Sciences, HES-SO Valais-Wallis, University of Applied Sciences and Arts Western Switzerland Valais, Leukerbad, Switzerland
  2. 2 Institute of Physiotherapy, Zurich University of Applied Sciences, Winterthur, Switzerland
  3. 3 School of Health Sciences, University of Applied Sciences and Arts Western Switzerland, Fribourg, Switzerland
  4. 4 Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne and Lausanne University Hospital, Lausanne, Switzerland
  5. 5 Directory of Research and Education, Physiotherapy Occupational Therapy Research, Center University Hospital Zurich, Zurich, Switzerland
  6. 6 Department of Physiotherapy, Inselspital, Bern University Hospital, Berne, Switzerland
  7. 7 Bern University of Applied Sciences Health, Berne, Switzerland
  8. 8 Faculty of Sports Sciences and Exercise Rehabilitation, Vrije Universiteit Brussel, Brussels, Belgium
  1. Correspondence to Roger Hilfiker, School of Health Sciences, University of Applied Sciences and Arts Western Switzerland Valais, 3954 Leukerbad, Switzerland; roger.hilfiker{at}


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
  • exercise
  • 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.