title: Exercise for the management of cancer-related fatigue in adults.
abstract: BACKGROUND
  Cancer-related fatigue is recognised as an important symptom associated with cancer and its treatment. A number of studies have investigated the effects of physical activity in reducing cancer-related fatigue. This is an updated version of the original Cochrane review published in The Cochrane Library (2008, Issue 1). The original review identified some benefits of physical activity on fatigue in cancer both during and after adjuvant treatment. We identified a number of limitations in the evidence, providing clear justification for an updated review.
  
  
  OBJECTIVE
  To evaluate the effect of exercise on cancer-related fatigue both during and after cancer treatment.
  
  
  METHODS
  We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 1, 2011), MEDLINE (1966 to March 2011), EMBASE (1980 to March 2011), CINAHL (1982 to March 2011), British Nursing Index (January 1984 to March 2011), AMED (1985 to March 2011), SIGLE (1980 to March 2011) and Dissertation Abstracts International (1861 to March 2011) using key words. We also searched reference lists off all studies identified for inclusion and relevant reviews. In addition, we handsearched relevant journals and contacted experts in the field of cancer-related fatigue.
  
  
  METHODS
  We sought and included randomised controlled trials (RCTs) that investigated the effect of exercise on cancer-related fatigue in adults.
  
  
  METHODS
  Two review authors independently assessed the risk of bias of studies and extracted data based upon predefined criteria. Where data were available we performed meta-analyses for fatigue using a random-effects model.
  
  
  RESULTS
  For this update we identified a total of 56 studies (4068 participants) for inclusion (28 from the original search and 28 from the updated search), with the majority carried out in participants with breast cancer (28 studies). A meta-analysis of all fatigue data, incorporating 38 comparisons, provided data for 1461 participants who received an exercise intervention and 1187 control participants. At the end of the intervention period exercise was seen to be statistically more effective than the control intervention (standardised mean difference (SMD) -0.27, 95% confidence interval (CI) -0.37 to -0.17). Benefits of exercise on fatigue were observed for interventions delivered during or post-adjuvant cancer therapy. In relation to diagnosis, we identified benefits of exercise on fatigue for breast and prostate cancer but not for those with haematological malignancies. Finally, aerobic exercise significantly reduced fatigue but resistance training and alternative forms of exercise failed to reach significance.
  
  
  CONCLUSIONS
  The findings of the updated review have enabled a more precise conclusion to be made in that aerobic exercise can be regarded as beneficial for individuals with cancer-related fatigue during and post-cancer therapy, specifically those with solid tumours. Further research is required to determine the optimal type, intensity and timing of an exercise intervention.
authors.affiliation: Faculty of Health & Life Sciences, University of the West of England, Bristol, UK. fiona.cramp@uwe.ac.uk
authors.forename: Fiona
authors.initials: F
authors.lastname: Cramp
authors.forename: James
authors.initials: J
authors.lastname: Byron-Daniel
mesh_terms: D000328:Adult; D015444:Exercise / Q000502:physiology; D005221:Fatigue / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000150:complications* / Q000628:therapy; D016032:Randomized Controlled Trials as Topic