title: Effects of Supervised Multimodal Exercise Interventions on Cancer-Related Fatigue: Systematic Review and Meta-Analysis of Randomized Controlled Trials.
abstract: OBJECTIVE
  Cancer-related fatigue (CRF) is the most common and devastating problem in cancer patients even after successful treatment. This study aimed to determine the effects of supervised multimodal exercise interventions on cancer-related fatigue through a systematic review and meta-analysis.
  
  
  METHODS
  A systematic review was conducted to determine the effectiveness of multimodal exercise interventions on CRF. Databases of PubMed, CENTRAL, EMBASE, and OVID were searched between January and March 2014 to retrieve randomized controlled trials. Risk of bias was evaluated using the PEDro scale.
  
  
  RESULTS
  Nine studies (n = 772) were included in both systematic review and meta-analysis. Multimodal interventions including aerobic exercise, resistance training, and stretching improved CRF symptoms (SMD = -0.23; 95% CI: -0.37 to -0.09; P = 0.001). These effects were also significant in patients undergoing chemotherapy (P < 0.0001). Nonsignificant differences were found for resistance training interventions (P = 0.30). Slight evidence of publication bias was observed (P = 0.04). The studies had a low risk of bias (PEDro scale mean score of 6.4 (standard deviation (SD) ± 1.0)).
  
  
  CONCLUSIONS
  Supervised multimodal exercise interventions including aerobic, resistance, and stretching exercises are effective in controlling CRF. These findings suggest that these exercise protocols should be included as a crucial part of the rehabilitation programs for cancer survivors and patients during anticancer treatments.
authors.affiliation: Facultad de Cultura Física, Deporte y Recreación, Universidad de Santo Tomás, Carrera 9 No. 51-23, Bogotá, Colombia.
authors.forename: José Francisco
authors.initials: JF
authors.lastname: Meneses-Echávez
authors.affiliation: Departamento de Enfermería, Facultad de Enfermería, Universidad de Granada, Campus de Melilla, Granada, Spain.
authors.forename: Emilio
authors.initials: E
authors.lastname: González-Jiménez
authors.affiliation: Facultad de Cultura Física, Deporte y Recreación, Universidad de Santo Tomás, Carrera 9 No. 51-23, Bogotá, Colombia.
authors.forename: Robinson
authors.initials: R
authors.lastname: Ramírez-Vélez
mesh_terms: D000328:Adult; D005081:Exercise Therapy / Q000379:methods / Q000706:statistics & numerical data; D005221:Fatigue / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000534:rehabilitation*; D016032:Randomized Controlled Trials as Topic