title: Moderate-intensity exercise reduces fatigue and improves mobility in cancer survivors: a systematic review and meta-regression.
abstract: OBJECTIVE
  Is there a dose-response effect of exercise on inflammation, fatigue and activity in cancer survivors?
  
  
  METHODS
  Systematic review with meta-regression analysis of randomised trials.
  
  
  METHODS
  Adults diagnosed with cancer, regardless of specific diagnosis or treatment.
  
  
  METHODS
  Exercise interventions including aerobic and/or resistance as a key component.
  
  
  METHODS
  The primary outcome measures were markers of inflammation (including C-reactive protein and interleukins) and various measures of fatigue. The secondary outcomes were: measures of activity, as defined by the World Health Organization's International Classification of Functioning, Disability and Health, including activities of daily living and measures of functional mobility (eg, 6-minute walk test, timed sit-to-stand and stair-climb tests). Risk of bias was evaluated using the PEDro scale, and overall quality of evidence was assessed using the Grades of Research, Assessment, Development and Evaluation (GRADE) approach.
  
  
  RESULTS
  Forty-two trials involving 3816 participants were included. There was very low-quality to moderate-quality evidence that exercise results in significant reductions in fatigue (SMD 0.32, 95% CI 0.13 to 0.52) and increased walking endurance (SMD 0.77, 95% CI 0.26 to 1.28). A significant negative association was found between aerobic exercise intensity and fatigue reduction. A peak effect was found for moderate-intensity aerobic exercise for improving walking endurance. No dose-response relationship was found between exercise and markers of inflammation or exercise duration and outcomes. Rates of adherence were typically high and few adverse events were reported.
  
  
  CONCLUSIONS
  Exercise is safe, reduces fatigue and increases endurance in cancer survivors. The results support the recommendation of prescribing moderate-intensity aerobic exercise to reduce fatigue and improve activity in people with cancer.
  
  
  BACKGROUND
  PROSPERO CRD42015019164.
authors.affiliation: School of Allied Health, La Trobe University and Allied Health Clinical Research Office, Eastern Health.
authors.forename: Amy M
authors.initials: AM
authors.lastname: Dennett
authors.affiliation: School of Allied Health, La Trobe University and Northern Health.
authors.forename: Casey L
authors.initials: CL
authors.lastname: Peiris
authors.affiliation: School of Allied Health, La Trobe University and Northern Health.
authors.forename: Nora
authors.initials: N
authors.lastname: Shields
authors.affiliation: Department of Mathematics and Statistics, La Trobe University, Melbourne, Australia.
authors.forename: Luke A
authors.initials: LA
authors.lastname: Prendergast
authors.affiliation: School of Allied Health, La Trobe University and Allied Health Clinical Research Office, Eastern Health.
authors.forename: Nicholas F
authors.initials: NF
authors.lastname: Taylor
mesh_terms: D000203:Activities of Daily Living; D005081:Exercise Therapy / Q000379:methods*; D005221:Fatigue / Q000628:therapy*; D006304:Health Status; D006801:Humans; D009369:Neoplasms / Q000503:physiopathology / Q000534:rehabilitation*; D011788:Quality of Life; D016059:Range of Motion, Articular / Q000502:physiology*; D017741:Survivors
keywords: Cancer; Exercise therapy; Fatigue; Mobility; Physical therapy (specialty)