|Key message:Aerobic exercise may help reduce cancer-related fatigue during and after treatment for solid tumours.|
“Exercise is good for you” is a familiar mantra and now there is evidence that aerobic exercise, such as walking or cycling, may help relieve the tiredness experienced by people having treatment for cancer, particularly solid tumours. A Cochrane review published in 2008 has now been updated, with 28 additional randomized controlled trials (RCTs) bringing the total to 56 RCTs with over 4000 people. Half the trials involved people with breast cancer. Exercise interventions varied between studies.
What did they find?
- Overall, people following an exercise programme either during or after cancer treatment showed a A statistically significant result is one which is unlikely to have happened by chance. This is not the same thing as clinical significance. More improvement in fatigue compared with those in control groups
- These benefits were seen after aerobic exercise programmes but not resistance training or low-intensity mind-body interventions
- Exercise helped fatigue in people with breast cancer and prostate cancer but not those with lymphoma, myeloma or leukaemia
How good is the evidence?
- Study quality varied, with more recent studies generally being of better quality, and many were small
- Studies varied in the stage and types of cancer, the treatments being received by patients and the type, intensity and frequency of exercise
- Data were not available for meta-analysis (combining results from multiple studies) for all studies found to be suitable for the review
- The authors expressed a concern that failure to report data in full might have affected the results
- There is a lack of evidence on long-term benefits of exercise (or lack of them) and on how the frequency and type of exercise, and the type of cancer, might affect the results
This is one of three reviews on the treatment of cancer-related fatigue from the Cochrane Pain, Palliative and Supportive Care Group, with the other reviews focusing on drug therapy and on psychosocial interventions.
The effectiveness of psychosocial interventions involving ‘trained helper’ support for improving quality of life and well-being in newly diagnosed cancer patients is explored in a new review, published today, from the Cochrane Gynaecological Cancer Group. Variation across studies in the participants, in the types of trained helper and in the content and delivery of the intervention made it difficult to be clear about how effective this approach might be for people with cancer, although nurse-led interventions look promising. The review authors point out that this is an area of considerable interest which is gaining increased support for research from funding bodies, and the review contains some helpful suggestions for those undertaking future research in this area.
The Gynaecological Cancer Group also published two new reviews earlier this year, which looked at the impact of exercise on quality of life during and after cancer treatment. The studies were judged to be at high risk of bias, so the results need to be interpreted with caution, but their findings are of interest and again suggest that exercise can be beneficial. There are links below to all the reviews and Cochrane summaries and podcasts where available.
Cramp F, Byron-Daniel J. Exercise for the management of cancer-related fatigue in adults. Cochrane Database of Systematic Reviews 2012, Issue 11. Art. No.: CD006145. DOI: 10.1002/14651858.CD006145.pub3
The 2012 update of this review was funded by the National Institute for Health Research (NIHR) (www.nihr.ac.uk) Health Technology Assessment Programme (https://www.nihr.ac.uk/funding-and-support/funding-for-research-studies/funding-programmes/health-technology-assessment/).
Wiley Press release: “Cancer: Exercise reduces tiredness”
Minton O, Richardson A, Sharpe M, Hotopf M, Stone P. Drug therapy for the management of cancer-related fatigue. Cochrane Database of Systematic Reviews 2010, Issue 7. Art. No.: CD006704. DOI: 10.1002/14651858.CD006704.pub3.
Cochrane summary: http://summaries.cochrane.org/CD006704/drugs-for-cancer-related-fatigue
Goedendorp MM, Gielissen MFM, Verhagen CAHHVM, Bleijenberg G. Psychosocial interventions for reducing fatigue during cancer treatment in adults. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD006953. DOI: 10.1002/14651858.CD006953.pub2.
Galway K, Black A, Cantwell M, Cardwell CR, Mills M, Donnelly M. Psychosocial interventions to improve quality of life and emotional wellbeing for recently diagnosed cancer patients. Cochrane Database of Systematic Reviews 2012, Issue 11. Art. No.: CD007064. DOI: 10.1002/14651858.CD007064.pub2.
Mishra SI, Scherer RW, Snyder C, Geigle PM, Berlanstein DR, Topaloglu O. Exercise interventions on health-related quality of life for people with cancer during active treatment. Cochrane Database of Systematic Reviews 2012, Issue 8. Art. No.: CD008465. DOI: 10.1002/14651858.CD008465.pub2.
Cochrane Journal Club: http://www.cochranejournalclub.com/exercise-interventions-for-cancer-survivors-clinical/
Mishra SI, Scherer RW, Geigle PM, Berlanstein DR, Topaloglu O, Gotay CC, Snyder C. Exercise interventions on health-related quality of life for cancer survivors. Cochrane Database of Systematic Reviews 2012, Issue 8. Art. No.: CD007566. DOI: 10.1002/14651858.CD007566.pub2.