Moderators of exercise effects on cancer-related fatigue

a meta-analysis of individual patient data


<p><b>PURPOSE:</b> Fatigue is a common and potentially disabling symptom in patients with cancer. It can often be effectively reduced by exercise. Yet, effects of exercise interventions might differ across subgroups. We conducted a meta-analysis using individual patient data of randomized controlled trials (RCTs) to investigate moderators of exercise intervention effects on cancer-related fatigue.</p><p><b>METHODS:</b> We used individual patient data from 31 exercise RCTs worldwide, representing 4,366 patients, of whom 3,846 had complete fatigue data. We performed a one-step individual patient data meta-analysis, using linear mixed-effect models to analyze the effects of exercise interventions on fatigue (z-score) and to identify demographic, clinical, intervention- and exercise-related moderators. Models were adjusted for baseline fatigue and included a random intercept on study level to account for clustering of patients within studies. We identified potential moderators by testing their interaction with group allocation, using a likelihood ratio test.</p><p><b>RESULTS:</b> Exercise interventions had statistically significant beneficial effects on fatigue (β= -0.17 [95% confidence interval (CI) -0.22;-0.12]). There was no evidence of moderation by demographic or clinical characteristics. Supervised exercise interventions had significantly larger effects on fatigue than unsupervised exercise interventions (βdifference= -0.18 [95%CI -0.28;-0.08]). Supervised interventions with a duration ≤12 weeks showed larger effects on fatigue (β= -0.29 [95% CI -0.39;-0.20]) than supervised interventions with a longer duration. </p><p><b>CONCLUSIONS: </b>In this individual patient data meta-analysis, we found statistically significant beneficial effects of exercise interventions on fatigue, irrespective of demographic and clinical characteristics. These findings support a role for exercise, preferably supervised exercise interventions, in clinical practice. Reasons for differential effects in duration require further exploration.</p>

Reference van Vulpen, J. K., Sweegers, M. G., Peeters, P. H. M., Courneya, K. S., Newton, R. U., Aaronson, N. K., Jacobsen, P. B., Galvão, D. A., Chinapaw, M. J., Steindorf, K., Irwin, M. L., Stuiver, M. M., Hayes, S., Griffith, K. A., Mesters, I., Knoop, H., Goedendorp, M. M., Mutrie, N., Daley, A. J., ... Buffart, L. M. (2020). Moderators of exercise effects on cancer-related fatigue: a meta-analysis of individual patient data. ​Medicine & Science in Sports & Exercise, 52(2), 303-314.
Published by  Urban Vitality 1 February 2020

Publication date

Feb 2020


Jonna K van Vulpen
Maike G Sweegers
Petra H M Peeters
Kerry S Courneya
Robert U Newton
Neil K Aaronson
Paul B Jacobsen
Daniel A Galvão
Mai J Chinapaw
Karen Steindorf
Melinda L Irwin
Martijn M Stuiver
Sandi Hayes
Kathleen A Griffith
Ilse Mesters
Hans Knoop
Martine M Goedendorp
Nanette Mutrie
Amanda J Daley
Alex McConnachie
Martin Bohus
Lene Thorsen
Karl-Heinz Schulz
Camille E Short
Erica L James
Ronald C Plotnikoff
Martina E Schmidt
Cornelia M Ulrich
Marc van Beurden
Hester S Oldenburg
Gabe S Sonke
Wim H van Harten
Kathryn H Schmitz
Kerri M Winters-Stone
Miranda J Velthuis
Dennis R Taaffe
Willem van Mechelen
Marie José Kersten
Frans Nollet
Jennifer Wenzel
Joachim Wiskemann
Irma M Verdonck-de Leeuw
Johannes Brug
Anne M May
Laurien M Buffart

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