Skip to main content

Advertisement

Log in

Effects of aerobic exercise on cancer-related fatigue in breast cancer patients receiving chemotherapy: a meta-analysis

  • Research Article
  • Published:
Tumor Biology

Abstract

Increasing scientific evidences suggest that aerobic exercise may improve cancer-related fatigue in breast cancer patients, but many existing studies have yielded inconclusive results. This meta-analysis aimed to derive a more precise estimation of the effects of aerobic exercise on cancer-related fatigue in breast cancer patients receiving chemotherapy. The PubMed, CISCOM, CINAHL, Web of Science, Google Scholar, EBSCO, Cochrane Library, and CBM databases were searched from inception through July 1, 2013 without language restrictions. Crude standardized mean difference (SMD) with 95 % confidence interval (CI) was calculated. Twelve comparative studies were assessed with a total of 1,014 breast cancer patients receiving chemotherapy, including 522 patients in the aerobic exercise group (intervention group) and 492 patients in the usual care group (control group). The meta-analysis results revealed that the Revised Piper Fatigue Scale (RPFS) scores of breast cancer patients in the intervention group were significantly lower than those in the control group (SMD = −0.82, 95% CI = −1.04 ∼ −0.60, P < 0.001). However, there was no significant difference in the Functional Assessment of Chronic Illness Treatment-Fatigue scale (FACIT-F) scores between the intervention and control groups (SMD = 0.09, 95% CI = −0.07 ∼ 0.25, P = 0.224). Subgroup analysis by ethnicity indicated that there were significant differences in RPFS and FACIT-F scores between the intervention and control groups among Asian populations (RPFS: SMD = −1.08, 95% CI = −1.35 ∼ −0.82, P < 0.001; FACIT-F: SMD = 1.20, 95 % CI = 0.70 ∼ 1.71, P < 0.001), but not among Caucasian populations (all P > 0.05). The current meta-analysis indicates that aerobic exercise may improve cancer-related fatigue in breast cancer patients receiving chemotherapy, especially among Asian populations.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011;61(2):69–90.

    Article  PubMed  Google Scholar 

  2. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA Cancer J Clin. 2012;62(1):10–29.

    Article  PubMed  Google Scholar 

  3. Gonzalez-Angulo AM, Morales-Vasquez F, Hortobagyi GN. Overview of resistance to systemic therapy in patients with breast cancer. Adv Exp Med Biol. 2007;608:1–22.

    Article  CAS  PubMed  Google Scholar 

  4. Truong PT, Olivotto IA, Whelan TJ, Levine M. Clinical practice guidelines for the care and treatment of breast cancer: 16. Locoregional post-mastectomy radiotherapy. CMAJ. 2004;170(8):1263–73.

    Article  PubMed Central  PubMed  Google Scholar 

  5. Grimison PS, Stockler MR. Quality of life and adjuvant systemic therapy for early-stage breast cancer. Expert Rev Anticancer Ther. 2007;7(8):1123–34.

    Article  PubMed  Google Scholar 

  6. Courneya KS, Mackey JR, McKenzie DC. Exercise for breast cancer survivors: research evidence and clinical guidelines. Phys Sportsmed. 2002;30(8):33–42.

    Article  PubMed  Google Scholar 

  7. Short CE, James EL, Girgis A, McElduff P, Plotnikoff RC. Move more for life: the protocol for a randomised efficacy trial of a tailored-print physical activity intervention for post-treatment breast cancer survivors. BMC Cancer. 2012;12:172.

    Article  PubMed Central  PubMed  Google Scholar 

  8. Fong DY, Ho JW, Hui BP, Lee AM, Macfarlane DJ, Leung SS, et al. Physical activity for cancer survivors: meta-analysis of randomised controlled trials. BMJ. 2012;344:e70.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Knols R, Aaronson NK, Uebelhart D, Fransen J, Aufdemkampe G. Physical exercise in cancer patients during and after medical treatment: a systematic review of randomized and controlled clinical trials. J Clin Oncol. 2005;23(16):3830–42.

    Article  PubMed  Google Scholar 

  10. McNeely ML, Campbell KL, Rowe BH, Klassen TP, Mackey JR, Courneya KS. Effects of exercise on breast cancer patients and survivors: a systematic review and meta-analysis. CMAJ. 2006;175(1):34–41.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Courneya KS, Segal RJ, Mackey JR, Gelmon K, Reid RD, Friedenreich CM, et al. Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomized controlled trial. J Clin Oncol. 2007;25(28):4396–404.

    Article  PubMed  Google Scholar 

  12. Courneya KS, Friedenreich CM. Physical exercise and quality of life following cancer diagnosis: a literature review. Ann Behav Med. 1999;21(2):171–9.

    Article  CAS  PubMed  Google Scholar 

  13. Courneya KS, Vallance JK, McNeely ML, Karvinen KH, Peddle CJ, Mackey JR. Exercise issues in older cancer survivors. Crit Rev Oncol Hematol. 2004;51(3):249–61.

    Article  PubMed  Google Scholar 

  14. Goodwin P, Esplen MJ, Butler K, Winocur J, Pritchard K, Brazel S, et al. Multidisciplinary weight management in locoregional breast cancer: results of a phase ii study. Breast Cancer Res Treat. 1998;48(1):53–64.

    Article  CAS  PubMed  Google Scholar 

  15. Cramp F, Daniel J. Exercise for the management of cancer-related fatigue in adults. Cochrane Database Syst Rev. 2008(2):CD006145.

  16. Friedenreich CM, Cust AE. Physical activity and breast cancer risk: impact of timing, type and dose of activity and population subgroup effects. Br J Sports Med. 2008;42(8):636–47.

    Article  CAS  PubMed  Google Scholar 

  17. Jones LW, Viglianti BL, Tashjian JA, Kothadia SM, Keir ST, Freedland SJ, et al. Effect of aerobic exercise on tumor physiology in an animal model of human breast cancer. J Appl Physiol. 2010;108(2):343–8.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Jones LW, Eves ND, Haykowsky M, Freedland SJ, Mackey JR. Exercise intolerance in cancer and the role of exercise therapy to reverse dysfunction. Lancet Oncol. 2009;10(6):598–605.

    Article  PubMed  Google Scholar 

  19. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25(9):603–5.

    Article  PubMed  Google Scholar 

  20. Zintzaras E, Ioannidis JP. Hegesma: genome search meta-analysis and heterogeneity testing. Bioinformatics. 2005;21(18):3672–3.

    Article  CAS  PubMed  Google Scholar 

  21. Ioannidis JP, Patsopoulos NA, Rothstein HR. Reasons or excuses for avoiding meta-analysis in forest plots. BMJ. 2008;336(7658):1413–5.

    Article  PubMed Central  PubMed  Google Scholar 

  22. Peters JL, Sutton AJ, Jones DR, Abrams KR, Rushton L. Comparison of two methods to detect publication bias in meta-analysis. JAMA. 2006;295(6):676–80.

    Article  CAS  PubMed  Google Scholar 

  23. Xu Y. Intervention of aerobic exercise on the cancer-related fatigue in breast cancer patients undergoing chemotherapy in outpatient department. Hainan Med J. 2012;23(19):145–7.

    Google Scholar 

  24. Wang YJ, Boehmke M, Wu YW, Dickerson SS, Fisher N. Effects of a 6-week walking program on Taiwanese women newly diagnosed with early-stage breast cancer. Cancer Nurs. 2011;34(2):E1–E13.

    Article  PubMed  Google Scholar 

  25. Yao MC, Liu ZP. Effects of aerobic exercises on post-chemotherapy fatigue in patients with breast cancer. Today Nurse. 2010;7:95–6.

    Google Scholar 

  26. Mustian KM, Peppone L, Darling TV, Palesh O, Heckler CE, Morrow GR. A 4-week home-based aerobic and resistance exercise program during radiation therapy: a pilot randomized clinical trial. J Support Oncol. 2009;7(5):158–67.

    PubMed Central  PubMed  Google Scholar 

  27. Danhauer SC, Mihalko SL, Russell GB, Campbell CR, Felder L, Daley K, et al. Restorative yoga for women with breast cancer: findings from a randomized pilot study. Psychooncology. 2009;18(4):360–8.

    Article  PubMed Central  PubMed  Google Scholar 

  28. Zhao J, Liu HP, Chen JL, Liu Y. The effect of home-based aerobic exercise on breast cancer patients with cancer-related fatigue in outpatient clinics receiving chemotherapy. Chin J Nursing. 2008;43(7):585–8.

    Google Scholar 

  29. Yuen HK, Sword D. Home-based exercise to alleviate fatigue and improve functional capacity among breast cancer survivors. J Allied Health. 2007;36(4):e257–75.

    PubMed  Google Scholar 

  30. Mutrie N, Campbell AM, Whyte F, McConnachie A, Emslie C, Lee L, et al. Benefits of supervised group exercise programme for women being treated for early stage breast cancer: pragmatic randomised controlled trial. BMJ. 2007;334(7592):517.

    Article  PubMed Central  PubMed  Google Scholar 

  31. Moadel AB, Shah C, Wylie-Rosett J, Harris MS, Patel SR, Hall CB, et al. Randomized controlled trial of yoga among a multiethnic sample of breast cancer patients: effects on quality of life. J Clin Oncol. 2007;25(28):4387–95.

    Article  PubMed  Google Scholar 

  32. Daley AJ, Crank H, Saxton JM, Mutrie N, Coleman R, Roalfe A. Randomized trial of exercise therapy in women treated for breast cancer. J Clin Oncol. 2007;25(13):1713–21.

    Article  PubMed  Google Scholar 

  33. Campbell A, Mutrie N, White F, McGuire F, Kearney N. A pilot study of a supervised group exercise programme as a rehabilitation treatment for women with breast cancer receiving adjuvant treatment. Eur J Oncol Nurs. 2005;9(1):56–63.

    Article  PubMed  Google Scholar 

  34. Smets EM, Visser MR, Willems-Groot AF, Garssen B, Oldenburger F, van Tienhoven G, et al. Fatigue and radiotherapy: (a) experience in patients undergoing treatment. Br J Cancer. 1998;78(7):899–906.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  35. Jacobsen PB, Hann DM, Azzarello LM, Horton J, Balducci L, Lyman GH. Fatigue in women receiving adjuvant chemotherapy for breast cancer: characteristics, course, and correlates. J Pain Symptom Manage. 1999;18(4):233–42.

    Article  CAS  PubMed  Google Scholar 

  36. Mock V, Atkinson A, Barsevick A, Cella D, Cimprich B, Cleeland C, et al. NCCN practice guidelines for cancer-related fatigue. Oncology (Williston Park). 2000;14(11A):151–61.

    CAS  Google Scholar 

  37. Curt GA, Breitbart W, Cella D, Groopman JE, Horning SJ, Itri LM, et al. Impact of cancer-related fatigue on the lives of patients: New findings from the fatigue coalition. Oncologist. 2000;5(5):353–60.

    Article  CAS  PubMed  Google Scholar 

  38. Ahlberg K, Ekman T, Gaston-Johansson F, Mock V. Assessment and management of cancer-related fatigue in adults. Lancet. 2003;362(9384):640–50.

    Article  PubMed  Google Scholar 

  39. Gutstein HB. The biologic basis of fatigue. Cancer. 2001;92(6 Suppl):1678–83.

    Article  CAS  PubMed  Google Scholar 

  40. Morrow GR, Hickok JT, Andrews PL, Stern RM. Reduction in serum cortisol after platinum based chemotherapy for cancer: a role for the hpa axis in treatment-related nausea? Psychophysiology. 2002;39(4):491–5.

    Article  PubMed  Google Scholar 

  41. Irvine D, Vincent L, Graydon JE, Bubela N, Thompson L. The prevalence and correlates of fatigue in patients receiving treatment with chemotherapy and radiotherapy. A comparison with the fatigue experienced by healthy individuals. Cancer Nurs. 1994;17(5):367–78.

    Article  CAS  PubMed  Google Scholar 

  42. Andrykowski MA, Curran SL, Lightner R. Off-treatment fatigue in breast cancer survivors: a controlled comparison. J Behav Med. 1998;21(1):1–18.

    Article  CAS  PubMed  Google Scholar 

  43. Mock V, Dow KH, Meares CJ, Grimm PM, Dienemann JA, Haisfield-Wolfe ME, et al. Effects of exercise on fatigue, physical functioning, and emotional distress during radiation therapy for breast cancer. Oncol Nurs Forum. 1997;24(6):991–1000.

    CAS  PubMed  Google Scholar 

  44. Decker TW, Cline-Elsen J, Gallagher M. Relaxation therapy as an adjunct in radiation oncology. J Clin Psychol. 1992;48(3):388–93.

    Article  CAS  PubMed  Google Scholar 

  45. Forester B, Kornfeld DS, Fleiss JL, Thompson S. Group psychotherapy during radiotherapy: effects on emotional and physical distress. Am J Psychiatry. 1993;150(11):1700–6.

    Article  CAS  PubMed  Google Scholar 

  46. Mock V, Frangakis C, Davidson NE, Ropka ME, Pickett M, Poniatowski B, et al. Exercise manages fatigue during breast cancer treatment: a randomized controlled trial. Psychooncology. 2005;14(6):464–77.

    Article  PubMed  Google Scholar 

  47. Butt Z, Lai JS, Rao D, Heinemann AW, Bill A, Cella D. Measurement of fatigue in cancer, stroke, and HIV using the Functional Assessment of Chronic Illness Therapy-Fatigue (Facit-F) scale. J Psychosom Res. 2013;74(1):64–8.

    Article  PubMed Central  PubMed  Google Scholar 

  48. Carayol M, Bernard P, Boiche J, Riou F, Mercier B, Cousson-Gelie F, et al. Psychological effect of exercise in women with breast cancer receiving adjuvant therapy: what is the optimal dose needed? Ann Oncol. 2013;24(2):291–300.

    Article  CAS  PubMed  Google Scholar 

  49. Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of Observational Studies in Epidemiology (Moose) group. JAMA. 2000;283(15):2008–12.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

This was funded by the Department of Science and Technology Project of Liaoning Province (2013225305). All authors read and approved the final manuscript. We would like to acknowledge the helpful comments on this paper received from our reviewers.

Conflicts of interest

None

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jin-Jiang Xu.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zou, LY., Yang, L., He, XL. et al. Effects of aerobic exercise on cancer-related fatigue in breast cancer patients receiving chemotherapy: a meta-analysis. Tumor Biol. 35, 5659–5667 (2014). https://doi.org/10.1007/s13277-014-1749-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13277-014-1749-8

Keywords

Navigation