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Effectiveness of exercise training on cancer-related fatigue in colorectal cancer survivors: a systematic review and meta-analysis of randomized controlled trials

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Abstract

Purpose

To investigate the effects of exercise training on cancer-related fatigue (CRF) in colorectal cancer survivors.

Methods

Randomized controlled trials published between 1 January 2010 and 19 October 2020, selected through online search conducted in PubMed, Scopus, Web of Science, SPORTDiscus and PEDro databases, were included. Eligible trials compared the effect of exercise training interventions, versus non-exercise controls on CRF, in colorectal cancer survivors, during or after treatment. The methodological quality of individual studies was analysed using the Physiotherapy Evidence Database (PEDro) scale. Standardized mean differences (SMD) that were pooled using random-effects models were included as the effect size. In addition, 95% prediction intervals (PI) were calculated.

Results

Six trials involving 330 colorectal cancer patients met the inclusion criteria and presented reasonable to good methodological quality. An overall small-to-moderate effect of exercise training on CRF was found (SMD =  − 0.29: 95% CI: [− 0.53; − 0.06]; p = 0.01; PI: [− 0.63; 0.04]; low-quality evidence). Subgroup analysis revealed moderate effects of exercise interventions performed during chemotherapy (SMD =  − 0.63; 95% CI: [− 1.06; − 0.21]; p = 0.003) and small, non-significant effects, when exercise training was performed after cancer treatment (SMD =  − 0.14; 95% CI: [− 0.43; 0.14]; p = 0.32). Steady improvements were achieved when a combination of aerobic plus resistance exercise was used, in interventions lasting 12 to 24 weeks.

Conclusion

Exercise training could be regarded as a supportive therapy for the clinical management of CRF in colorectal cancer patients undergoing chemotherapy, but further studies are necessary to clarify the effects of exercise interventions on CRF after cancer treatment.

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Data availability

The data supporting the conclusions of this article are included in the manuscript and in its supplementary files.

Code availability

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Acknowledgements

Authors acknowledge the financial support provided by the Portuguese Foundation for Science and Technology to their research unit (REF UIDB/05704/2020)

Funding

Pedro Machado holds a PhD fellowship supported by the Portuguese Foundation for Science and Technology (REF UIDB/05704/2020).

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Authors and Affiliations

  1. Center for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, Leiria, Portugal

    Pedro Machado, Cândida G. Silva & Nuno Morais

  2. University of Coimbra, Research Unit for Sport and Physical Activity (CIDAF, UID/PTD/04213/2019), Faculty of Sport Sciences and Physical Education, Coimbra, Portugal

    Pedro Machado

  3. Saúde Positiva, Clínica de Saúde Física e Mental, Aveiro, Portugal

    Nuno Morais

  4. School of Health Sciences (ESSLei), Polytechnic of Leiria, Leiria, Portugal

    Pedro Machado, Miguel Morgado, João Raposo, Marco Mendes, Cândida G. Silva & Nuno Morais

  5. Coimbra Chemistry Centre, Institute of Molecular Sciences (CQC-IMS), Department of Chemistry, University of Coimbra, Coimbra, Portugal

    Cândida G. Silva

  6. Centre for Rapid and Sustainable Product Development (CDRSP), Polytechnic of Leiria, Marinha Grande, Portugal

    Nuno Morais

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All the authors contributed to conceived and the designed the study. PM, MM, JR and MM conducted the screening of studies and data extraction. CS and NM provided statistical expertise and contributed to the analysis, discussion and preparation of manuscript. All authors participated in the revision and final approval of the manuscript.

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Correspondence to Pedro Machado.

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Machado, P., Morgado, M., Raposo, J. et al. Effectiveness of exercise training on cancer-related fatigue in colorectal cancer survivors: a systematic review and meta-analysis of randomized controlled trials. Support Care Cancer 30, 5601–5613 (2022). https://doi.org/10.1007/s00520-022-06856-3

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