Moderators of Exercise Effects on Cancer-related Fatigue: A Meta-analysis of Individual Patient Data
van Vulpen, Jonna K; Sweegers, Maike G; Peeters, Petra H M; Courneya, Kerry S; Newton, Robert U; Aaronson, Neil K; Jacobsen, Paul B; Galvão, Daniel A; Chinapaw, Mai J; Steindorf, Karen; Irwin, Melinda L; Stuiver, Martijn M; Hayes, Sandi; Griffith, Kathleen A; Mesters, Ilse; Knoop, Hans; Goedendorp, Martine M; Mutrie, Nanette; Daley, Amanda J; McConnachie, Alex; Bohus, Martin; Thorsen, Lene; Schulz, Karl-Heinz; Short, Camille E; James, Erica L; Plotnikoff, Ronald C; Schmidt, Martina E; Ulrich, Cornelia M; van Beurden, Marc; Oldenburg, Hester S; Sonke, Gabe S; van Harten, Wim H; Schmitz, Kathryn H; Winters-Stone, Kerri M; Velthuis, Miranda J; Taaffe, Dennis R; van Mechelen, Willem; Kersten, Marie José; Nollet, Frans; Wenzel, Jennifer; Wiskemann, Joachim; Verdonck-de Leeuw, Irma M; Brug, Johannes; May, Anne M; Buffart, Laurien M
(2020) Medicine and Science in Sports and Exercise, volume 52, issue 2, pp. 303 - 314
(Article)
Abstract
PURPOSE: 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 (RCT) to investigate moderators of exercise intervention effects
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on cancer-related fatigue. METHODS: We used individual patient data from 31 exercise RCT worldwide, representing 4366 patients, of whom 3846 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. RESULTS: Exercise interventions had statistically significant beneficial effects on fatigue (β = -0.17; 95% confidence interval [CI], -0.22 to -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 to -0.08). Supervised interventions with a duration ≤12 wk showed larger effects on fatigue (β = -0.29; 95% CI, -0.39 to -0.20) than supervised interventions with a longer duration. CONCLUSIONS: 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.
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Keywords: CANCER, EXERCISE, FATIGUE, INDIVIDUAL PATIENT DATA META-ANALYSIS, Journal Article
ISSN: 0195-9131
Publisher: Lippincott Williams and Wilkins
Note: Publisher Copyright: © Lippincott Williams & Wilkins.
(Peer reviewed)