Effects of exercise interventions on cancer-related fatigue in breast cancer patients: an overview of systematic reviews

Abstract

Objective This overview of systematic reviews aims to critically appraise and consolidate evidence from current systematic reviews (SRs)/meta-analyses on the effects of exercise interventions on cancer-related fatigue (CRF) in breast cancer patients. Methods SRs/meta-analyses that explored the effects of exercise interventions on CRF in breast cancer patients compared with the routine methods of treatment and care were retrieved from nine databases. The methodological quality of the included SRs was appraised using A MeaSurement Tool to Assess systematic Reviews II (AMSTAR II). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to calculate the grading of outcomes in the included SRs. The exercise type, frequency, duration, and inclusion/absence of supervision were further evaluated with subgroup analyses. The Stata 16.0 software was utilized for data analysis. Results Twenty-nine reviews were included. The overall methodological quality and level of evidence of the included reviews were unsatisfactory, with only three reviews rated as high methodological quality and no review identified as high-quality evidence. Moderate certainty evidence indicated that exercise could improve fatigue in breast cancer patients (SMD = − 0.40 [95%CI − 0.58, − 0.22]; P = 0.0001). Subgroup analysis based on the types of exercise showed that yoga (SMD = − 0.30 [95%CI − 0.56, − 0.05]; I2 = 28.7%) and aerobic exercise (SMD = − 0.29 [95%CI − 0.56, − 0.02]; I2 = 16%) had a significantly better effect on CRF in breast cancer patients; exercising for over 6 months (SMD = − 0.88 [95%CI − 1.59, − 0.17]; I2 = 42.7%; P = 0.0001), three times per week (SMD = − 0.77 [95%CI − 1.04, − 0.05]; I2 = 0%; P = 0.0001), and for 30 to 60 min per session (SMD = − 0.81 [95%CI − 1.15, − 0.47]; I2 = 42.3%; P = 0.0001) can contribute to a moderate improvement of CRF. Supervised exercise (SMD = − 0.48 [95%CI − 0.77, − 0.18]; I2 = 87%; P = 0.001) was shown to relieve CRF. Conclusion Exercise played a favorable role in alleviating CRF in breast cancer. Yoga was recommended as a promising exercise modality for CRF management in the majority of the included studies. Exercising for at least three times per week with 30 to 60 min per session could be recommended as a suitable dosage for achieving improvement in CRF. Supervised exercise was found to be more effective in alleviating CRF than unsupervised exercise. More rigorously designed clinical studies are needed to specify the exact exercise type, duration, frequency, and intensity to have an optimal effect on CRF in breast cancer patients. Trial registration ClinicalTrials.gov Identifier: CRD42020219866.

Effects of combined exercises on shoulder mobility and strength of the upper extremities in breast cancer rehabilitation: a 3-week randomized controlled trial

“…In contrast, both groups improved their strength performance after a three-week combined strength and mobility training on FIVE® devices, respectively device-supported training. Because of the specificity of the two approaches, these results are in accordance with our initial theoretical assumptions, and they support and complement previous results concerning aerobic capacity, lower and upper limb strength, and agility [ 26 , 27 , 29 ].…”

“…Previous studies examined the effects of aerobic and resistance training in breast cancer patients, but did not analyze the results of a combined mobility and resistance training on devices in breast cancer patients in rehabilitation [ 25 , 26 ]. Apart from that, the implementation of FIVE® devices in exercise therapy has not been investigated for patients in breast cancer rehabilitation yet [ 27 ].…”

“…Additionally, only the treatment type “irradiation” had a significant influence on the mobility in the sagittal plane on the right side. This may be due to the fact that the lymph nodes are also treated during irradiation, which increases the risk of lymphatic congestion (lymphedema) in the chest or arm and can severely limit the patient’s mobility [ 27 , 28 ].…”

A Cross-Sectional Study Based on Forty Systematic Reviews of Foods with Function Claims (FFC) in Japan: Quality Assessment Using AMSTAR 2

“…Our findings of the poor methodological quality of SRs in the food field are in line with those from assessments of the methodological quality of SRs that used the AMSTAR 2 tool in other fields, including acupuncture [16,17], dentistry [18], Tai Chi [19,20], surgery [21,22], major depression in adults [23], chronic obstructive pulmonary disease [24], cardiovascular risk [25], physical activity [26], pancreatic cancer [27], chronic heart failure [28], cancerrelated fatigue [29], Alzheimer's disease [30], chronic spinal pain [31], neonatal pain [32], hip fractures [33], and atopic eczema [34]. Although the target patients or participants and interventions in those studies differed between each study, all demonstrated that the majority of SRs included had low methodological quality ("low" or "critically low").…”

Factors associated with physical activity among Thai women with breast cancer postmastectomy at Siriraj Hospital, Thailand

“…PA has been suggested as a possible intervention to enhance the quality of life of women with breast cancer both pre-and postdiagnosis, and after surgery [13]. Exercise can help women with breast cancer and survivors improve their quality of life, cardiorespiratory tness, physical functioning, and tiredness [14]. PA may also increase overall and disease-free recovery in women with breast cancer as exercise can help women with breast cancer and survivors improve their quality of life, cardiorespiratory tness, physical functioning, and tiredness well as reduce breast cancer recurrence and improve quality of life in women with breast cancer postmastectomy.…”