Meneses-Echavez, J.F., Gonzalez-Jimenez, E., & Ramirez-Velez, R. (2015). Effects of supervised multimodal exercise interventions on cancer-related fatigue: Systematic review and meta-analysis of randomized controlled trials. BioMed Research International, 2015, 328636. 

DOI Link


STUDY PURPOSE: To determine the effects of a supervised multimodal exercise intervention on cancer-related fatigue (CRF) through a systematic review and meta-analysis
TYPE OF STUDY: Meta-analysis and systematic review

Search Strategy

DATABASES USED: PubMed, CENTRAL, EMBASE, OVID, reference lists of selected reviews, ASCO meeting abstracts from 2004 to 2014, Lancet Oncology, Journal of Clinical Oncology, Journal of National Cancer Institute, Journal of Breast Cancer, Breast Journal, and Breast
KEYWORDS: Randomized, controlled trial OR controlled clinical trial OR randomized OR trial OR clinical trial as topic; AND cancer OR tumour OR tumor OR neoplasm OR carcino OR leukaemi OR leukemi AND physical activity OR exercise OR strength OR resistance OR stretching AND fatigue
INCLUSION CRITERIA: PICO: Patients aged 18 years or older with any cancer diagnosis and treatment. The intervention was multimodal exercise, and the control was conventional care, where patients did not participate in any exercise program. The exercise required supervision by health professionals. Outcome Measures: CRF symptoms, score of 5–10 on the Physiotherapy Evidence Database (PEDro) scale
EXCLUSION CRITERIA: The intervention did not exert a large physiological impact (energy expenditure).

Literature Evaluated

EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Independent data extraction by two investigators with the third individual acting as an arbitrator for disputes

Sample Characteristics

  • SAMPLE RANGE ACROSS STUDIES = 22–235 patients
  • KEY SAMPLE CHARACTERISTICS: Age ranged from 46–60 years with a mean of 55.5 years; 54.2% were female and were receiving treatment; most common treatment was chemotherapy; average months since diagnosis was 8.2 months; most common diagnoses were breast and prostate cancers

Phase of Care and Clinical Applications

PHASE OF CARE: Active antitumor treatment
APPLICATIONS: Palliative care


Supervised multimodal exercise programs resulted in an overall reduction of fatigue in cancer survivors (SMD = –0.23, p = 0.001) with low statistical heterogeneity. Slight evidence of publication bias was noted. Length (weeks of training), frequency (sessions/week), and duration (minutes/session) were linearly associated with overall improvement in CRF (Tau squared = 0.04, p = 0.04). Aerobic exercise, resistance training, and stretching were implemented in seven of the nine studies, and the pooled effect estimate showed significant reductions in CRF (SMD = –0.35, p = 0.01). Two studies used resistance training, and the pooled effect estimate showed no significant reductions in CRF (SMD = –0.17, p = 0.3). Reported adverse events occurred infrequently (n = 7 events, one requiring hospitalization). Most studies were conducted during treatment (chemotherapy) and resulted in significant reductions of CRF (SMD = –0.23, p < 0.0001). No significant reductions in CRF were reported after anticancer treatment (p = 0.1).


Supervised multimodal exercise programs implemented during treatment are supported as an intervention for reducing CRF.


  • Considerable statistical heterogeneity in effect estimates existed.
  • Risk of bias was evaluated by a single investigator.

Nursing Implications

Supervised multimodal exercise programs are safe and beneficial for patients receiving anticancer therapy. Referrals to exercise professionals to plan a personalized exercise program for patients with cancer is recommended.

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