Jonna K VAN Vulpen1, Maike G Sweegers, Petra H M Peeters1, Kerry S Courneya2, Robert U Newton3, Neil K Aaronson4, Paul B Jacobsen5, Daniel A Galvão3, Mai J Chinapaw6, Karen Steindorf7, Melinda L Irwin8, Martijn M Stuiver9, Sandi Hayes10, Kathleen A Griffith11, Ilse Mesters12, Hans Knoop13, Martine M Goedendorp, Nanette Mutrie14, Amanda J Daley15, Alex McConnachie16, Martin Bohus, Lene Thorsen, Karl-Heinz Schulz17, Camille E Short18, Erica L James19, Ronald C Plotnikoff20, Martina E Schmidt7, Cornelia M Ulrich21, Marc VAN Beurden22, Hester S Oldenburg22, Gabe S Sonke22, Wim H VAN Harten, Kathryn H Schmitz23, Kerri M Winters-Stone24, Miranda J Velthuis25, Dennis R Taaffe3, Willem VAN Mechelen6, Marie José Kersten26, Frans Nollet27, Jennifer Wenzel28, Joachim Wiskemann, Irma M Verdonck-DE Leeuw, Johannes Brug, Anne M May1, Laurien M Buffart. 1. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, THE NETHERLANDS. 2. Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, Alberta, CANADA. 3. Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, AUSTRALIA. 4. Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, THE NETHERLANDS. 5. Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD. 6. Amsterdam UMC, Vrije Universiteit, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, THE NETHERLANDS. 7. Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, GERMANY. 8. Yale School of Public Health, New Haven, CT. 9. Center for Quality of Life, Netherlands Cancer Institute, Amsterdam, THE NETHERLANDS. 10. School of Public Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD, AUSTRALIA. 11. The George Washington University School of Nursing, Washington, DC. 12. Department of Epidemiology, Maastricht University, THE NETHERLANDS. 13. Amsterdam UMC, University of Amsterdam, Department of Medical Psychology, Amsterdam, THE NETHERLANDS. 14. Physical Activity for Health Research Center, University of Edinburgh, Edinburgh, UNITED KINGDOM. 15. School of Sport, Exercise and Health Sciences, University of Loughborough, Loughborough, Leicestershire, UNITED KINGDOM. 16. Institute of Health and Wellbeing, University of Glasgow, Glasgow, UNITED KINGDOM. 17. Athleticum-Competence Center for Sports- and Exercise Medicine and Institute for Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, GERMANY. 18. Freemasons Foundation Centre of Men's Health, School of Medicine, University of Adelaide, SA, AUSTRALIA. 19. School of Medicine & Public Health, the University of Newcastle, Callaghan, NSW, AUSTRALIA. 20. Priority Research Centre for Physical Activity and Nutrition, the University of Newcastle, Callaghan, NSW, AUSTRALIA. 21. Huntsman Cancer Institute and Department of Population Health Sciences, University of Utah, Salt Lake City, UT. 22. Netherlands Cancer Institute, Amsterdam, THE NETHERLANDS. 23. Department of Public Health Science, College of Medicine and Cancer Institute, Pennsylvania State University, Hershey, PA. 24. Knight Cancer Institute, School of Nursing, Oregon Health & Science University, Portland, OR. 25. Netherlands comprehensive cancer organisation (IKNL), Utrecht, THE NETHERLANDS. 26. Amsterdam UMC, University of Amsterdam, Department of Hematology, Amsterdam, THE NETHERLANDS. 27. Amsterdam UMC, University of Amsterdam Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam, THE NETHERLANDS. 28. Johns Hopkins School of Nursing, Johns Hopkins School of Medicine, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD.
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 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.
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 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.
Authors: Jesse A Berlin; Jill Santanna; Christopher H Schmid; Lynda A Szczech; Harold I Feldman Journal: Stat Med Date: 2002-02-15 Impact factor: 2.373
Authors: K M Winters-Stone; J Dobek; L M Nail; J A Bennett; M C Leo; B Torgrimson-Ojerio; S-W Luoh; A Schwartz Journal: Osteoporos Int Date: 2012-09-21 Impact factor: 4.507
Authors: Karen M Mustian; Catherine M Alfano; Charles Heckler; Amber S Kleckner; Ian R Kleckner; Corinne R Leach; David Mohr; Oxana G Palesh; Luke J Peppone; Barbara F Piper; John Scarpato; Tenbroeck Smith; Lisa K Sprod; Suzanne M Miller Journal: JAMA Oncol Date: 2017-07-01 Impact factor: 31.777
Authors: Laurien M Buffart; Joeri Kalter; Mai J M Chinapaw; Martijn W Heymans; Neil K Aaronson; Kerry S Courneya; Paul B Jacobsen; Robert U Newton; Irma M Verdonck-de Leeuw; Johannes Brug Journal: Syst Rev Date: 2013-09-13
Authors: Ryan J Marker; Andrew J Kittelson; Catherine M Jankowski; Jared J Scorsone; John C Peters; W Thomas Purcell Journal: Rehabil Oncol Date: 2022-04
Authors: Alix G Sleight; Sylvia L Crowder; Jacek Skarbinski; Paul Coen; Nathan H Parker; Aasha I Hoogland; Brian D Gonzalez; Mary C Playdon; Steven Cole; Jennifer Ose; Yuichi Murayama; Erin M Siegel; Jane C Figueiredo; Heather S L Jim Journal: Cancers (Basel) Date: 2022-04-14 Impact factor: 6.575
Authors: A M May; E M Monninkhof; E W Koevoets; S B Schagen; M B de Ruiter; M I Geerlings; L Witlox; E van der Wall; M M Stuiver; G S Sonke; M J Velthuis; J J Jobsen; M B E Menke-Pluijmers; E Göker; C C van der Pol; M E M M Bos; L W Tick; N A van Holsteijn; J van der Palen Journal: Breast Cancer Res Date: 2022-05-26 Impact factor: 8.408
Authors: Michael J Toth; Thomas B Voigt; Timothy W Tourville; Shannon M Prior; Blas A Guigni; Axel V Schlosberg; Isaac B Smith; Taylor J Forest; Peter A Kaufman; Marie E Wood; Hibba Rehman; Kim Dittus Journal: J Appl Physiol (1985) Date: 2020-05-07
Authors: Joske Nauta; Femke van Nassau; Adrie J Bouma; Leonie A Krops; Hidde P van der Ploeg; Evert Verhagen; Lucas H V van der Woude; Helco G van Keeken; L M Buffart; Ron Diercks; Vincent de Groot; Johan de Jong; Caroline Kampshoff; Martin Stevens; Inge van den Akker-Scheek; Marike van der Leeden; Willem van Mechelen; Rienk Dekker Journal: BMJ Open Date: 2022-03-15 Impact factor: 2.692
Authors: Anouk E Hiensch; Evelyn M Monninkhof; Martina E Schmidt; Eva M Zopf; Kate A Bolam; Yvonne Wengström; Karen Steindorf; Anne M May; Neil K Aaronson; Jon Belloso; Wilhelm Bloch; Dorothea Clauss; Johanna Depenbusch; Milena Lachowicz; Mireia Pelaez; Helene Rundqvist; Elzbieta Senkus; Martijn M Stuiver; Mark Trevaskis; Ander Urruticoechea; Friederike Rosenberger; Elsken van der Wall; G Ardine de Wit; Philipp Zimmer Journal: Trials Date: 2022-07-29 Impact factor: 2.728
Authors: Clare M P Roscoe; Andy Pringle; Charlotte Chandler; Mark A Faghy; Ben Barratt Journal: Int J Environ Res Public Health Date: 2022-03-18 Impact factor: 3.390