Moderators of exercise effects on cancer-related fatigue: a meta-analysis of individual patient data

van Vulpen, J. K. et al. (2020) Moderators of exercise effects on cancer-related fatigue: a meta-analysis of individual patient data. Medicine and Science in Sports and Exercise, 52(2), pp. 303-314. (doi: 10.1249/MSS.0000000000002154) (PMID:31524827)

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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 (RCTs) to investigate moderators of exercise intervention effects on cancer-related fatigue. We used individual patient data from 31 exercise RCTs worldwide, representing 4,366 patients, of whom 3,846 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. Exercise interventions had statistically significant beneficial effects on fatigue (β= -0.17 [95% confidence interval (CI) -0.22;-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;-0.08]). Supervised interventions with a duration ≤12 weeks showed larger effects on fatigue (β= -0.29 [95% CI -0.39;-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.

Item Type:Articles
Additional Information:The POLARIS study is supported by the Bas Mulder Award, granted to L. M. Buffart by the Alpe d’HuZes foundation/Dutch Cancer Society (VU2011–5045). The contribution of J. K. van Vulpen is financially supported by the World Cancer Research Fund The Netherlands (WCRF NL, project number 2013/997).
Glasgow Author(s) Enlighten ID:McConnachie, Professor Alex
Authors: van Vulpen, J. K., Sweegers, M. G., Peeters, P. H.M., Courneya, K. S., Newton, R. U., Aaronson, N. K., Jacobsen, P. B., Galvão, D. A., Chinapaw, M. J., Steindorf, K., Irwin, M. L., Stuiver, M. M., Hayes, S., Griffith, K. A., Mesters, I., Knoop, H., Goedendorp, M. M., Mutrie, N., Daley, A. J., McConnachie, A., Bohus, M., Thorsen, L., Schulz, K.-H., Short, C. E., James, E. L., Plotnikoff, R. C., Schmidt, M. E., Ulrich, C. M., van Beurden, M., Oldenburg, H. S., Sonke, G. S., van Harten, W. H., Schmitz, K. H., Winters-Stone, K. M., Velthuis, M. J., Taaffe, D. R., van Mechelen, W., Kersten, M. J., Nollet, F., Wenzel, J., Wiskemann, J., Verdonck-de Leeuw, I. M., Brug, J., May, A. M., and Buffart, L. M.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
Journal Name:Medicine and Science in Sports and Exercise
Publisher:Lippincott, Williams & Wilkins
ISSN (Online):1530-0315
Published Online:13 September 2019
Copyright Holders:Copyright © 2019 by the American College of Sports Medicine
First Published:First published in Medicine and Science in Sports and Exercise 52(2):303-314
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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