TY - JOUR
T1 - Moderators of Exercise Effects on Cancer-related Fatigue
T2 - A Meta-analysis of Individual Patient Data
AU - Van Vulpen, Jonna K.
AU - Sweegers, Maike G.
AU - Peeters, Petra H.M.
AU - Courneya, Kerry S.
AU - Newton, Robert U.
AU - Aaronson, Neil K.
AU - Jacobsen, Paul B.
AU - Galvaõ, Daniel A.
AU - Chinapaw, Mai J.
AU - Steindorf, Karen
AU - Irwin, Melinda L.
AU - Stuiver, Martijn M.
AU - Hayes, Sandi
AU - Griffith, Kathleen A.
AU - Mesters, Ilse
AU - Knoop, Hans
AU - Goedendorp, Martine M.
AU - Mutrie, Nanette
AU - Daley, Amanda J.
AU - McConnachie, Alex
AU - Bohus, Martin
AU - Thorsen, Lene
AU - Schulz, Karl Heinz
AU - Short, Camille E.
AU - James, Erica L.
AU - Plotnikoff, Ronald C.
AU - Schmidt, Martina E.
AU - Ulrich, Cornelia M.
AU - Van Beurden, Marc
AU - Oldenburg, Hester S.
AU - Sonke, Gabe S.
AU - Van Harten, Wim H.
AU - Schmitz, Kathryn H.
AU - Winters-Stone, Kerri M.
AU - Velthuis, Miranda J.
AU - Taaffe, Dennis R.
AU - Van Mechelen, Willem
AU - Kersten, Marie José
AU - Nollet, Frans
AU - Wenzel, Jennifer
AU - Wiskemann, Joachim
AU - Verdonck-De Leeuw, Irma M.
AU - Brug, Johannes
AU - May, Anne M.
AU - Buffart, Laurien M.
N1 - Funding Information: The content is solely the responsibility of the authors and does not necessarily represent the official views of the (U.S.) National Institutes of Health. Funding Information: In conclusion, we found that exercise has statistically significant beneficial effects on fatigue in patients with cancer. These benefits are consistent across subgroups formed on the basis of demographic and clinical characteristics. The effect of exercise interventions on fatigue is significantly larger when performed under supervision. Differential effects of duration and potential roles of adherence and contamination in these findings need further exploration. Our results support implementation of exercise, preferably supervised exercise interventions, in clinical practice. The results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation, and results of the present study do not constitute endorsement by ACSM. Conflicts of interest: None declared. Source of funding: 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). Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the (U.S.) National Institutes of Health. Publisher Copyright: © Lippincott Williams & Wilkins. Copyright: Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/2/1
Y1 - 2020/2/1
N2 - 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- A nd 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.
AB - 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- A nd 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.
KW - Cancer
KW - Exercise
KW - Fatigue
KW - Individual Patient Data Meta-Analysis
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UR - http://www.scopus.com/inward/citedby.url?scp=85074763027&partnerID=8YFLogxK
UR - https://pure.uva.nl/ws/files/60164055/mss_2019_09_09_buffart_19_00216_sdc1.pdf
UR - https://pure.hva.nl/ws/files/6761842/MSS_2019_09_09_BUFFART_19_00216_SDC1.pdf
U2 - https://doi.org/10.1249/MSS.0000000000002154
DO - https://doi.org/10.1249/MSS.0000000000002154
M3 - Article
C2 - 31524827
SN - 0195-9131
VL - 52
SP - 303
EP - 314
JO - Medicine and science in sports and exercise
JF - Medicine and science in sports and exercise
IS - 2
ER -
