Aerobic exercise

The CAUSE randomized controlled trial enrolled 140 long-term female breast cancer survivors (stage II-III, aged 59.0±6.4 years, 11±1 years post-treatment with Epirubicin) randomized to supervised aerobic exercise (thrice-weekly treadmill walking/running for five months) or usual care, with 69 non-cancer controls (aged 57.8±4.9 years) for comparison. The exercise group achieved significant improvements in VO2peak versus usual care, though the magnitude of CRF change was significantly less than in non-cancer controls, indicating a blunted but meaningful exercise response. Significant improvements were observed in subjective vitality, life satisfaction, fatigue, body image, and health-related quality of life compared to usual care. Improvements in mental fatigue and selected HRQoL domains persisted at one-year follow-up. No significant between-group differences in cardiovascular risk factors were found. Effects were most pronounced in survivors with high baseline symptom burden.

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Across 29 systematic reviews, subgroup analysis by exercise type showed aerobic exercise significantly reduced cancer-related fatigue in breast cancer patients (SMD = −0.29, 95% CI −0.56 to −0.02, I² = 16%). The low heterogeneity (I² = 16%) indicates consistent effects across different study populations. The overall pooled effect for all exercise types showed moderate certainty evidence of fatigue improvement (SMD = −0.40, 95% CI −0.58 to −0.22, P = 0.0001). Supervised exercise was more effective than unsupervised (SMD = −0.48, 95% CI −0.77 to −0.18, P = 0.001).

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A systematic review searched ZipSearch, Google Scholar, and MEDLINE from 2008-2018, evaluating 83 abstracts and selecting 35 articles for full analysis across 20 unique search queries. The review concluded that exercise provides several benefits to cancer patients regardless of stage or cancer type, serving as primary prevention (reducing cancer incidence), secondary prevention (improving outcomes during treatment including prehabilitation for surgical patients), and tertiary prevention (enhancing recovery). Healthcare professionals were encouraged to incorporate exercise recommendations into cancer care at all stages.

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A meta-analysis of 9 high-quality studies (n = 1156 breast cancer survivors) found supervised aerobic exercise significantly reduced cancer-related fatigue compared to conventional care (SMD = −0.51, 95% CI −0.81 to −0.21), though with high statistical heterogeneity (I² = 75%, P = 0.001). Meta-regression analysis revealed exercise volume parameters were closely related to effect estimates on fatigue. Egger's test indicated moderate evidence of publication bias (P = 0.04). Study quality was assessed using the PEDro score, and all included studies were rated as high quality. The search encompassed PubMed/MEDLINE, EMBASE, Scopus, CENTRAL, and CINAHL databases without language restrictions.

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A systematic review of 5 studies (selected from 23 meeting initial search criteria, filtered by PEDro quality scores) evaluated exercise interventions for cancer-related fatigue in breast cancer patients. 4 of 5 studies (80%) showed improvement in fatigue levels. Interventions ranged from 6 weeks to 12 months and included 8-week aquatic aerobic and resistance exercise, 12-week combined aerobic/resistance/stretching programs, 6- and 14-week home-based walking programs, and a yearlong home-based aerobic program. Intensity was monitored via RPE and/or heart rate. Cancer-related fatigue affects 70-100% of patients undergoing treatment, yet only 68% receive information about fatigue management. No study reported adverse effects from exercise implementation. Three validated fatigue outcome tools were used across the studies.

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